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Periodontitis and general health: what the studies actually show

Periodontitis is a chronic inflammation of the tissues that support the teeth. Many studies associate it with general diseases: diabetes, heart and blood-vessel disease, pregnancy complications, kidney disease, rheumatoid arthritis and dementia. But an association is not proof of cause, and treating the gums has not been shown to prevent most of these diseases. This page gives the overview, condition by condition, and points to the detailed articles in this section.

Contents7 sections
  1. Four different questions that should not be confused
  2. Summary table of the relationships studied
  3. The mechanisms studied
  4. Pregnancy, kidneys, rheumatoid arthritis: three links to read with care
  5. What is solid and what is not
  6. Prevention, nutrition and micronutrition: the place of this perspective
  7. What this means for you

Four different questions that should not be confused

For each disease, four separate questions arise. Association: do people with periodontitis have this disease more often? Observational studies answer this. Mechanisms: are there plausible biological pathways? Laboratory, animal and human studies. Causation: does periodontitis genuinely contribute to the disease, independently of smoking, age, diabetes or social circumstances? Treatment effect: does treating periodontitis improve the general disease? Only randomised trials, in which treatment is allocated by chance, can tell.

A 'yes' to the first question says nothing about the fourth. This is the most common misunderstanding: reading that a disease is 'linked' to the gums does not mean that treating the gums prevents it. The table below summarises the evidence for each relationship studied, with its limitations.

Summary table of the relationships studied

ConditionObserved associationMechanisms studiedCausationDemonstrated effect of periodontal treatment
DiabetesTwo-way relationship, recognised by the EFP–IDF consensus [1]Inflammation (IL-1β, TNF-α, IL-6), oxidative stress and insulin resistance [1]Plausible; inconsistent genetic signal [2]Mean HbA1c reduction of about 0.4 percentage points at 3–4 months (moderate certainty) [3]; effect on complications not demonstrated
Cardiovascular diseaseIndependent association [4] [5]Bacteraemia, endothelial dysfunction, inflammation [6]Not established according to the AHA [5]Improvement in markers (CRP, endothelial function) [7] [8]; effect on heart attack and stroke not demonstrated [9]
PregnancyWeak but independent association with preterm birth, low birth weight and pre-eclampsia [10]Bacterial and inflammatory spread [6]Not establishedNo clear difference in preterm birth; possible reduction in low birth weight (low certainty) [11]
Chronic kidney diseaseSevere periodontitis associated with lower kidney function [12]Systemic inflammation, which explains only part of the link [12]Not establishedMostly non-randomised studies: lower CRP; effect on kidney function uncertain [13]
Rheumatoid arthritisModest association [14]Protein citrullination, role of P. gingivalis [6]No causal genetic signal [2]Short-term reduction in disease activity (DAS28) [15]
Alzheimer's disease and dementiaRisk increased by about 20% in meta-analyses [16] [17]P. gingivalis gingipains found in brain tissue [18]Not established; no genetic signal [2]Not demonstrated; trial of a gingipain inhibitor negative [19]
Metabolic fatty liver diseaseAssociation (OR 1.34) [20]Endotoxaemia, inflammation [6]Suggestive genetic signal [2]Not assessed in robust trials
PneumoniaAssociation with respiratory diseases, including pneumonia [21]Aspiration of oral bacteria [6]Not establishedOral care in care homes: uncertain effect on incidence; pneumonia mortality possibly reduced (low certainty) [22]
Digestive cancersColorectal cancer: association in cohort studies [23]Translocation of oral bacteria (Fusobacterium nucleatum) [23]No genetic signal for gastric cancer [2]Not assessed
Inflammatory bowel diseasePeriodontitis more frequent in patients (Crohn's disease, ulcerative colitis) [24]Mouth–gut axis: bacteria and lymphocytes migrating to the gut (animal models) [6]No genetic signal [2]Not demonstrated
Metabolic syndrome, obesityAssociation, stronger with severe periodontitis [25] [26]Shared low-grade inflammationNot establishedNot demonstrated
'Mendelian randomisation' studies use genetic variants to approach causation. They have important limitations in periodontology (weak genetic markers, mainly European populations) [2]: their results, positive or negative, are not conclusive on their own.
From Dr Hazout's dissertation (2025): from gum inflammation to atheroma plaque — mechanisms under study, not proof of causation.

