title: Periodontal systemic associations: review of the evidence.
abstract: OBJECTIVE
  To critically appraise recent research into associations between periodontal disease and systemic diseases and conditions specifically respiratory disease, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer.
  
  
  METHODS
  A MEDLINE literature search of papers published between 2002 and April 2012 was conducted. Studies that included periodontitis as an exposure were identified. Cross-sectional epidemiological investigations on large samples, prospective studies and systematic reviews formed the basis of the narrative review. A threshold set for the identification of periodontitis was used to identify those studies that contributed to the conclusions of the review.
  
  
  RESULTS
  Many of the investigations were cross-sectional secondary analyses of existing data sets in particular the NHANES studies. There were a small number of systematic reviews and prospective studies. There was substantial variability in the definitions of exposure to periodontitis. A small number of studies met the threshold set for periodontitis and supported associations; however, in some of the chronic diseases there were no such studies. There was strong evidence from randomized controlled trials that interventions, which improve oral hygiene have positive effects on the prevention of nosocomial pneumonias.
  
  
  CONCLUSIONS
  There was substantial heterogeneity in the definitions used to identify periodontitis and very few studies met a stringent threshold for periodontitis. Published evidence supports modest associations between periodontitis and some, although not all, of the diseases and conditions reviewed. There is a need to reach a consensus on what constitutes periodontitis for future studies of putative associations with systemic diseases.
authors.affiliation: Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK. g.linden@qub.ac.uk
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Linden
authors.forename: Amy
authors.initials: A
authors.lastname: Lyons
authors.forename: Frank A
authors.initials: FA
authors.lastname: Scannapieco
mesh_terms: D002318:Cardiovascular Diseases; D003428:Cross Infection; D003430:Cross-Sectional Studies; D006801:Humans; D009749:Nutrition Surveys; D010510:Periodontal Diseases; D010518:Periodontitis; D011446:Prospective Studies