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Vol. 3 No. 1 (2026)

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November 10, 2026
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November 9, 2026

Copyright (c) 2026 Afnan Nasser Alhadili, Muna Mubarak Aldafiry, Shatha Ahmed Marwaye Namazi, Mohammed Ayel Mohammed Moayede, Wafa Mohammed Nour Samkari, Yahya Hassan Owaidi Al-Hadry, Ali Mohammed Salem Assiri, Hussam Al-Deen Abdu Ahmad Sharahili, Nehad Abdoh Ahmed Sharahili, Fawaz Ibrahim Qasim Muyidi

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This work is licensed under a Creative Commons Attribution 4.0 International License.

The Oral–Systemic Inflammation Axis: Integrating Dental Assisting, Hematological Biomarkers, Laboratory Diagnostics, Pharmacological Interventions, and Physical Rehabilitation

https://doi.org/10.64483/202631825
Afnan Nasser Alhadili
Dental Clinic Complex in South Riyadh, Ministry of health, Saudi Arabia
Muna Mubarak Aldafiry
Long-term Care, Ministry of Health (Civil Service), Saudi Arabia
Shatha Ahmed Marwaye Namazi
King Saud Medical City (KSMC), Ministry of health, Saudi Arabia
Mohammed Ayel Mohammed Moayede
TB center in Jazan, Ministry of Health, Saudi Arabia
Wafa Mohammed Nour Samkari
King Fahad General Hospital, Jeddah, Ministry of Health, Saudi Arabia
Yahya Hassan Owaidi Al-Hadry
General Directorate of Prison Health Services, Jazan Prison Health Center, Medical Services of the Ministry of Interior, Saudi Arabia
Ali Mohammed Salem Assiri
Muhayel General Hospital, Muhayel Asir City, Ministry of Health, Saudi Arabia
Hussam Al-Deen Abdu Ahmad Sharahili
King Fahd Central Hospital, Jazan – Ministry of Health, Saudi Arabia
Nehad Abdoh Ahmed Sharahili
Erada and Mental Health Hospital, Jazan – Ministry of Health, Saudi Arabia
Fawaz Ibrahim Qasim Muyidi
Jazan – Al-Harth General Hospital – Ministry of Health – Jazan Health Cluster, Saudi Arabia

Corresponding Author(s) : Afnan Nasser Alhadili

afnannasser12@gmail.com

Saudi Journal of Medicine and Public Health, Vol. 3 No. 1 (2026)

Abstract

Periodontitis and related oral infections are increasingly recognized as modifiable contributors to systemic inflammation, with consequences for cardiometabolic, respiratory, and immune health. This narrative review synthesizes literature published between 2017 and 2025 on the oral–systemic inflammation axis and integrates the contributions of seven health disciplines: laboratory medicine, dental assisting, nursing, medical genetics, pharmacy, hematology, and physical therapy. Mechanistic evidence indicates that dysbiotic biofilms, neutrophil and monocyte dysregulation, oxidative stress, and cytokine spillover link oral inflammation with systemic disease. Biomarkers such as C-reactive protein, interleukin-6, and blood-cell ratios offer accessible monitoring tools, while genetic variation modulates susceptibility. Mechanical biofilm control, rational antimicrobial and anti-inflammatory prescribing, nursing surveillance, and structured exercise each demonstrate measurable effects on inflammatory burden. We propose an integrated interprofessional framework, identify evidence gaps, and outline priorities for standardized biomarker panels and collaborative care pathways.

