Systemic inflammation at the oral-ocular interface: a 3P medicine perspective on the relationship between periodontitis and eye diseases.

Abstract

Rationale and purpose: Periodontitis is a common source of chronic systemic inflammation, driven by bacterial translocation and cytokine release through ulcerated gingival epithelium, and may contribute to the development of various chronic ocular diseases. This study investigated the association between periodontitis and multiple ocular conditions, interpreting the findings within the framework of Predictive, Preventive, and Personalized Medicine (3PM).

Working hypothesis and methods: We hypothesized that periodontitis, as a treatable inflammatory condition, serves as a predictive marker and modifiable risk factor for ocular diseases involving vascular and immune-mediated mechanisms. Data from 11,448 adults aged ≥ 40 years from the Korea National Health and Nutrition Examination Survey (2008-2010) were analyzed. Periodontal status was classified using the Community Periodontal Index (CPI): no periodontitis (CPI ≤ 2), moderate (CPI = 3), and severe (CPI = 4). Ophthalmologists assessed ocular diseases, including cataract, pterygium, diabetic retinopathy, glaucoma suspect, blepharoptosis, and age-related macular degeneration (AMD), using standardized diagnostic protocols. Multivariable logistic regression adjusted for key covariates, and Pearson correlation analysis was conducted.

Results: Periodontitis was independently associated with higher risks of cataract (adjusted OR = 1.26), diabetic retinopathy (OR = 1.66), pterygium (OR = 1.22), glaucoma suspect (OR = 1.10), and blepharoptosis (OR = 1.16). These associations were more pronounced in individuals with severe periodontitis. No significant association was observed with early or late AMD. CPI scores showed weak but significant positive correlations with several ocular conditions, particularly cataract and diabetic retinopathy.

Conclusions and expert recommendations in the framework of 3pm: Periodontitis may serve as a predictive biomarker for ocular diseases with shared inflammatory and vascular pathways. Early identification and management of periodontal disease offer a targeted preventive strategy to reduce systemic inflammatory burden and ocular comorbidities. Personalized care models incorporating periodontal status into ocular screening protocols may improve diagnostic precision and enable risk-adapted interventions. These findings support the integration of oral health into multidisciplinary care frameworks, advancing the paradigm shift from reactive to predictive and personalized ophthalmology.