PISA: Inflamed Surface Area of Gums Triggering Systemic Hyperinflammation

ABSTRACT Periodontitis, a chronic inflammatory disease, causes progressive loss of periodontal tissues. Traditional measures like clinical attachment loss and probing pocket depth fail to quantify the inflammatory burden accurately. The Periodontal Inflamed Surface Area (PISA) quantifies the surface area of bleeding pocket epithelium, offering a better measure of inflammation. This review explores the association between PISA and systemic disorders such as cardiovascular disease, diabetes, dementia, and rheumatoid arthritis (RA). Studies show higher PISA levels correlate with elevated systemic inflammatory markers, including high-sensitivity C-reactive protein and vascular stiffness. In Type 2 diabetes mellitus, PISA is positively associated with HbA1c levels, indicating a dose-response relationship. Additional links have been identified between PISA and conditions like dementia, RA, and diabetic complications. These findings underscore PISA’s value in assessing the systemic impact of periodontitis, advocating for its integration into holistic patient care and further research to standardize its use.