Malocclusion as a factor of systemic inflammation

Malocclusion and systemic consequences: a brief summary of the evidence

Malocclusion, or misaligned bite, is a widespread oral health issue associated with a range of diseases and conditions that can affect a patient’s overall health and quality of life. The presented evidence highlights the link between oral disorders associated with malocclusion and systemic diseases; this requires dentists to be attentive to potential systemic consequences during examination and treatment planning.

Key factors

• Oral bacteria have been detected in Alzheimer’s disease foci and atherosclerotic plaques, indicating the potential translocation of pathogens from the oral cavity into the systemic circulation and tissues.
• Periodontal disease has been consistently documented as a risk factor for cardiovascular pathology, stroke, and impaired glycemic control in patients with diabetes.
• Evidence has accumulated suggesting that the systemic dissemination of oral bacteria and their products (e.g., LPS) can initiate or sustain chronic systemic inflammation, contributing to polyetiological diseases.

Implications for dental practice

Clinical significance and screening

For the clinician—dentist, it is important to consider that the signs and symptoms of malocclusion often coexist with periodontal disorders, impaired hygiene, and increased colonization by pathogens. During history taking and examination, occlusal disorders, periodontal indices (PD, CAL, BOP), plaque index, and caries status should be documented.

Pathogenetic mechanisms – a brief explanation

The mechanisms linking oral infection to systemic conditions include the mobilization of bacteria and bacterial components into the bloodstream during periodontitis, the activation of a systemic inflammatory response (elevated CRP, cytokines), and local effects on the vascular wall at sites of atherosclerotic lesions. These processes are complex and multifactorial.

Management recommendations and interdisciplinary collaboration

• Include assessment of periodontal status and systemic disease risks in the overall dental examination plan.
• При наличии выраженного пародонтита и факторов риска (сердечно‑сосудистые заболевания, диабет, нейродегенеративные изменения) организовывать координацию с терапевтом, кардиологом, эндокринологом или неврологом для совместного управления рисками.
• Implement active periodontal therapy (SRP techniques, inflammation control, hygiene motivation), occlusal correction, and, if necessary, orthodontic/prosthetic treatment to restore functional homeostasis, which may reduce the inflammatory burden.
• Assess and optimize associated risk factors: tobacco use, glycemic control, dyslipidemia, etc.

Practical tips for dentists

Prevention and monitoring

Regular monitoring of periodontal parameters, educating patients on effective hygiene techniques, and planning early orthodontic or prosthetic correction for functional disorders can help reduce chronic inflammation in the oral cavity.

Documentation and patient awareness

Document the connection between identified oral issues and potential systemic risks, discuss with the patient the need for interdisciplinary follow-up and medical consultations in the presence of risk factors.

Expert commentary

Although associations between oral infections and systemic diseases are well-documented, causal relationships remain a subject of research. From a practical standpoint, clinicians should rely on evidence-based practices for screening and treating periodontal and occlusal disorders, consider oral treatment as part of comprehensive patient management, and establish communication with general practitioners and relevant specialists.