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World J Clin Cases. Jan 26, 2023; 11(3): 545-555
Published online Jan 26, 2023. doi: 10.12998/wjcc.v11.i3.545
Could there be an interplay between periodontal changes and pancreatic malignancies?
Bogdan Silviu Ungureanu, Dorin Nicolae Gheorghe, Flavia Mirela Nicolae, Sandu Râmboiu, Petru Adrian Radu, Valeriu Marin Șurlin, Victor Dan Eugen Strâmbu, Dan Ionut Gheonea, Alexandra Roman, Petra Șurlin
Bogdan Silviu Ungureanu, Dan Ionut Gheonea, Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
Dorin Nicolae Gheorghe, Flavia Mirela Nicolae, Petra Șurlin, Department of Periodontology, Research Center of Periodontal-Systemic Implications, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
Sandu Râmboiu, Valeriu Marin Șurlin, Department 1st of Surgery, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
Petru Adrian Radu, Victor Dan Eugen Strâmbu, Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, Bucharest 020021, Romania
Alexandra Roman, Department of Periodontology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania
Author contributions: Șurlin P, Șurlin VM, Gheonea DI contributed to conceiving the study; Nicolae FM, Ungureanu BS, Râmboiu S contributed to the investigation; Strâmbu VDE, Gheonea DI, Roman A contributed to the supervision; Nicolae FM, Gheorghe DN, Șurlin P wrote the original draft; Nicolae FM, Ungureanu BS, Radu PA, Șurlin P edited the original draft; All authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Flavia Mirela Nicolae, MD, Doctor, Researcher, Department of Periodontology, Research Center of Periodontal-Systemic Implications, University of Medicine and Pharmacy of Craiova, Str. Petru Rareș, nr. 2, Craiova 200349, Romania. flavia.nicolae23@yahoo.com
Received: November 18, 2022
Peer-review started: November 18, 2022
First decision: December 10, 2022
Revised: December 19, 2022
Accepted: January 10, 2023
Article in press: January 10, 2023
Published online: January 26, 2023
Processing time: 68 Days and 21.6 Hours
Abstract

The term "periodontal disease" refers to a group of chronic inflammatory illnesses caused by specific microorganisms from subgingival biofilm, that affect the tooth-supporting tissues. Recent research has also shown that periodontal infection plays a role in aggravating systemic disease states at distal sites, reinforcing the significance of the oral cavity for general health. Additionally, it has been suggested that gastroenterological malignancies may be promoted by hematogenous, enteral or lymphatic translocation of periopathogens. In the past 25 years, the global burden of pancreatic cancer (PC) has more than doubled, making it one of the major causes of cancer-related mortality. Periodontitis has been linked to at least 50% increased risk of PC and it could be considered a risk factor for this malignancy. A recent study performed on 59000 African American women with a follow up of 21 years showed that participants who had poor dental health had higher chances of PC. The findings, according to researchers, might be related to the inflammation that some oral bacteria trigger. Regarding the mortality of PC, periodontitis considerably raises the chance of dying from PC. Microbiome alterations in the gut, oral cavity and pancreatic tissues of PC patients occur when compared to healthy flora, demonstrating a link between PC and microecology. Inflammation may also contribute to PC development, although the underlying pathway is not yet known. The function of the microbiome in PC risk has drawn more focus over the last decade. Future risk of PC has been linked to the oral microbiome, specifically increased levels of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans and decreased relative abundance of Leptotrichia and Fusobacteria, suggesting that it may have an impact on the inflammatory condition by expanding, altering, and regulating the commensal microbiome. Patients who received periodontal treatment had significantly decreased incidence rate ratios for PC. By analyzing patterns in the microbiome composition throughout PC development and establishing strategies to enhance the cancer-associated microbial system, we can increase the efficacy of therapy and eventually find an application for the microbial system. The development of immunogenomics and gut micro-genomics in the life sciences will result in a significant advancement in our understanding of how microbial systems and immunotherapy interact, and it may also have intriguing therapeutic implications for extending the lifetime of PC patients.

Keywords: Periodontal disease; Pancreatic cancer; Microbiome; Periodontitis; Periopathogens; Periodontal medicine

Core Tip: It has been suggested that gastroenterological malignancies may be promoted by hematogenous, enteral or lymphatic translocation of periopathogens. Periodontitis has been linked to at least 50% increased risk of pancreatic cancer (PC) and it could be considered a risk factor for this malignancy. Future risk of PC has been linked to the oral microbiome, specifically increased levels of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans and decreased relative abundance of Leptotrichia and Fusobacteria. By analyzing patterns in the microbiome composition throughout PC development and establishing strategies to enhance the cancer-associated microbial system, we can increase the efficacy of therapy.