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This high magnification of a dentinal tubule inside a tooth hows filamentous bacteria invading the tubules. (Adriaens et al., (1988). J. Clin. Periodontol. 59:493-503, Ultrastructural Observations on Bacterial Invasion in Cementum and Radicular Dentin of Periodontally Diseased Human Teeth)

Bacteria such as Prevotella intermedia, Porphyromonas gingivalis, Fusobacterium nucleatum, Bacteroides forsythus, Peptostreptococcus micros and Streptococcus intermedius have been indentified in the inner portion of teeth (dentine). Where the enamel coating or coverage of a tooth has been destroyed (ieg. due to breakage, grinding or decayl) the open dentin could act as bacterial reservoir from which periodontal pathogens can recolonize treated periodontal pockets. This might well be the reason that periodntal therapy fails and the disease recurrs.

These bacteria can even invade the outer surface of the tooth root where it connects to the bone (know as the cementum). In fact, 59% of the diseased teeth that were tested in a particular study harboured the same bacteria in the nerve of the tooth as those that were found in the infected bone on the outside of the tooth, around the roots.

These structures are likely to serve as bacterial reservoirs from which bacterial recolonization can occur.

But not only is reinfection of the periodontal area a possibility, but microbial factors such as bacterial components, toxins products by bacteria, enzymes, and harmful metabolic by-products can spread from these areas of infection to other sites in the mouth and cause problems. This spread of the bacteria and their toxins pose a potential risk to the systemic health of the individual. Overall, 28 of the 36 studies done on the role of periodontitis and cardiovascular disease (CVD) show that periodontitis is an independent risk factor for cardio-vascular disease-related events such as a myocardial infardtion (heart attack) or a stroke. This is independent of other known risk factors such as diabetes, hypertension, BMI, smoking, age, cholestrol, etc., the degree of risk being higher for a stroke than for a heart attack. The more teeth that are affected by periodontal disease, the higher the risk.

Periodontal infection may lead to low-level bacteremia (bacetria in the blood). This can result in altered coagulability, platelet function and endothelial/vessel wall integrity. Oral or periodontal bacetria have even been found in carotid atheromas.

Even chewing with teeth that have periodontitis may induce the systemic spread of the bacerial endotoxin.