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Can Systemic Diseases Co-induce (Not Just Exacerbate) Periodontitis? A Hypothetical "Two-hit" Model

¹ Department of Oral Biology & Pathology, School of Dental Medicine, SUNY at Stony Brook, Stony Brook, NY;
² Department of Surgical Specialties, College of Dentistry, University of Nebraska Medical Center, Lincoln, NE; and
³ Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA

View larger version (26K): [in a new window]   Figure. A hypothetical "two-hit" model of induction of chronic destructive periodontitis. The first "hit" involves the periodontopathic subgingival biofilm and its microbial products, such as endotoxin. The second "hit" involves a medical systemic disease, such as (but not limited to) rheumatoid arthritis and post-menopausal osteoporosis, which increases biomarkers of systemic inflammation in the circulation, including C-reactive protein (CRP), cytokines (e.g., IL-6), prostanoids (e.g. , PGE2), and matrix metalloproteinases (e.g., MMP-9). CVD, cardiovascular disease.