The mechanisms studied

Educational infographic: organs and diseases associated with periodontitis, and the main mechanisms studied (bacteraemia, aspiration and gut translocation, low-grade inflammation, endothelial dysfunction, trained myelopoiesis). Associations and hypotheses, not proven causal links.
Educational infographic: organs and diseases associated with periodontitis, and the main mechanisms studied (bacteraemia, aspiration and gut translocation, low-grade inflammation, endothelial dysfunction, trained myelopoiesis). Associations and hypotheses, not proven causal links.
  • Bacteraemia: through the ulcerated lining of the pockets, bacteria briefly enter the bloodstream, including during chewing or brushing [6].
  • Low-grade inflammation: inflammatory mediators (IL-6, TNF-α) and CRP, a protein made by the liver, rise in the blood; periodontal treatment lowers CRP by 0.69 mg/L on average at six months [7].
  • Oral–gut spread: swallowed bacteria and immune cells activated in the mouth can reach the gut, according to animal models [6].
  • Endothelial dysfunction: the inner lining of the arteries dilates less well; it improves six months after intensive periodontal treatment [8].
  • Trained myelopoiesis: periodontal inflammation durably 'reprogrammes' bone-marrow stem cells, which then produce more reactive white blood cells; this mechanism, described mainly in animals, could link several inflammatory diseases [6].

Pregnancy, kidneys, rheumatoid arthritis: three links to read with care

Pregnancy. Pregnancy hormones make the gums more reactive to plaque, and gum bleeding is common in pregnant women [10]. Observational studies find a weak but independent association between periodontitis and preterm birth, low birth weight or pre-eclampsia [10]. As for treatment, the Cochrane review finds no clear difference in preterm birth; a reduction in low birth weight is possible, with low certainty [11]. Non-surgical periodontal treatment was carried out during pregnancy in these trials; a current or planned pregnancy should be mentioned to the practice.

Chronic kidney disease. In a large population study, severe periodontitis is associated with lower kidney function and more albumin in the urine; inflammation measured by CRP explains only part of this link [12]. Treatment studies are mostly non-randomised: CRP falls after periodontal treatment, but the effect on kidney function remains uncertain [13]. Anyone under follow-up for kidney disease should mention it and their medication at the practice, and the periodontal report can be sent to the nephrologist.

Rheumatoid arthritis. The association is modest: a meta-analysis finds slightly more periodontitis in patients with rheumatoid arthritis than in healthy controls, but not compared with controls who have osteoarthritis [14]. The mechanism studied involves P. gingivalis, which can modify proteins (citrullination) against which patients' immune systems react [6]. After non-surgical periodontal treatment, disease activity (DAS28 score) falls in the short term in the available trials, with follow-up of six weeks to six months [15]. When the hands are affected, brushing becomes difficult: aids can be discussed at the consultation.

For these three conditions the conclusion is the same: associations exist, mechanisms are being studied, and no trial shows that treating the gums prevents the disease. Periodontal treatment remains justified for the mouth, and coordination with the doctor who follows the disease is useful.

What is solid and what is not

The most thoroughly documented link concerns diabetes: the 2022 Cochrane review shows a fall in HbA1c after periodontal treatment, with moderate certainty [3]. For the heart and blood vessels, the association is well established and some markers improve after treatment, but the American Heart Association statement points out that causation has not been demonstrated and that no trial has measured an effect on heart attacks [5] [9]. For Alzheimer's disease, the associations are real but modest and inconsistent, with no trial showing a preventive effect [16] [17]. Each article details the studies, positive and negative.

These uncertainties are no reason to neglect periodontitis: it destroys bone, leads to tooth loss and is treated in its own right. Dr Hazout does not present this treatment as a proven way to prevent a general disease. Three measures, however, have an established benefit for both the gums and general health: stopping smoking, controlling diabetes and regular oral hygiene [27].

Prevention, nutrition and micronutrition: the place of this perspective

Slide from Dr Hazout's university diploma dissertation (2025): markers studied (high-sensitivity CRP, HbA1c, IL-6, microbiota) and a diagram adapted from Hajishengallis and Chavakis (2021). Research avenues, not routine tests.
Slide from Dr Hazout's university diploma dissertation (2025): markers studied (high-sensitivity CRP, HbA1c, IL-6, microbiota) and a diagram adapted from Hajishengallis and Chavakis (2021). Research avenues, not routine tests.

Dr Hazout has added to his training as a periodontist a university diploma (DU) in anti-ageing and preventive medicine (2025) and a European university diploma in micronutrition and preventive medicine (2026). This perspective helps to understand the inflammatory background on which periodontitis develops; it accompanies the mechanical treatment of the pockets and does not replace it. In practice, the consultation includes a lifestyle review: smoking, diet (free sugars, ultra-processed foods), physical activity, sleep, current medication and medical history.

  • If you have risk factors for diabetes and no recent check-up, Dr Hazout suggests discussing it with your GP, as the scientific societies recommend [27]; with your consent, the practice sends them a periodontal report.
  • Diet influences gum inflammation: the trials, their limits and the advice that follows from them are detailed in the article on nutrition, micronutrition and inflammation.
  • No food supplement is offered routinely, and none treats periodontitis; tests and supplements are sorted out in the article on blood tests and supplements.
Encrypted streaming. A video shown on screen can always be filmed or captured.
Narrated educational documentary (about 7 min, French subtitles): communication between periodontal bacteria, blood vessels and blood-sugar regulation. It illustrates mechanisms under study; it does not prove a causal link.

