Please wait a minute...
Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2016, Vol. 10 Issue (4) : 405-409     DOI: 10.1007/s11684-016-0476-5
Mouth the mirror of lungs: where does the connection lie?
Jananni Muthu1(),Sivaramakrishnan Muthanandam2,Jaideep Mahendra3
1. Department of Periodontology, Indira Gandhi Institute of Dental Sciences, Pondicherry 605005, India
2. Department of Oral Pathology and Microbiology, Indira Gandhi Institute of Dental Sciences, Pondicherry 605005, India
3. Department of Periodontology, Meenakshi Ammal Dental College & Hospital, Chennai 600095, India
Download: PDF(124 KB)   HTML
Export: BibTeX | EndNote | Reference Manager | ProCite | RefWorks

Periodontitis is the chronic destructive disease of the periodontium (Gums) caused by host bacterial interactions. The effect of such host bacterial interactions in oral cavity also evokes a systemic response. Numerous studies have found common mechanisms of destruction for periodontal diseases and other chronic diseases like diabetes mellitus, atherosclerosis, respiratory diseases, and adverse pregnancy outcomes. Oral colonization by respiratory pathogens appears to be a risk factor for development of respiratory diseases and oral interventions aimed at reducing oral bacterial count have resulted in reduced incidence of these reparatory illness. This reflects the importance of oral hygiene among patients with respiratory illness. This review highlights the association between periodontal diseases and respiratory diseases.

Keywords periodontitis      respiratory diseases      acute pneumonia      COPD     
Corresponding Authors: Jananni Muthu   
Just Accepted Date: 08 October 2016   Online First Date: 02 November 2016    Issue Date: 01 December 2016
URL:     OR
Fig.1  Mechanisms of action of oral bacteria in the pathogenesis of respiratory infection.
1 Reddy MS. Reaching a better understanding of non-oral disease and the implication of periodontal infections. Periodontol 2000 2007; 44(1): 9–14
doi: 10.1111/j.1600-0757.2007.00213.x pmid: 17474922
2 American Academy of Periodontology. Oral Health Information for the Public: Mouth Body Connection. . (Accessed <Date>January 16</Date>, 2008)
3 Page RC. The pathobiology of periodontal diseases may affect systemic diseases: inversion of a paradigm. Ann Periodontol 1998; 3(1): 108–120
doi: 10.1902/annals.1998.3.1.108 pmid: 9722695
4 Verghese A, Berk SL. Bacterial pneumonia in the elderly. Medicine (Baltimore) 1983; 62(5): 271–285
doi: 10.1097/00005792-198309000-00002 pmid: 6353130
5 Scannapieco FA, Stewart EM, Mylotte JM. Colonization of dental plaque by respiratory pathogens in medical intensive care patients. Crit Care Med 1992; 20(6): 740–745
doi: 10.1097/00003246-199206000-00007 pmid: 1597025
6 No author listed. Centers for Disease Control and Prevention (CDC). Morb Mortal Wkly Rep. 1997; 46(RR-1): 1–79
7 Scannapieco FA, Stewart EM, Mylotte JM. Colonization of dental plaque by respiratory pathogens in medical intensive care patients. Crit Care Med 1992; 20(6): 740–745
doi: 10.1097/00003246-199206000-00007 pmid: 1597025
8 Sumi Y, Miura H, Sunakawa M, Michiwaki Y, Sakagami N. Colonization of denture plaque by respiratory pathogens in dependent elderly. Gerodontology 2002; 19(1): 25–29
doi: 10.1111/j.1741-2358.2002.00025.x pmid: 12164235
9 Sumi Y, Kagami H, Ohtsuka Y, Kakinoki Y, Haruguchi Y, Miyamoto H. High correlation between the bacterial species in denture plaque and pharyngeal microflora. Gerodontology 2003; 20(2): 84–87