Keywords

oral–systemic axis; periodontitis; inflammatory biomarkers; interprofessional care; exercise
Alhadili, A. N., Aldafiry, M. M., Namazi, S. A. M., Moayede, M. A. M., Samkari, W. M. N., Al-Hadry, Y. H. O., … Muyidi, F. I. Q. (2026). The Oral–Systemic Inflammation Axis: Integrating Dental Assisting, Hematological Biomarkers, Laboratory Diagnostics, Pharmacological Interventions, and Physical Rehabilitation. Saudi Journal of Medicine and Public Health, 3(1), 325–336. https://doi.org/10.64483/202631825
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References
  1. 1. Botelho, J., Machado, V., Hussain, S. B., Zehra, S. A., Proenca, L., Orlandi, M., ... & D'Aiuto, F. (2021). Periodontitis and circulating blood cell profiles: a systematic review and meta-analysis. Experimental Hematology, 93, 1-13.
  2. 2. Bui, F. Q., Almeida-da-Silva, C. L. C., Huynh, B., Trinh, A., Liu, J., Woodward, J., ... & Ojcius, D. M. (2019). Association between periodontal pathogens and systemic disease. Biomedical journal, 42(1), 27-35.
  3. 3. Chapple, I. L., Mealey, B. L., Van Dyke, T. E., Bartold, P. M., Dommisch, H., Eickholz, P., ... & Yoshie, H. (2018). Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. Journal of periodontology, 89, S74-S84.
  4. 4. D'Aiuto, F., Gkranias, N., Bhowruth, D., Khan, T., Orlandi, M., Suvan, J., ... & Mellor, T. (2018). Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial. The lancet Diabetes & endocrinology, 6(12), 954-965.
  5. 5. Docherty, S., Harley, R., McAuley, J. J., Crowe, L. A., Pedret, C., Kirwan, P. D., ... & Millar, N. L. (2022). The effect of exercise on cytokines: implications for musculoskeletal health: a narrative review. BMC Sports Science, Medicine and Rehabilitation, 14(1), 5.
  6. 6. Ferreira, R. D. O., Correa, M. G., Magno, M. B., Almeida, A. P. C. P. S. C., Fagundes, N. C. F., Rosing, C. K., ... & Lima, R. R. (2019). Physical activity reduces the prevalence of periodontal disease: systematic review and meta-analysis. Frontiers in physiology, 10, 234.
  7. 7. Fest, J., Ruiter, R., Ikram, M. A., Voortman, T., Van Eijck, C. H., & Stricker, B. H. (2018). Reference values for white blood-cell-based inflammatory markers in the Rotterdam Study: a population-based prospective cohort study. Scientific reports, 8(1), 10566.
  8. 8. Figuero, E., Roldan, S., Serrano, J., Escribano, M., Martin, C., & Preshaw, P. M. (2020). Efficacy of adjunctive therapies in patients with gingival inflammation: A systematic review and meta‐analysis. Journal of Clinical Periodontology, 47, 125-143.
  9. 9. Furman, D., Campisi, J., Verdin, E., Carrera-Bastos, P., Targ, S., Franceschi, C., ... & Slavich, G. M. (2019). Chronic inflammation in the etiology of disease across the life span. Nature medicine, 25(12), 1822-1832.
  10. 10. Hajishengallis, G. (2022). Interconnection of periodontal disease and comorbidities: Evidence, mechanisms, and implications. Periodontology 2000, 89(1), 9-18.
  11. 11. Hajishengallis, G., & Chavakis, T. (2021). Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities. Nature Reviews Immunology, 21(7), 426-440.
  12. 12. Hajishengallis, G., Chavakis, T., & Lambris, J. D. (2020). Current understanding of periodontal disease pathogenesis and targets for host‐modulation therapy. Periodontology 2000, 84(1), 14-34.
  13. 13. Herrera, D., Matesanz, P., Martín, C., Oud, V., Feres, M., & Teughels, W. (2020). Adjunctive effect of locally delivered antimicrobials in periodontitis therapy: A systematic review and meta‐analysis. Journal of Clinical Periodontology, 47, 239-256.
  14. 14. Herrera, D., Sanz, M., Shapira, L., Brotons, C., Chapple, I., Frese, T., ... & Vinker, S. (2023). Association between periodontal diseases and cardiovascular diseases, diabetes and respiratory diseases: Consensus report of the Joint Workshop by the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe). Journal of Clinical Periodontology, 50(6), 819-841.
  15. 15. Jaiswal, S., Natarajan, P., Silver, A. J., Gibson, C. J., Bick, A. G., Shvartz, E., ... & Ebert, B. L. (2017). Clonal hematopoiesis and risk of atherosclerotic cardiovascular disease. New England Journal of Medicine, 377(2), 111-121.
  16. 16. Jaiswal, S., & Ebert, B. L. (2019). Clonal hematopoiesis in human aging and disease. Science, 366(6465), eaan4673.
  17. 17. Jepsen, S., Caton, J. G., Albandar, J. M., Bissada, N. F., Bouchard, P., Cortellini, P., ... & Yamazaki, K. (2018). Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. Journal of clinical periodontology, 45, S219-S229.
  18. 18. Kc, S., Wang, X. Z., & Gallagher, J. E. (2020). Diagnostic sensitivity and specificity of host‐derived salivary biomarkers in periodontal disease amongst adults: systematic review. Journal of clinical periodontology, 47(3), 289-308.
