FALL 2026
Untreated Periodontal Disease and Their Relation to Major Health Complications
L’drina Aldonza
Texas A&M International University
ABSTRACT
While many only begin to concern themselves for their health in later stages of life or when complications begin to arise, the ideal time to care for one's health is during youth, before any problem begins. This care may take on many forms, but one often overlooked, or more importantly, underemphasized for its grand effects on overall health in the body is maintaining adequate dental health. Touted more often than not to children to avoid cavities or plaque, proper dental health can lessen the likelihood of major health concerns such as health disease and diabetes (Shmerling 2024). Proper dental care can mediate periodontal disease, a risk factor in major health complications. While avoiding or treating periodontal disease cannot lessen the possibility of these health complications to zero percent, understanding why the health concerns occur, how periodontal disease may cause or worsen these complications, and how they can be relieved is an important topic that will be further discussed.
HEART DISEASE
There are many illnesses that afflict the heart with the leading conditions including coronary artery disease, stroke, and high blood pressure, all of which hold links to periodontal disease. Coronary artery disease (CAD) is a health disease that creates a buildup of fat and cholesterol in the arteries, creating plaque that reduces the amount of blood that is supplied to the heart (Mayo Clinic 2024). When individuals are afflicted with periodontal disease, there is a buildup of bacteria in the mouth, which includes but is not limited to Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola (Bourgeois D et al., 2019). The relationship between periodontal disease and CAD begins when these bacteria enter the bloodstream either through cuts in the mouth or inflammation in the gum line. The latter is caused by a buildup of plaque and bacteria which triggers an immune response in the form of inflammation (Gasner 2025). When this inflammation becomes critical enough, a space develops between the gum and the tooth known as a gum pocket (Donos, 2018). This leaves enough room for bacteria within the mouth to slip between the gumline and enter the bloodstream.
Once inside the bloodstream, they travel to the arteries and trigger a response from the immune system in the form of inflammation (Ravnskov et. al, 2023). However when monocytes (immune cells) enter the artery wall to handle the bacteria, they also handle excess cholesterol within the arteries by engulfing the lipids (Yu et. al, 2013). Unable to fully consume the excess cholesterol, the monocytes gain a foamy appearance, leading to their name of foam cells. (Yu et. al, 2013). Foam cells can release a signal called TNF-α which calls more immune cells to the arteries to fix what is wrong (Viedt et. al, 2002). The lipid overload of these immune cells then triggers apoptosis, leading to cell death. Large-scale apoptosis can lead to large clogs that can form a necrotic core (Gui et. al, 2022). This necrotic core leads to more plaque formation via signaling proteins such as TNF-α and rupture of the fibrous cap (Neel et. al, 2023). The fibrous cap is the muscle cells that form beneath the plaque of the inner lining of the arteries and its rupture leads to coronary thrombosis (blockage in the artery) which can lead to coronary artery disease (Alonso-Herranz et. al, 2023). The formation and the accumulation of the decayed foam cells lead to a blockage within the arteries that can reduce the amount of blood that may pass through and thus cause coronary artery disease.
DIABETES
The relationship between diabetes and periodontal disease is unique in that it forms a circular relationship where the worsening effects of one condition negatively affects the other. Diabetes is the condition where the blood sugar or amount of glucose within the body gets too high due to misregulation or misproduction of insulin. There are two types of diabetes: Type 1 (insulin-dependent, body produces very little insulin) and Type 2 (non-insulin dependent, insulin resistance) (Bascones-Martinez et. al, 2011). There are several ways that diabetes impacts periodontal disease: increased sugar levels in the mouth, reduced immune system, and thickened artery walls. One of the more apparent ways to determine if someone has diabetes is to smell their breath. Diabetes increases the amount of sugar within the bloodstream and similarly in the saliva, there is an increased amount of glucose. This leads to a sweet, almost fruity smell from the mouth, common in those with uncontrolled diabetes or poor glycemic control (Rohani, 2019). The increased levels of sugar within the mouth reduces the buffering capacity of the salvia or its ability to protect the teeth and gums from increased levels of acid (Rohani, 2019). Diabetes causes a reduced immune system by causing chronic inflammation that in turn reduces T cell activity (Shomali et. al, 2021).
A reduced immune system affects foam cells by impacting monocytes’ ability to engulf lipids within the artery. When the monocytes' ability to engulf lipids is impaired, there is an excess amount of cholesterol causing the formation of foam cells and thus leading to plaque within the arteries. Aside from plaque within the pathway, diabetes can also cause the arteries to be thickened in a condition known as atherosclerosis (Gui et. al, 2022). The formation of foam cells and excess cholesterol that isn’t engulfed creates plaque along the artery walls that cause them to be thickened. Thickening of artery walls reduces the amount of nutrient and blood flow to the gums, making them more susceptible to periodontal disease. (Zardawi, 2021). In turn periodontal disease affects diabetes by reducing glycemic control with chronic inflammation. The entrance of bacteria from periodontal disease into the bloodstream causes inflammation by releasing signalers such as TNF-α (also called cytokines). These cytokines impact insulin signaling pathways by making them less receptive to signals to absorb excess glucose (Shoelson, 2006). This causes a buildup of glucose in the body, otherwise known as diabetes. This describes the complex relationship between diabetes and periodontal disease, where the progression of one disease affects the other. Periodontal disease causes inflammation that worsens the body's ability to receive insulin signaling and diabetes causes inflammation that reduces monocytes’ ability to engulf lipids encouraging the formation of plaque and thickening the artery walls.
DISCUSSION
While the presence of periodontal disease does not always indicate the individual afflicted has either diabetes or coronary heart disease, with predisposition such as family history, having periodontal disease serves as a strong risk factor. For those already afflicted, periodontal disease can worsen its effects. This is particularly true for those with diabetes as it forms a two way street, with the effects of one directly worsening the effects of another. Though the links between proper dental health and major health complications are not always evident, a slipping dental routine can lead to the development of heart disease or diabetes. Being informed on the adverse effects they pose is the first major step in taking control of your health long before these complications arise. Prevention is the best medication and as such keeping yourself informed and on top of your health is the best prescription you can write yourself.
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