Chronic periodontitis, inflammatory cytokines, and interrelationship with other chronic diseases

Figures & data

Table 1. Abbreviated version of classification of periodontal diseases and conditions [5,6].

I.	Gingival diseases
II.	Chronic periodontitis
III.	Aggressive periodontitis
IV.	Periodontitis as a manifestation of systemic diseases
V.	Necrotizing periodontal diseases
VI.	Abscesses of the periodontium
VII.	Combined periodontic-endodontic lesions
VIII.	Development or acquired deformities and conditions

Table 2. Guidelines for determining severity of periodontitis [8].

	Slight (mild)	Moderate	Severe (advanced)
Probing depths	>3 and <5 mm	≥5 and <7 mm	≥7 mm
Bleeding on probing	Yes	Yes	Yes
Radiographic bone loss	Up to 15% of root length or ≥2 and ≤3 mm	16–30% or >3 and ≤5 mm	>30% or >5 mm
Clinical attachment loss	1–2 mm	3–4 mm	≥5 mm

Figure 1. A conceptual framework for chronic inflammation in periodontal tissues.

Environmental stressors, (a), and host responses, (b), contribute to periodontal chronic inflammation. Several cellular and molecular factors are responsible for an imbalance towards a proinflammatory rather than anti-inflammatory immune response, that culminates into tissue injury. A bidirectional link with other systemic inflammatory diseases may operate and need to be further investigated.

Figure 2. Chronic periodontitis and some common systemic diseases.

Chronic periodontitis shares several associations with numerous chronic inflammatory diseases. Proinflammatory cytokines are, among other factors, important immune-related mediators involved in the disease pathogenesis. Only the most common noncommunicable diseases and pregnancy complications were exemplified, although others (rheumatoid arthritis, neurodegenerative disorders, etc.) exhibit also associations with chronic periodontitis. Illustration adapted medical elements from Servier Medical Art http://smart.servier.com/, with permission to reproduce under the Creative Commons Attribution 3.0 Unported License https://creativecommons.org/licenses/by/3.0/

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