Led by Mevlut Yordanagil from the Department of Surgical Oncology at Kocaeli City Hospital, Turkey, and colleagues, the study aimed to explore whether periodontal disease could act as a predisposing factor for complications in patients with gallstones. Periodontitis, characterized by persistent inflammation of the gums and supporting structures of the teeth, has long been associated with low-grade systemic inflammation, which may contribute to various extraoral health issues.
The researchers conducted a prospective observational study involving 160 adult patients who were diagnosed with either acute calculous cholecystitis or symptomatic gallstones. Participants were categorized based on their periodontal status into “normal/mild” or “moderate/severe” periodontitis groups. In addition, the study measured inflammatory indices, including the lymphocyte-to-C-reactive protein ratio (LCR), neutrophil-to-lymphocyte ratio (NLR), derived NLR (d-NLR), and platelet-to-lymphocyte ratio (PLR), to assess the systemic inflammatory response and its potential association with gallbladder pathology.
The following were the key findings of the study:
- Moderate to severe periodontitis was far more common in patients with cholecystitis compared to those with uncomplicated gallstones (80% vs. 22.5%).
- Patients with cholecystitis showed lower LCR values and higher NLR, d-NLR, and PLR levels, reflecting increased systemic inflammation.
- Multivariate analysis identified periodontitis and all inflammatory markers as independent predictors of acute cholecystitis.
- Severe periodontitis was especially prevalent among individuals with active acute cholecystitis, suggesting that poor oral health may contribute to worsening gallbladder inflammation.
The study highlights the importance of considering periodontal status as part of the overall evaluation and management of patients with gallstones. By identifying periodontitis as a modifiable risk factor, healthcare providers may improve preventive strategies and potentially reduce the incidence of biliary complications. The authors suggest that routine dental assessment and management of chronic periodontal disease could complement traditional approaches to gallstone treatment, especially for individuals at higher risk of developing cholecystitis.
While the study establishes a strong association between periodontitis and acute cholecystitis, the authors note that further research is needed to fully elucidate the underlying mechanisms linking oral inflammation to gallbladder pathology. Nonetheless, these findings add to the growing evidence that oral health is intricately connected to systemic diseases and may influence outcomes beyond the oral cavity.
“Periodontitis appears to have a significant association with acute gallstone-related cholecystitis, likely driven by systemic inflammatory pathways,” the authors noted. They added that the findings underscore the importance of incorporating periodontal care into both preventive and therapeutic approaches for gallbladder disease, presenting a potential new avenue for improving patient outcomes.
Reference:
Yordanagil, M., Turgut, H.T., Tuzun, B. et al. Periodontitis as a potential predisposing factor for gallstone cholecystitis: exploring the role of chronic systemic inflammation. Surg Today (2025). https://doi.org/10.1007/s00595-025-03199-4
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