Crystal Marruganti explains why periodontal care is essential to supporting a patient’s whole-body health.
For years, periodontitis has been considered an isolated oral infection that was limited to the mouth. We now know it is far more complex. Periodontitis is a chronic inflammatory condition triggered by a dysbiosis within the oral microbiome in a susceptible individual. The inflammatory mediators released in the gums – cytokines, prostaglandins and C-reactive proteins – circulate through the bloodstream, influencing distant organs and metabolic pathways. This suggests their potential role in systemic inflammatory and infectious processes.
It also explains the close association between periodontal diseases and other conditions such as diabetes, cardiovascular diseases and metabolic syndrome. The relationship is bidirectional: uncontrolled systemic inflammation worsens periodontal breakdown, while untreated periodontitis can significantly increase the systemic inflammatory load.
Understanding this connection changes how we approach our patients. Managing periodontal health means managing inflammation at a systemic level – and this requires us, as oral healthcare providers, to consider more than just the plaque.
Lifestyle: the forgotten determinant
Lifestyle is one of the most powerful, and often overlooked, determinants of periodontal health. Our most recent research has focused on how daily lifestyle behaviours – such as nutrition, stress levels, sleep quality and physical activity – influence both oral and systemic health.
Nutrition is a fundamental part of everyone’s life. Diets that are high in refined carbohydrates and ultra-processed foods, and low in fibers and fresh fruits and vegetable, may fuel pathogenic oral bacteria and eventually increase oxidative stress and systemic inflammation. By contrast, diets rich in antioxidants, omega-3 fatty acids and polyphenols support microbial balance and reduce gingival (as well as systemic) inflammation.
While smoking still remains the most destructive modifiable risk factor for periodontal diseases, high stress levels and poor sleep quality are increasingly recognised as key contributors to the disease. Elevated cortisol levels impair immune regulation, while chronic fatigue alters inflammatory thresholds, making individuals more prone to infections and more vulnerable to the microbial challenge.
Physical inactivity also plays a role, and our research identified what we called the ‘physical activity paradox’ whereby leisure-time physical activity was identified as a protective indicator for periodontitis, while occupational physical activity was identified as a risk indicator for the disease, as it maintains the low-grade systemic inflammation that quietly accelerates periodontal breakdown.
Unique position
Moreover, given the strong links between lifestyle behaviours and systemic conditions such as diabetes, hypertension, cardiovascular diseases, and periodontitis, the lifestyle changes we foster our patients to adopt can bring about dramatic benefits extending beyond the oral cavity. These improvements may include reduced blood pressure, improved glycaemic control, and overall improved systemic health and wellbeing.
In fact, because oral healthcare providers maintain frequent contact with the general public, we are in the unique and privileged position to be able to promote holistic wellbeing and thus play a pivotal role in preventing chronic diseases, starting right from the dental chair. Highlighting the broader public health implications of this approach, I was deeply honoured to be featured in the Forbes 30 Under 30 list for science and healthcare, which highlights the growing appreciation of oral health as a cornerstone of overall health and wellbeing.
Bringing science to the chairside
In my daily clinical practice at Harley Street Dental Studio, I work to implement the daily application of this research. An essential part of this process is also educating our patients to understand why the disease appeared in the first place and what to do in order to prevent any further periodontal breakdown or tooth loss. This presents an incredible opportunity to merge evidence with patients’ education.
For this reason, we now routinely integrate systemic screening into periodontal assessments – for example, by measuring HbA1c levels and assessing for lifestyles such as diet quality, frequency of physical activity, perceived stress levels and sleep quality. These indicators help identify patients whose oral inflammation may be a symptom of wider metabolic imbalance.
Treatment plans include not only specific periodontal non-surgical or surgical care but also tailored tips on anti-inflammatory nutrition, smoking cessation, stress management and microbiome-friendly habits. When patients begin to view their oral health as part of their overall wellbeing, the results are transformative – not only for their gums, but for their general health.
How practice and academia feed into each other
Balancing academic research and teaching with private clinical work can be challenging, but it is also deeply rewarding. As complimentary as they are, academia and clinical practice actually feed into each other.
The clinical challenges I observe in practice often inspire new research questions and trigger the proposal of new studies to help solve a specific clinical problem. Conversely, insights from the research work and literature continually refine the clinical protocols I implement in practice, in order to offer the most cutting-edge, evidence-based care to my patients.
From disease management to wellness promotion
Looking ahead, the field of periodontology is moving rapidly towards precision and integration. Advances in microbiome mapping, salivary diagnostics and personalised medicine will allow us to predict disease risk and speed of progression with greater accuracy. But, given the multifactorial nature of periodontitis, technology alone will not give us all the answers we may need.
The greatest progress will come from behavioural change – in both patients and professionals. As dentists, we have a unique opportunity to act as early detectors of systemic conditions and as advocates for healthier lifestyles. By embracing a truly integrative model of care, we move from treating the disease to promoting wellness, that could revolutionise our patients’ lives.
Ultimately, periodontal care is not just about treating the gums – but it’s also about supporting whole-body health, and to treat the mouth as the gateway to systemic wellbeing.
References
- Marruganti, C., Suvan, J. E., & D’Aiuto, F. (2023). Periodontitis and metabolic diseases (diabetes and obesity): Tackling multimorbidity. Periodontology 2000, 10.1111/prd.12536. Advance online publication. https://doi.org/10.1111/prd.12536
- Marruganti, C., Gaeta, C., Romandini, M., Ferrari Cagidiaco, E., Parrini, S., Discepoli, N., & Grandini, S. (2024). Multiplicative effect of stress and poor sleep quality on periodontitis: A university-based cross-sectional study. Journal of periodontology, 95(2), 125–134. https://doi.org/10.1002/JPER.23-0209
- Marruganti, C., Romandini, M., Gaeta, C., Cagidiaco, E. F., Discepoli, N., Parrini, S., Graziani, F., & Grandini, S. (2023). Healthy lifestyles are associated with a better response to periodontal therapy: A prospective cohort study. Journal of clinical periodontology, 50(8), 1089–1100. https://doi.org/10.1111/jcpe.13813
- Marruganti, C., Baima, G., Grandini, S., Graziani, F., Aimetti, M., Sanz, M., & Romandini, M. (2023). Leisure-time and occupational physical activity demonstrate divergent associations with periodontitis: A population-based study. Journal of clinical periodontology, 50(5), 559–570. https://doi.org/10.1111/jcpe.13766
- Marruganti, C., Traversi, J., Gaeta, C., Ferrari Cagidiaco, E., Parrini, S., Discepoli, N., & Grandini, S. (2022). Adherence to Mediterranean diet, physical activity level, and severity of periodontitis: Results from a university-based cross-sectional study. Journal of periodontology, 93(8), 1218–1232. https://doi.org/10.1002/JPER.21-0643.
