Oxidative Stress as an Etiopathogenic Factor in Periodontal Disease
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Periodontal disease is a chronic, multifactorial inflammatory condition characterized by the progressive destruction of the tooth-supporting tissues. In recent years, oxidative stress has been recognized as a relevant pathophysiological mechanism in its development and progression due to the imbalance between the production of reactive oxygen species and the body’s antioxidant mechanisms. Objective: To analyze the role of oxidative stress as an etiopathogenic factor in periodontal disease through a review of recent literature. Methodology: A narrative review of scientific articles published between 2020 and 2025 was conducted. The search was carried out in PubMed and Scopus databases, selecting relevant studies related to oxidative stress and periodontal disease. Results: The reviewed evidence indicates that oxidative stress plays an active role in the periodontal inflammatory response, promoting tissue destruction and bone resorption. Additionally, several studies report the presence of oxidative biomarkers associated with the severity of the disease. Conclusion: Oxidative stress plays a significant role in the pathogenesis of periodontal disease by contributing to the amplification of the inflammatory process and damage to periodontal tissues; therefore, its study represents an important area of research for future diagnostic and therapeutic strategies.
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1. Sczepanik FSC, Grossi ML, Casati M, Goldberg M, Glogauer M, Fine N, et al. Periodontitis is an inflammatory disease of oxidative stress: We should treat it that way. Periodontol 2000. 2020;84(1):45-68. https://doi.org/10.1111/prd.12342
2. Patil RT, Dhadse PV, Salian SS, Punse SD. Role of Oxidative Stress in Periodontal Diseases. Cureus. 2024;16(5):e60779. https://doi.org/10.7759/cureus.60779
3. Lv W, Hu S, Yang F, Lin D, Zou H, Zhang W, et al. Heme oxygenase-1: potential therapeutic targets for periodontitis. PeerJ. 2024;12:e18237. https://doi.org/10.7717/peerj.18237
4. Jia Y, Li Z, Huang P, Wang Y, Yang B. Mechanisms and therapeutic perspectives of mitochondrial dysfunction of macrophages in periodontitis. Front Cell Infect Microbiol. 2025;15:1634909. https://doi.org/10.3389/fcimb.2025.1634909
5. Jiang Q, Zhao Y, Shui Y, Zhou X, Cheng L, Ren B, et al. Interactions Between Neutrophils and Periodontal Pathogens in Late-Onset Periodontitis. Front Cell Infect Microbiol. 2021;11:627328. https://doi.org/10.3389/fcimb.2021.627328
6. Zhu R, Mi X, Li Y. Effects of Hypoxic Environment on Periodontal Tissue through the ROS / TXNIP / NLRP3 Inflammasome Pathway. Biomed Res Int. 2022;2022:35083332. https://doi.org/10.1155/2022/35083332
7. Zhao M, Xie Y, Gao W, Li C, Ye Q, Li Y. Diabetes mellitus promotes susceptibility to periodontitis—novel insight into the molecular mechanisms. Front Endocrinol (Lausanne). 2023;14:1192625. https://doi.org/10.3389/fendo.2023.1192625
8. Mirnic J, Djuric M, Brkic S, Gusic I, Stojilkovic M, Tadic A, et al. Pathogenic Mechanisms That May Link Periodontal Disease and Type 2 Diabetes Mellitus—The Role of Oxidative Stress. Int J Mol Sci. 2024;25(18):9806. https://doi.org/10.3390/ijms25189806
9. Papadakis KA, Doufexi AE, Kalamaki MS, Bourazanas E, Lymperaki E. The Role of Oxidative Stress in the Relationship Between Periodontitis and Alzheimer's Disease: A Review of the Literature. J Pers Med. 2025;15(1):40863446. https://doi.org/10.3390/jpm15010000
10. Mohideen K, Chandrasekaran K, Veeraraghavan H, Faizee SH, Dhungel S, Ghosh S. Meta-Analysis of Assessment of Total Oxidative Stress and Total Antioxidant Capacity in Patients with Periodontitis. Dis Markers. 2023;2023:9949047. https://doi.org/10.1155/2023/9949047
11. Zhao Z, Ming Y, Li X, Tan H, He X, Yang L, et al. Hyperglycemia Aggravates Periodontitis via Autophagy Impairment and ROS-Inflammasome-Mediated Macrophage Pyroptosis. Int J Mol Sci. 2023;24(7):6309. https://doi.org/10.3390/ijms24076309
12. Konečná B, Chobodová P, Janko J, Baňasová L, Bábíčková J, Celec P, et al. The Effect of Melatonin on Periodontitis. Int J Mol Sci. 2021;22(5):2390. https://doi.org/10.3390/ijms22052390
13. Gurbuz ES, Guney Z, Kurgan S, Balci N, Serdar MA, Gunhan M. Oxidative Stress and FOXO-1 Relationship in Stage III Periodontitis. Clin Oral Investig. 2024;28(5):267. https://doi.org/10.1007/s00784-024-05670-x