  19. 19. Khalafi, M., & Symonds, M. E. (2020). The impact of high‐intensity interval training on inflammatory markers in metabolic disorders: A meta‐analysis. Scandinavian journal of medicine & science in sports, 30(11), 2020-2036.
  20. 20. Kinane, D. F., Stathopoulou, P. G., & Papapanou, P. N. (2017). Periodontal diseases. Nature reviews Disease primers, 3(1), 17038.
  21. 21. Lertpimonchai, A., Rattanasiri, S., Arj‐Ong Vallibhakara, S., Attia, J., & Thakkinstian, A. (2017). The association between oral hygiene and periodontitis: a systematic review and meta‐analysis. International dental journal, 67(6), 332-343.
  22. 22. Libby, P. (2021). The changing landscape of atherosclerosis. Nature, 592(7855), 524-533.
  23. 23. Loos, B. G., & Van Dyke, T. E. (2020). The role of inflammation and genetics in periodontal disease. Periodontology 2000, 83(1), 26-39.
  24. 24. Martínez-García, M., & Hernández-Lemus, E. (2021). Periodontal inflammation and systemic diseases: an overview. Frontiers in physiology, 12, 709438.
  25. 25. Munz, M., Richter, G. M., Loos, B. G., Jepsen, S., Divaris, K., Offenbacher, S., ... & Schaefer, A. S. (2019). Meta-analysis of genome-wide association studies of aggressive and chronic periodontitis identifies two novel risk loci. European Journal of Human Genetics, 27(1), 102-113.
  26. 26. Nidorf, S. M., Fiolet, A. T., Mosterd, A., Eikelboom, J. W., Schut, A., Opstal, T. S., ... & Thompson, P. L. (2020). Colchicine in patients with chronic coronary disease. New England journal of medicine, 383(19), 1838-1847.
  27. 27. Nieman, D. C., & Wentz, L. M. (2019). The compelling link between physical activity and the body's defense system. Journal of sport and health science, 8(3), 201-217.
  28. 28. Ridker, P. M., Everett, B. M., Thuren, T., MacFadyen, J. G., Chang, W. H., Ballantyne, C., ... & Glynn, R. J. (2017). Antiinflammatory therapy with canakinumab for atherosclerotic disease. New England journal of medicine, 377(12), 1119-1131.
  29. 29. Sälzer, S., Graetz, C., Dörfer, C. E., Slot, D. E., & Van der Weijden, F. A. (2020). Contemporary practices for mechanical oral hygiene to prevent periodontal disease. Periodontology 2000, 84(1), 35-44.
  30. 30. Sanz, M., Marco del Castillo, A., Jepsen, S., Gonzalez‐Juanatey, J. R., D’Aiuto, F., Bouchard, P., ... & Wimmer, G. (2020). Periodontitis and cardiovascular diseases: Consensus report. Journal of clinical periodontology, 47(3), 268-288.
  31. 31. Sanz, M., Herrera, D., Kebschull, M., Chapple, I., Jepsen, S., Berglundh, T., ... & Wennström, J. (2020). Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline. Journal of clinical periodontology, 47, 4-60.
  32. 32. Schenkein, H. A., Papapanou, P. N., Genco, R., & Sanz, M. (2020). Mechanisms underlying the association between periodontitis and atherosclerotic disease. Periodontology 2000, 83(1), 90-106.
  33. 33. Sczepanik, F. S. C., Grossi, M. L., Casati, M., Goldberg, M., Glogauer, M., Fine, N., & Tenenbaum, H. C. (2020). Periodontitis is an inflammatory disease of oxidative stress: We should treat it that way. Periodontology 2000, 84(1), 45-68.
  34. 34. Shungin, D., Haworth, S., Divaris, K., Agler, C. S., Kamatani, Y., Keun Lee, M., ... & Johansson, I. (2019). Genome-wide analysis of dental caries and periodontitis combining clinical and self-reported data. Nature communications, 10(1), 2773.
  35. 35. Sies, H., Berndt, C., & Jones, D. P. (2017). Oxidative stress. Annual review of biochemistry, 86, 715-748.
  36. 36. Tardif, J. C., Kouz, S., Waters, D. D., Bertrand, O. F., Diaz, R., Maggioni, A. P., ... & Roubille, F. (2019). Efficacy and safety of low-dose colchicine after myocardial infarction. New England journal of medicine, 381(26), 2497-2505.
  37. 37. Teughels, W., Feres, M., Oud, V., Martín, C., Matesanz, P., & Herrera, D. (2020). Adjunctive effect of systemic antimicrobials in periodontitis therapy: a systematic review and meta‐analysis. Journal of clinical periodontology, 47, 257-281.
  38. 38. Tonetti, M. S., Greenwell, H., & Kornman, K. S. (2018). Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Journal of periodontology, 89, S159-S172.
  39. 39. Wang, Y., Andrukhov, O., & Rausch-Fan, X. (2017). Oxidative stress and antioxidant system in periodontitis. Frontiers in physiology, 8, 910.
  40. 40. Worthington, H. V., MacDonald, L., Pericic, T. P., Sambunjak, D., Johnson, T. M., Imai, P., & Clarkson, J. E. (2019). Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. The Cochrane database of systematic reviews, 2019(4), CD012018.
  41. 41. Zahorec, R. (2021). Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratislava Medical Journal, 122(7), 474-488.
  42. 42. Zhang, Q., Li, C., Worthington, H. V., & Hua, F. (2020). Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia. Cochrane Database of Systematic Reviews, (12).
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