The landscape in dentistry is changing as emerging studies continue to reveal that periodontal health impacts systemic health, and vice versa. Population studies, clinical studies, and in vitro animal studies underscore the critical importance of oral health to systemic health. These inextricable relationships come to the forefront as oral diseases, such as periodontal disease, take root. Special populations bring to bear the multimodal relationships between oral and systemic health. Specifically, periodontal disease has been associated with diabetes, metabolic syndrome, obesity, eating disorders, liver disease, cardiovascular disease, Alzheimer disease, rheumatoid arthritis, adverse pregnancy outcomes, and cancer. Although bidirectional relationships are recognized, the potential for multiple comorbidities, relationships, and connections (multimodal relationships) also exists. Proposed mechanisms that mediate this connection between oral and systemic health include predisposing and precipitating factors, such as genetic factors (gene polymorphisms), environmental factors (stress, habits—such as smoking and high-fat diets/consumption of highly processed foods), medications, microbial dysbiosis and bacteremias/viremias/microbemias, and an altered host immune response. Thus, in a susceptible host, these predisposing and precipitating factors trigger the onset of periodontal disease and systemic disease/conditions. Further, high-throughput sequencing technologies are shedding light on the dark matter that comprises the oral microbiome. This has resulted in better characterization of the oral microbial dysbiosis, including putative bacterial periodontopathogens and shifts in oral virome composition during disease. Multiple laboratory and clinical studies have illustrated that both eukaryotic and prokaryotic viruses within subgingival plaque and periodontal tissues affect periodontal inflammation, putative periodontopathogens, and the host immune response. Although the association between herpesviruses and periodontitis and the degree to which these viruses directly aggravate periodontal tissue damage remain unclear, the benefits to periodontal health found from prolonged administration of antivirals in immunocompromised or immunodeficient individuals demonstrates that specific populations are possibly more susceptible to viral periodontopathogens. Thus, it may be important to further examine the implications of viral pathogen involvement in periodontitis and perhaps it is time to embrace the viral dark matter within the periodontal environment to fully comprehend the pathogenesis and systemic implications of periodontitis. Emerging data from the coronavirus disease 2019 pandemic further underscores the inextricable connection between oral and systemic health, with high levels of the severe acute respiratory syndrome coronavirus 2 angiotensin-converting enzyme 2 receptor noted on oral tissues (tongue) and an allostatic load or overload paradigm of chronic stress likely contributing to rapid breakdown of oral/dental, periodontal, and peri-implant tissues. These associations exist within a framework of viremias/bacteremias/microbemias, systemic inflammation, and/or disturbances of the immune system in a susceptible host. A thorough review of systemic and oral diseases and conditions and their mechanistic, predisposing, and precipitating factors are paramount to better addressing the oral and systemic health and needs of our patients.

中文翻译：

---

口腔健康与全身健康有着千丝万缕的联系：特殊人群带来了将牙周病与全身疾病和病症联系起来的多模式关系和因素

随着新兴研究不断揭示牙周健康影响全身健康，牙科领域的格局正在发生变化，反之亦然。人口研究、临床研究和体外动物研究强调了口腔健康对全身健康的至关重要性。随着牙周病等口腔疾病的生根发芽，这些密不可分的关系变得尤为突出。特殊人群带来口腔和全身健康之间的多模式关系。具体来说，牙周病与糖尿病、代谢综合征、肥胖、饮食失调、肝脏疾病、心血管疾病、阿尔茨海默病、类风湿性关节炎、不良妊娠结局和癌症有关。尽管双向关系已得到认可，但多种合并症、关系和联系（多模式关系）的可能性也存在。介导口腔和全身健康之间这种联系的拟议机制包括诱发因素和促发因素，例如遗传因素（基因多态性）、环境因素（压力、习惯——例如吸烟和高脂肪饮食/高度加工食品的消费）、药物、微生物失调和菌血症/病毒血症/微生物血症，以及宿主免疫反应的改变。因此，在易感宿主中，这些诱发因素和促发因素会引发牙周病和全身性疾病/病症的发作。此外，高通量测序技术正在揭示构成口腔微生物组的暗物质。这使得更好地表征口腔微生物失调，包括假定的细菌性牙周病原体和疾病期间口腔病毒组组成的变化。多项实验室和临床研究表明，龈下菌斑和牙周组织内的真核和原核病毒都会影响牙周炎症、推定的牙周病原体和宿主免疫反应。尽管疱疹病毒与牙周炎之间的关联以及这些病毒直接加重牙周组织损伤的程度尚不清楚，但在免疫功能低下或免疫缺陷个体中长期服用抗病毒药物对牙周健康的益处表明，特定人群可能更容易受到病毒性牙周病原体的影响。因此，进一步研究病毒病原体对牙周炎的影响可能很重要，也许是时候接受牙周环境中的病毒暗物质，以充分理解牙周炎的发病机制和系统影响。2019 年冠状病毒病大流行的新数据进一步强调了口腔和全身健康之间密不可分的联系，口腔组织（舌头）上存在高水平的严重急性呼吸综合征冠状病毒 2 血管紧张素转换酶 2 受体，以及慢性压力的变态负荷或超负荷范例，可能导致口腔/牙齿、牙周和种植体周围的快速损坏组织。这些关联存在于易感宿主的病毒血症/菌血症/微生物血症、全身炎症和/或免疫系统紊乱的框架内。彻底审查全身和口腔疾病和病症及其机制、诱发因素和诱发因素对于更好地解决患者的口腔和全身健康和需求至关重要。