Which systemic conditions should I consider when evaluating a patient with severe periodontitis?

When evaluating a patient presenting with severe periodontitis, several systemic conditions should be considered due to their known associations with periodontal disease. Diabetes mellitus (both type 1 and type 2) is a key systemic condition that significantly influences the severity and progression of periodontitis, as poor glycaemic control exacerbates periodontal inflammation and tissue destruction NICE CG153[Chi et al. 2010]. Psoriasis is another systemic inflammatory condition linked with periodontitis, where immune dysregulation may contribute to periodontal tissue breakdown NICE CG153[Chi et al. 2010]. Additionally, viral infections such as COVID-19 have been recently implicated in worsening periodontal status, possibly through systemic inflammatory pathways and immune modulation Tamimi et al. 2022. Other systemic diseases that may manifest with or exacerbate periodontitis include immunodeficiency states, haematological disorders, and other chronic inflammatory conditions, which should be considered during assessment Chi et al. 2010.

Therefore, a comprehensive evaluation of severe periodontitis should include screening for diabetes, assessment of inflammatory systemic diseases like psoriasis, and consideration of recent or ongoing viral infections such as COVID-19. This integrated approach aligns with UK clinical guidelines emphasizing the importance of systemic health in oral disease management and is supported by emerging literature highlighting the bidirectional relationship between systemic conditions and periodontitis NICE CG153[Chi et al. 2010; Tamimi et al. 2022].