What this means for you

If you have a general disease and signs of periodontitis (bleeding gums, receding gums, loose teeth), the two sets of care benefit from knowing about each other. At the practice in Levallois-Perret, your medical situation is taken into account from the first visit. Periodontitis treatment is the same as for any patient, adapted to your medical situation, and maintenance keeps the results.

If you are in good health, remember that periodontitis is common, often silent, and that it is treated because it damages the mouth. A benefit for the heart or the brain is possible, not a certainty.

Related articles

Gums and general health · 8 min

Diabetes and periodontitis: understanding a two-way link

Diabetes increases the risk of periodontitis, and periodontitis makes diabetes harder to control. It is the most thoroughly documented relationship between the mouth and…

Gums and general health · 8 min

Periodontitis and diseases of the heart and blood vessels: where does the evidence stand?

People with periodontitis more often have cardiovascular disease. Cardiology and periodontology societies acknowledge this. But they also stress that no trial has yet…

Gums and general health · 9 min

Periodontitis and Alzheimer's disease: a real association, unproven causation

Several large studies, including two cohorts published in 2026, associate periodontitis with a higher risk of dementia and Alzheimer's disease. Other cohorts do not find…

Gums and general health · 8 min

Nutrition, micronutrition and periodontal inflammation: what the evidence shows

Diet influences gum inflammation: a few randomised trials show this, over short periods and with modest effects. The idea that periodontitis contributes to the chronic…

Gums and general health · 8 min

Blood tests and food supplements: what is useful and what is not

A blood test can be useful around periodontitis, but not just any test. And many supplements are marketed 'for the gums' without solid evidence. This article sorts them…

Frequently asked questions

Can my periodontitis cause a heart attack?

Studies show an association and plausible mechanisms, but causation has not been established. Treatment improves some vascular markers, with no evidence so far of fewer heart attacks.

If I have my gums treated, will my diabetes improve?

On average, yes, modestly: the 2022 Cochrane review measures a fall in HbA1c a few months after treatment. The effect varies between individuals and does not replace diabetes treatment.

Should I tell my doctor that I have periodontitis?

Yes, it is useful, particularly if you have diabetes, cardiovascular disease, kidney disease, rheumatoid arthritis or are pregnant. European recommendations encourage this coordination between dentists and family doctors.

I am pregnant: can my gums be treated?

Yes. Non-surgical periodontal treatment was carried out during pregnancy in the clinical trials. Tell the practice about the pregnancy.

Does periodontal treatment protect against Alzheimer's disease?

This has not been demonstrated. Associations exist, but no randomised trial has shown that periodontal treatment reduces the risk of dementia.