14. Jos P, Teles L, Ferreira B, Ara E. Patent Mining on the Use of Antioxidant Phytochemicals in the Technological Development for the Prevention and Treatment of Periodontitis. Antioxidants. 2024;13(5):38790671. https://doi.org/10.3390/antiox13050000
15. Karaca B, Yilmaz M, Gursoy UK. Targeting Nrf2 with Probiotics and Postbiotics in the Treatment of Periodontitis. Biomolecules. 2022;12(5):729. https://doi.org/10.3390/biom12050729
16. Marfiian OV, Demkovych AY, Bondarenko YI, Yaremchuk OZ. Modern views on the etiology and role of microbial persistence in the development of inflammatory processes in the periodontal complex (review). Medicni Perspektivi. 2024;29(3):27-35. https://doi.org/10.26641/2307-0404.2024.3.313482
17. Čižmárová B, Tomečková V, Hubková B, Hurajtová A, Ohlasová J, Birková A. Salivary Redox Homeostasis in Human Health and Disease. Int J Mol Sci. 2022;23(16):9168. https://doi.org/10.3390/ijms23169168
18. Guabello G, Zuffetti F, Ravidà A, Deflorian M, Carta G, Saleh MHA, et al. Avoiding implant-related complications in medically compromised patients with or without unhealthy lifestyle / Elevated oxidative stress. Periodontol 2000. 2023;93(1):329-349. https://doi.org/10.1111/prd.12503
19. Maquera-Huacho PM, Spolidorio DP, Manthey J, Grenier D. Effect of Hesperidin on Barrier Function and Reactive Oxygen Species Production in an Oral Epithelial Cell Model, and on Secretion of Macrophage-Derived Inflammatory Mediators during Porphyromonas gingivalis Infection. Int J Mol Sci. 2023;24(13):10850. https://doi.org/10.3390/ijms241310850
20. Georgiou AC, Ulloa PC, Kessel GMH Van, Crielaard W, Waal SV Van Der. Reactive oxygen species can be traced locally and systemically in apical periodontitis: A systematic review. Arch Oral Biol. 2021;129:105167. https://doi.org/10.1016/j.archoralbio.2021.105167
21. Rapone B, Ferrara E, Qorri E, Inchingolo F, Isola G, Dongiovanni P, et al. Research efficacy of gaseous ozone therapy as an adjuvant to periodontal treatment on oxidative stress mediators in patients with type 2 diabetes: a randomized clinical trial. BMC Oral Health. 2023;23(1):290. https://doi.org/10.1186/s12903-023-02980-y
22. Buranasin P, Kominato H, Mizutani K, Mikami R, Saito N. Influence of Reactive Oxygen Species on Wound Healing and Tissue Regeneration in Periodontal and Peri-Implant Tissues in Diabetic Patients. Antioxidants. 2023;12(9):1750. https://doi.org/10.3390/antiox12091750
23. Chen K, Ma S, Deng J, Jiang X, Ma F, Li Z. Ferroptosis: A New Development Trend in Periodontitis. Cells. 2022;11(21):3349. https://doi.org/10.3390/cells11213349
24. Ramos-Junior ES, Carolina A. Mitochondrial function in oral health and disease. J Immunol Methods. 2024;532:113729. https://doi.org/10.1016/j.jim.2024.113729
25. Varma SR, Ani OHAA, Narayanan JK, Mathew A. The role of Mitofusin-1 and Mitofusin-2 in periodontal disease: a comprehensive review. Front Oral Health. 2025;6:1540178. https://doi.org/10.3389/froh.2025.1540178
26. Dong Z, Wu L, Hong H. Mitochondrial Dysfunction in the Pathogenesis and Treatment of Oral Inflammatory Diseases. Int J Mol Sci. 2023;24(20):15483. https://doi.org/10.3390/ijms242015483
27. Zheng T, Lu F, Wu P, Chen Y, Zhang R, Li X. Ferroptosis and cuproptosis in periodontitis: recent biological insights and therapeutic advances. Front Immunol. 2025;16:1526961. https://doi.org/10.3389/fimmu.2025.1526961
28. Ying J, Zhang K, Huang Y, Zhu X, Ruan Y, Lin H, et al. Molecular hydrogen: Mechanism against oxidative stress and application in periodontitis: A review. Medicine (Baltimore). 2025;104(10):e41800. https://doi.org/10.1097/MD.0000000000041800
29. Yang K, Yang Y, Long T, Wang X, Chen Y, He C, et al. Hyperhomocysteinaemia aggravates periodontitis by suppressing the Nrf2/HO-1 signalling pathway. Redox Rep. 2025;30(1):2475691. https://doi.org/10.1080/13510002.2025.2475691
30. Ferrara E, Albenzio AD, Bassignani J, Di Tanna I, Murmura G, Balice G. The Periodontal – Cardiovascular Disease Association: Molecular Mechanisms and Clinical Implications. Int J Mol Sci. 2025;26(1):150. https://doi.org/10.3390/ijms26010150
31. Lv X, Han X, Yang Y, Ma Y, Wang Y, Zhang K. Hypochlorous acid solution serves as a potential anti-biofilm therapy for periodontitis via targeting quorum sensing of periodontal pathogens. J Oral Microbiol. 2025;17(1):2458806. https://doi.org/10.1080/20002297.2025.2458806