{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:44:01Z","timestamp":1789609441380,"version":"build-2803163510"},"reference-count":287,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:00:00Z","timestamp":1782518400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:00:00Z","timestamp":1782518400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Periodontal Research"],"abstract":"ABSTRACT<\/jats:title>\n \n Poor oral hygiene and periodontitis influence lung diseases such as pneumonia, chronic obstructive pulmonary disease (COPD), COVID\u201019, and asthma. The normal lung is not sterile, with a distinct microbial ecosystem that is spatially varied along the respiratory tract. The biogeography of the lung microbiome is balanced between microbial microaspiration from the oral\u2010pharynx and clearance. The mouth is an important reservoir for respiratory pathogens including\n \n Streptococcus pneumoniae<\/jats:italic>\n <\/jats:styled-content>\n ,\n \n Haemophilus influenzae<\/jats:italic>\n <\/jats:styled-content>\n ,\n \n Pseudomonas aeruginosa<\/jats:italic>\n <\/jats:styled-content>\n , and\n \n Staphylococcus aureus<\/jats:styled-content>\n ,\n <\/jats:italic>\n as well as oral microbes (\n Porphyromonas<\/jats:italic>\n ,\n Prevotella<\/jats:italic>\n ,\n Fusobacterium,<\/jats:italic>\n etc.). Poor oral hygiene and periodontitis increase the bacterial load that can be aspirated, and the host produces pro\u2010inflammatory components that enhance microbial virulence and compromize epithelial integrity. Both poor oral hygiene and periodontitis have been associated with pneumonia, particularly in hospitals and nursing home settings. Periodontitis may also facilitate viral pneumonia (including COVID\u201019) by altering receptor expression and immune function. Periodontitis correlates with COPD severity and exacerbation frequency through pathways involving matrix metalloproteinases and cytokines. Periodontitis also is associated with asthma and acute exacerbations. Inflammation shapes the lung microbiome by impacting microbial nutrient availability through vascular leakage, inducing changes to epithelial cells which facilitate bacterial adherence, and inducing the production of cytokines, leading to mucus overproduction, inhibition of phagocytosis, and enhancement of microbial pathogen virulence. Multiple biological pathways have been examined in\u00a0vitro that suggest how \u201cthe oral\u2010lung axis\u201d influences pneumonia, COPD, and asthma. Periodontal treatment and effective oral hygiene should be well integrated into medical care to prevent and manage respiratory diseases.\n <\/jats:p>","DOI":"10.1111\/jre.70126","type":"journal-article","created":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T17:59:22Z","timestamp":1782583162000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Oral Health, Periodontitis, and Respiratory Diseases: Biological Pathways"],"prefix":"10.1111","author":[{"given":"Raluca P.","family":"Vacaru","sequence":"first","affiliation":[{"name":"Department of Embryology and Microbiology, Faculty of Dentistry Carol Davila University of Medicine and Pharmacy Bucharest Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea C.","family":"Didilescu","sequence":"additional","affiliation":[{"name":"Department of Embryology and Microbiology, Faculty of Dentistry Carol Davila University of Medicine and Pharmacy Bucharest Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8804-6593","authenticated-orcid":false,"given":"Frank A.","family":"Scannapieco","sequence":"additional","affiliation":[{"name":"Department of Oral Biology University at Buffalo Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,27]]},"reference":[{"issue":"1","key":"e_1_2_18_2_1","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1111\/prd.12621","article-title":"Relationship Between Periodontitis and Systemic Diseases: A Bibliometric and Visual Study","volume":"98","author":"Isola G.","year":"2025","journal-title":"Periodontology 2000"},{"key":"e_1_2_18_3_1","first-page":"1184","volume-title":"Harrison's Principles of Internal Medicine","author":"Levison M. 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