This course will provide an overview of cannabis use and its association with periodontitis. The pathogenesis and variations in disease mechanisms between users and non-users will be discussed. The course will also review the role of cannabinoids not only as therapeutic agents but also disease exacerbators.

Oral health and overall health are frequently misperceived as distinct domains. Periodontitis (PD), a prevalent infectious inflammatory disease globally, is associated with various systemic conditions, including diabetes, cardiovascular diseases, neurodegenerative diseases, and rheumatoid arthritis. Although the specific mechanisms linking PD to these systemic diseases remain uncertain, common underlying factors exist. Rheumatoid arthritis (RA) and PD are both chronic inflammatory conditions, albeit impacting different anatomical sites (joints and oral tissues). There is emerging evidence suggesting a bidirectional relationship between these conditions. Recent research indicates that inflammation and microorganisms at mucosal sites, such as the oral mucosa, gut, and lungs, may trigger autoimmunity and the development of joint disease in susceptible individuals. Individuals with RA exhibit a higher prevalence of PD compared to those without RA, and the severity of periodontal disease tends to be exacerbated in individuals with RA.

This session will delve into recent developments in our comprehension of the interconnection between RA and periodontitis, providing fresh insights into the molecular mechanisms through which PD contributes to and is impacted by RA. It will offer a comprehensive review of the scientific evidence linking RA and PD, highlighting shared pathogenic mechanisms. Additionally, it will explore how insights into this association can inform prevention and treatment strategies for both conditions. Specifically, antibodies to citrullinated antigens and immune-mediated destruction of synovial joints are the hallmarks of rheumatoid arthritis (RA). Understanding why citrullinated proteins become immunogenic in this disease is believed to inform the origins of autoimmunity in RA. Because citrullination is a physiologic post-translational modification, one theory is that conditions promoting abnormal citrullination are initiators of self-reactive immune responses to citrullinated proteins in RA. Periodontal disease is common in RA, and periodontal pathogens have been implicated as potential disease triggers by inducing citrullinated antigens. When we explore this link using the lens of the ever-present oral microbiome, we discover a circular relationship between the two diseases, highlighting the importance of periodontal care in RA management pathways and emphasizing the need for closer working relationships between rheumatologists and oral healthcare professionals. In addition, the circular model of RA pathogenesis includes the host response. Exploring another side of the host response will be focused on neutrophil extracellular traps and a series of studies will be presented that make the case for post-translational modifications of proteins within periodontal tissues derived from NET formation, as one potential trigger for the break in immune tolerance that generates autoimmunity in RA.

The topic for the second annual Robert J. Genco Perio-Systemic Symposium is the relationship between periodontitis and cardiovascular diseases. Dr. Genco was a pioneer in this area of investigation identifying and characterizing early on the epidemiologic link between these diseases. Recent advances in cardiology have identified inflammation as an important component in the pathogenesis of cardiovascular diseases. In parallel, the role on inflammation in the pathogenesis of periodontitis has been well characterized in recent years. The goal of this symposium is to bring leaders in the field of cardiology who were instrumental in demonstrating the inflammatory link to cardiovascular diseases to the podium along with an expert in periodontal disease pathogenesis and its link to systemic disease to provide the latest data and concepts to members of the Academy.  The subject matter will span from the bench to the clinic to bring valuable knowledge of this important area to the practicing periodontist.

There is mounting evidence regarding the bi-directional link between periodontal disease and Alzheimer's Disease. Within the Alzheimer’s Disease research field there is a growing consensus for the need to identify upstream causation events prior to the irreversible pathological changes in the brain. Among the putative mediators are the potential role of translocation to the brain of periodontitis-associated pathogens, such as Porphyromonas gingivalis, and their products. The basic clinical criteria for Alzheimer’s Disease as well as other common neurodegenerative disorders will be highlighted in this perio-systemic program. The program presentations will cover the current and future therapeutic landscapes and practical adjustments for periodontists when treating individuals with memory and other cognitive disorders.

Since the first proof of COVID-19 viral carriage in saliva was established in a small patient population, the potential intricate roles of saliva in transmission, pathogenicity, and severity of the infection are being actively studied. The viral load in the oral cavity has been correlated with clinical symptoms including taste alterations have been demonstrated. Our group is focused on identifying the molecular mechanisms behind these clinical correlations in the oral environment of patients with COVID-19.