doi: 10.1111/j.1741-2358.2003.00084.x pmid: 14697018
10 Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R; CDC; Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health-care—associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004; 53(RR-3): 1–36
pmid: 15048056
11 Fourrier F, Duvivier B, Boutigny H, Roussel-Delvallez M, Chopin C. Colonization of dental plaque: a source of nosocomial infections in intensive care unit patients. Crit Care Med 1998; 26(2): 301–308
doi: 10.1097/00003246-199802000-00032 pmid: 9468169
12 Didilescu AC, Skaug N, Marica C, Didilescu C. Respiratory pathogens in dental plaque of hospitalized patients with chronic lung diseases. Clin Oral Investig 2005; 9(3): 141–147
doi: 10.1007/s00784-005-0315-6 pmid: 15909174
13 Abe S, Ishihara K, Adachi M, Okuda K. Oral hygiene evaluation for effective oral care in preventing pneumonia in dentate elderly. Arch Gerontol Geriatr 2006; 43(1): 53–64
doi: 10.1016/j.archger.2005.09.002 pmid: 16271775
14 Russell SL, Boylan RJ, Kaslick RS, Scannapieco FA, Katz RV. Respiratory pathogen colonization of the dental plaque of institutionalized elders. Spec Care Dentist 1999; 19(3): 128–134
doi: 10.1111/j.1754-4505.1999.tb01413.x pmid: 10860077
15 Joshi N, O’Bryan T, Appelbaum PC. Pleuropulmonary infections caused by Eikenella corrodens. Rev Infect Dis 1991; 13(6): 1207–1212
doi: 10.1093/clinids/13.6.1207 pmid: 1775853
16 Zijlstra EE, Swart GR, Godfroy FJM, Degener JE. Pericarditis, pneumonia and brain abscess due to a combined Actinomyces—Actinobacillus actinomycetemcomitans infection. J Infect 1992; 25(1): 83–87
doi: 10.1016/0163-4453(92)93633-2 pmid: 1522328
17 Scannapieco FA, Wang B, Shiau HJ. Oral bacteria and respiratory infection: effects on respiratory pathogen adhesion and epithelial cell proinflammatory cytokine production. Ann Periodontol 2001; 6(1): 78–86
doi: 10.1902/annals.2001.6.1.78 pmid: 11887474
18 Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT, Lopatin D, Loesche WJ. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia 1998; 13(2): 69–81
doi: 10.1007/PL00009559 pmid: 9513300
19 Robert R, Grollier G, Frat JP, Godet C, Adoun M, Fauchère JL, Doré P. Colonization of lower respiratory tract with anaerobic bacteria in mechanically ventilated patients. Intensive Care Med 2003; 29(7): 1062–1068
doi: 10.1007/s00134-003-1729-8 pmid: 12698243
20 Gibbons RJ, Hay DI, Childs WC 3rd, Davis G. Role of cryptic receptors (cryptitopes) in bacterial adhesion to oral surfaces. Arch Oral Biol 1990; 35(Suppl): 107S–114S
doi: 10.1016/0003-9969(90)90139-2 pmid: 2088213
21 Barbara R. chronic obstructive pulmonary disease. Soc Work Health Care 1991; 16: 4–10
22 No author listed. GOLD—The Global Initiative for Chronic Obstructive Lung Disease. Available at
23 Deo V, Bhongade ML, Ansari S, Chavan RS. Periodontitis as a potential risk factor for chronic obstructive pulmonary disease: a retrospective study. Indian J Dent Res 2009; 20(4): 466–470
doi: 10.4103/0970-9290.59456 pmid: 20139573
24 Hyman JJ, Reid BC. Cigarette smoking, periodontal disease, and chronic obstructive pulmonary disease. J Periodontol 2004; 75(1): 9–15
doi: 10.1902/jop.2004.75.1.9 pmid: 15025211
25 Mannino DM, Davis KJ. Lung function decline and outcomes in an elderly population. Thorax 2006; 61(6): 472–477
doi: 10.1136/thx.2005.052449 pmid: 16517577
26 Bolin A, Eklund G, Frithiof L, Lavstedt S. The effect of changed smoking habits on marginal alveolar bone loss. A longitudinal study. Swed Dent J 1993; 17(5): 211–216
