Periodontal disease and systemic amyloidosis: From inflammation to amyloidosis — a troubling connection

It has become increasingly clear in recent years that periodontal disease can cause dramatic increases in the levels of markers of systemic inflam - mation and can also result in reductions in the levels of these markers. It is also known that amyloid fibril deposits derived from circulating acute-phase reactant serum amyloid A (SAA) lead to systemic AA amyloidosis. However, in up to approx- imately 12% of cases of AA amyloidosis no underlying etiology can be identified. Periodontal evaluations are not normally performed as a part of the medical as- sessment of patients with AA amyloidosis. Hence, destructive periodontal diseases may be an overlooked source of inflam - mation in these patients. Periodontal diseases have not been investigated in systemic AA amyloidosis with unknown etiology. Our hypothesis is that periodon- titis may be an important occult source of chronic inflammation that increases the levels of acute-phase reactants, which, in turn, might affect or cause the develop- ment of systemic AA amyloidosis. INTRODUCTION Periodontal diseases are moving into the focus of systemic diseases. Periodontitis is a chronic and occult infection. Our hypothesis is that periodontitis should be considered as a possible etiological factor along with the traditional factors for systemic AA