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Plaque and systemic disease: a reappraisal of the focal infection concept
Abstract:
The review presented here covers metastatic local and systemic disease secondary to the accumulation of plaque or the formation of other pathogenic microbial depots in the mouth. At least 3 pathways may link oral infection to secondary disease, to wit metastatic infection due to transient bacteremia, metastatic immunological injury, and metastatic toxic injury. The available evidence is presented and examples are provided. They concern among others such divergent diseases as acute bacterial myocarditis, infective endocarditis, brain abscess, uveitis and iridocyclitis, trigeminal and atypical facial neuralgia, unilateral facial paralysis, fever of "unknown' origin, and neutrophil dysfunction.
Insights
Oral infections can lead to metastatic local and systemic diseases through bacteremia, immunological, or toxic injury. This review explores the evidence linking oral microbial depots to various secondary conditions.
Area of Science:
- Oral microbiology
- Infectious diseases
- Pathology
Background:
- Oral microbial accumulations, such as plaque, can act as pathogenic depots.
- These oral foci are increasingly recognized as potential sources of systemic disease.
- Understanding the mechanisms of oral-to-systemic disease spread is crucial for public health.
Purpose of the Study:
- To review the metastatic local and systemic diseases linked to oral pathogenic microbial depots.
- To elucidate the potential pathways connecting oral infections to secondary diseases.
- To present evidence and examples of such associations.
Main Methods:
- Literature review of studies examining metastatic disease secondary to oral infections.
- Analysis of proposed pathways: metastatic infection via bacteremia, immunological injury, and toxic injury.
- Compilation of diverse clinical examples illustrating the oral-systemic disease link.
Main Results:
- Identified at least three distinct pathways for oral-to-systemic disease spread.
- Provided evidence linking oral microbial depots to conditions including myocarditis, endocarditis, brain abscess, uveitis, neuralgia, facial paralysis, and neutrophil dysfunction.
- Highlighted the significant, yet often overlooked, role of oral health in systemic disease etiology.
Conclusions:
- Oral infections and microbial depots are significant contributors to a range of metastatic local and systemic diseases.
- The pathways of bacteremia, immunological injury, and toxic injury provide a framework for understanding these connections.
- Further research and clinical attention are warranted to address the systemic implications of oral pathology.