pmid: 8291030
27 Burt BA, Ismail AI, Morrison EC, Beltran ED. Risk factors for tooth loss over a 28-year period. J Dent Res 1990; 69(5): 1126–1130
doi: 10.1177/00220345900690050201 pmid: 2335645
28 Hayes C, Sparrow D, Cohen M, Vokonas PS, Garcia RI. The association between alveolar bone loss and pulmonary function: the VA Dental Longitudinal Study. Ann Periodontol 1998; 3(1): 257–261
doi: 10.1902/annals.1998.3.1.257 pmid: 9722709
29 Scannapieco FA, Genco RJ. Association of periodontal infections with atherosclerotic and pulmonary diseases. J Periodontal Res 1999; 34(7): 340–345
doi: 10.1111/j.1600-0765.1999.tb02263.x pmid: 10685358
30 Scannapieco FA, Ho AW. Association of periodontal disease & chronic lung diseases. Analysis of NHANES III. J Periodontol 1999; 78: 1777–1782
31 Scannapieco FA, Ho AW. Potential association between chronic respiratory disease and periodontal diseases: analysis of National Health and Nutrition Examination Survey III. J Periodontol 2001; 72: 50–56
doi: 10.1902/jop.2001.72.1.50 pmid: 11210073
32 Prasanna SJ. Causal relationship between periodontitis and chronic obstructive pulmonary disease. J Indian Soc Periodontol 2011; 15(4): 359–365
doi: 10.4103/0972-124X.92570 pmid: 22368360
33 Scannapieco FA, Mylotte JM. Relationship between periodontal disease and bacterial pneumonia. J periodontal 1996; 67: 1114–1122
34 Scannapeico FA, Bush RB, Paju S. Association between periodontal disease and risk for nosocomial bacterial pneumonia —a systematic review. Ann Periodontol 2003; 8: 54–69
doi: 10.1902/annals.2003.8.1.54 pmid: 14971248
35 Pugin J, Auckenthaler R, Lew DP, Suter PM. Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clinical trial. JAMA 1991; 265(20): 2704–2710
doi: 10.1001/jama.1991.03460200084041 pmid: 2023353
36 Stoutenbeek CP, van Saene HK, Miranda DR, Zandstra DF, Langrehr D. The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma 1987; 27(4): 357–364
doi: 10.1097/00005373-198704000-00003 pmid: 3033259
37 Yoneyama T, Yoshida M, Ohrui T, Mukaiyama H, Okamoto H, Hoshiba K, Ihara S, Yanagisawa S, Ariumi S, Morita T, Mizuno Y, Ohsawa T, Akagawa Y, Hashimoto K, Sasaki H; Oral Care Working Group. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 2002; 50(3): 430–433
doi: 10.1046/j.1532-5415.2002.50106.x pmid: 11943036
38 Yoshida M, Yoneyama T, Akagawa Y. Oral care reduces pneumonia of elderly patients in nursing homes, irrespective of dentate or edentate status. Nippon Ronen Igakkai Zasshi 2001; 38(4): 481–483 (in Japanese)
doi: 10.3143/geriatrics.38.481 pmid: 11523155
39 Ishikawa A, Yoneyama T, Hirota K, Miyake Y, Miyatake K. Professional oral health care reduces the number of oropharyngeal bacteria. J Dent Res 2008; 87(6): 594–598
doi: 10.1177/154405910808700602 pmid: 18502972
40 Bassim CW, Gibson G, Ward T, Paphides BM, Denucci DJ. Modification of the risk of mortality from pneumonia with oral hygiene care. J Am Geriatr Soc 2008; 56(9): 1601–1607
doi: 10.1111/j.1532-5415.2008.01825.x pmid: 18691286
41 Treppening M. Geriatric oral health & pneumonia risk. Clin Infect Dis 2005; 40:1807–1810
42 Prevention of Ventilator Associated Pneumonia: Institute for Clinical Systems I<?Pub Caret?>mprovement. 5th ed. Bloomington. 2011.
[1] Namita Gupta,N.D. Gupta,Akash Gupta,Saif Khan,Neha Bansal. Role of salivary matrix metalloproteinase-8 (MMP-8) in chronic periodontitis diagnosis[J]. Front. Med., 2015, 9(1): 72-76.
Full text