References

  1. Sanz M, Ceriello A, Buysschaert M, Chapple I, Demmer RT, Graziani F, et al. Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology. J Clin Periodontol. 2018;45(2):138-149. DOI
  2. Zhao Y, Zhang C, Chang X, Zhang J, Shu C, Lin C, Hou J. Causal association between periodontitis and systemic diseases: a systematic review and meta-analysis of mendelian randomization studies. BMC Oral Health. 2026;26:383. DOI
  3. Simpson TC, Clarkson JE, Worthington HV, MacDonald L, Weldon JC, Needleman I, et al. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev. 2022;4:CD004714. PubMed
  4. Sanz M, Marco del Castillo A, Jepsen S, Gonzalez-Juanatey JR, D'Aiuto F, Bouchard P, et al. Periodontitis and cardiovascular diseases: Consensus report. J Clin Periodontol. 2020;47(3):268-288. DOI
  5. Tran AH, Zaidi AH, Bolger AF, Del Brutto OH, Hegde R, Patton LL, Rausch J, Zachariah JP ; au nom des comités de l’American Heart Association. Periodontal disease and atherosclerotic cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2026;153:e73-e88 (publié en ligne le 16 décembre 2025). DOI
  6. Hajishengallis G, Chavakis T. Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities. Nat Rev Immunol. 2021;21:426-440. DOI
  7. Luthra S, et al. Treatment of periodontitis and C-reactive protein: A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol. 2023;50(1):45-60. DOI
  8. Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M, et al. Treatment of periodontitis and endothelial function. N Engl J Med. 2007;356(9):911-920. DOI
  9. Ye Z, Cao Y, Miao C, Liu W, Dong L, Lv Z, Iheozor-Ejiofor Z, Li C. Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis. Cochrane Database Syst Rev. 2022;CD009197.pub5. DOI
  10. Wen X, Fu X, Zhao C, Yang L, Huang R. The bidirectional relationship between periodontal disease and pregnancy via the interaction of oral microorganisms, hormone and immune response. Front Microbiol. 2023;14:1070917. DOI
  11. Iheozor-Ejiofor Z, Middleton P, Esposito M, Glenny AM. Treating periodontal disease for preventing adverse birth outcomes in pregnant women. Cochrane Database Syst Rev. 2017;6:CD005297. DOI
  12. Schmidt-Lauber C, Ebinghaus M, Borof K, Lieske B, Klopp A, Thompson C, et al. Association of periodontitis with reduced kidney function and albuminuria in early chronic kidney disease: a population-based study. Int J Oral Sci. 2026;18:33. DOI
  13. Delbove T, Gueyffier F, Juillard L, Kalbacher E, Maucort-Boulch D, Nony P, et al. Effect of periodontal treatment on the glomerular filtration rate, reduction of inflammatory markers and mortality in patients with chronic kidney disease: A systematic review. PLoS One. 2021;16(1):e0245619. DOI
  14. Fuggle NR, Smith TO, Kaul A, Sofat N. Hand to mouth: a systematic review and meta-analysis of the association between rheumatoid arthritis and periodontitis. Front Immunol. 2016;7:80. DOI
  15. Oliveira SR, de Arruda JAA, Schneider AH, et al. Does non-surgical periodontal treatment contribute to rheumatoid arthritis amelioration? Evidence based on an overview and meta-analysis. Odontology. 2025;113:903-917. DOI
  16. Asher S, Stephen R, Mäntylä P, Suominen AL, Solomon A. Periodontal health, cognitive decline, and dementia: A systematic review and meta-analysis of longitudinal studies. J Am Geriatr Soc. 2022;70(9):2695-2709. DOI
  17. Dibello V, Custodero C, Cavalcanti R, et al. Impact of periodontal disease on cognitive disorders, dementia, and depression: a systematic review and meta-analysis. GeroScience. 2024;46:5133-5169. DOI
  18. Dominy SS, Lynch C, Ermini F, Benedyk M, Marczyk A, Konradi A, et al. Porphyromonas gingivalis in Alzheimer's disease brains: Evidence for disease causation and treatment with small-molecule inhibitors. Sci Adv. 2019;5(1):eaau3333. DOI
  19. Alzforum. Therapeutics – Atuzaginstat (COR388) : essai GAIN, résultats et statut du programme (consulté le 3 octobre 2026). alzforum.org
  20. Li H, Shi M, Yuan R, Wang H, Li Y, et al. Association between periodontitis and non-alcoholic fatty liver disease in community-dwelling adults: a systematic review and meta-analysis. Sci Rep. 2026;16:16217. DOI
  21. Wu Z, Xiao C, Chen F, Wang Y, Guo Z. Pulmonary disease and periodontal health: a meta-analysis. Sleep Breath. 2022;26:1857-1868. DOI
  22. Cao Y, Liu C, Lin J, Ng L, Needleman I, Walsh T, Li C. Oral care measures for preventing nursing home-acquired pneumonia. Cochrane Database Syst Rev. 2022;CD012416.pub3. DOI
  23. Chauca-Bajaña L, Ordoñez Balladares A, Lorenzo-Pouso AI, et al. Periodontitis and oral pathogens in colorectal cancer: a systematic review, meta-analysis, and trial sequential analysis. Dent J (Basel). 2025;13(12):595. DOI
  24. Ayati A, Khodabandelu S, Khaleghi S, et al. A systematic review and network meta-analysis of the association between periodontitis and inflammatory bowel diseases. BMC Oral Health. 2025;25:463. DOI
  25. Rosário-dos-Santos HL, Miranda SS, Gomes-Filho IS, et al. Periodontitis severity relationship with metabolic syndrome: A systematic review with meta-analysis. Oral Dis. 2023;29(7):2512-2520. DOI
  26. Kim CM, Lee S, Hwang W, Son E, Kim TW, Kim K, Kim YH. Obesity and periodontitis: A systematic review and updated meta-analysis. Front Endocrinol. 2022;13:999455. DOI
  27. Herrera D, Sanz M, Shapira L, Brotons C, Chapple I, Frese T, et al. Association between periodontal diseases and cardiovascular diseases, diabetes and respiratory diseases: Consensus report of the Joint Workshop by the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe). J Clin Periodontol. 2023;50(6):819-841. DOI

Patient pathway

  1. SignsPeriodontitis and general health: what the studies actually show
  2. DiagnosisPeriodontology: what a periodontist does and the warning signs to look out for
  3. TreatmentsHow periodontitis is treated: from assessment to stability
  4. ArticlesArticles on this topic
  5. First visitThe first consultation

Appointments

See Dr Hazout in Levallois-Perret

Monday to Thursday, 9 am to 7 pm, at 119 rue du Président Wilson.

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