Periodontal triggers of systemic disease: We are closer to causation than ever before

A peer-reviewed article written by Eric S. Bornstein, DMD


The first dental textbook pointing to oral bacterial colonies as the driving force behind systemic disease appeared in 1890.1 In this seminal text more than 130 years ago, Willoughby Dayton Miller wrote the following: “It has been established beyond all question that myriads of micro-organisms are constantly present in the human mouth, and that these, under favorable circumstances, are capable of manifesting an action of the utmost significance upon the local as well as the general health of the patient.”

Miller continued, “These various disturbances are produced partly by the direct action of the micro-organisms and their products upon the teeth and the mucous membrane of the mouth, partly by constant swallowing of large masses of bacteria, partly by carrying them into the lungs, particularly by violent inspiration, and, finally by their obtaining an entrance into the blood or lymph-vessels in the various ways described…”1

A critical look at the historical and contemporary data connecting periodontal disease to systemic disease proves Miller’s writings to be nothing short of visionary at the very dawn of dental bacteriology. This review will link these data and trace the last 160 years of medical discovery in the peer-reviewed literature. It will also suggest modern diagnostic procedures to assist dentists in showing patients, with their own objective personal data, the long-term systemic health benefits of treating periodontal disease in the dental office.

Educational objectives

  1. List the common risk factors for periodontal disease
  2. Discuss the role of inflammation and infection in periodontal disease
  3. Describe the relationship between periodontal disease and conditions, including diabetes, heart disease, and autoimmune disorders
  4. Outline how the information in this course can be used to improve patient care outcomes

Photo credit: 107499736 © Dmitry Kotin |

Quick Access Code: 2113

Not Enrolled

Course Includes

  • 1 Lesson
  • 1 Test
  • Course Certificate
  • CE credit(s): 3

    Course Type: Written

    Published Date: February 2023

    This continuing education (CE) activity was developed by Endeavor Business Media with no commercial support.

    This course was written for dentists, dental hygienists, and dental assistants, from novice to skilled.

    Educational methods: This course is a self-instructional journal and web activity.

    Provider disclosure: Endeavor Business Media neither has a leadership position nor a commercial interest in any products or services discussed or shared in this educational activity. No manufacturer or third party had any input in the development of the course content.

    Requirements for successful completion: To obtain 3 CE credits for this educational activity, you must pay the required fee, review the material, complete the course evaluation, and obtain an exam score of 70% or higher.

    CE planner disclosure: Laura Winfield, Endeavor Business Media dental group CE coordinator, neither has a leadership nor commercial interest with the products or services discussed in this educational activity. Ms. Winfield can be reached at

    Educational disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise.

    Image authenticity statement: The images in this educational activity have not been altered.

    Scientific integrity statement: Information shared in this CE course is developed from clinical research and represents the most current information available from evidence-based dentistry.

    Known benefits and limitations of the data: The information presented in this educational activity is derived from the data and information contained in the reference section.

    Registration: The cost of this CE course is $39.00 for 3 CE credits.

    Cancellation and refund policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting Endeavor Business Media in writing.

    Provider information:

    Dental Board of California: Provider RP5933. Course registration number CA code: 03-5933-22113. Expires November 2025. “This course meets the Dental Board of California’s requirements for 3 units of continuing education.”


    Endeavor Business Media is a nationally approved PACE program provider for FAGD/MAGD credit.
    Approval does not imply acceptance by any regulatory authority or AGD endorsement.
    11/1/2022 to 10/31/2024.
    Provider ID# 320452
    AGD code: 490


    Endeavor Business Media is designated as an approved Provider by the American Academy of Dental Hygiene, Inc. #AADHPNW (January 1, 2022–December 31, 2024). Approval does not imply acceptance by a state or provincial Board of Dentistry. Licensee should maintain this document in the event of an audit. AADH code:


    Endeavor Business Media is an ADA CERP–recognized provider.

    ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of dental continuing education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

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