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Levi-Richman Integration Initiative of the AAP Foundation

Your patients’ periodontal health is part of their systemic health.

Periodontal disease has been linked to overall systemic health — yet the connection remains largely unfamiliar to physicians. Know the evidence, look for the signs, and refer to a periodontist.

Gum health is the missing link — and it too often goes unchecked.

“Our goal here is to ‘put the mouth back in the body.’”

— Dr. Paul Levi, founding donor, quoting the late Dr. Bruce Donoff, a dentist and physician who served as dean of the Harvard School of Dental Medicine for 28 years

The evidence is mounting

Strong correlations between periodontal diseases and conditions such as diabetes, metabolic syndrome, and cardiovascular disease have been documented for years. Newer research points to an ever-growing list — from Alzheimer’s to erectile dysfunction.

The awareness gap

These relationships remain largely unfamiliar to the general public and to physicians — including cardiologists, pulmonologists, and endocrinologists whose patients could be in critical need of periodontal care.

What it means for patients

Patients with these systemic conditions are at increased risk of periodontal disease and should be evaluated for periodontal treatment.

Consider. Look. Refer.

Three steps to bring periodontal health into your patients’ care.

Consider the risk

Patients with systemic conditions linked to periodontal disease — such as diabetes, metabolic syndrome, and cardiovascular disease — are at increased risk of periodontal disease and should be evaluated for periodontal treatment.

Look for warning signs

Ask your patients whether they’ve noticed:

  • Red, swollen, or tender gums
  • Bleeding while brushing, flossing, or eating hard food
  • Gums receding or pulling away from the teeth
  • Loose or separating teeth
  • Persistent bad breath

Gum disease is often silent — symptoms may not appear until advanced stages.

Refer to a periodontist

Managing systemic health also means managing oral health

Explore the evidence by condition.

Concise research summaries for each condition, with print-ready flyers to keep in your practice or share with colleagues. New topics are added as they’re developed.
Oral Health &

Cardiovascular Health  

Heart disease, stroke, and peripheral artery disease.

Oral Health &

Endocrinology  

Diabetes, obesity, and metabolic syndrome.

Pregnancy Outcomes

“Compared with pregnant women without periodontitis, pregnant women with periodontitis had a doubled risk of preterm birth.”

Nannan, et al. PMID: 36388896
Dementias

“Periodontitis and tooth loss are associated with faster cognitive decline and higher dementia risk”

Demmer, et al. PMID: 42747062
Osteoporosis

“Osteoporosis patients were more exposed to periodontitis (OR, 1.96; 95% CI, 1.50–2.54).

Subgroup analyses showed that the higher risk of osteoporosis in periodontitis patients exists in both cross-sectional studies (OR, 2.17; 95% CI, 1.80–2.61) and case–control studies (OR 2.63; 95% CI, 1.69–4.09).”

Xu, et al. PMID: 32615008
Obesity

“Patients with BMI ≥ 30 kg/m2 show higher peri-implantitis rates at any given time point following implant placement.”

Selznik, et al. PMID: 41628897
Cancers

“Cancer risk, especially for lung and colorectal cancer, is elevated in individuals with periodontitis.”

Michaud, et al. PMID: 29342298
Head & Neck Cancers

“periodontitis contributes to an enhanced risk of head and neck cancer, particularly oropharyngeal cancer, with Fusobacterium nucleatum functioning as a potential intermediary.”

Xiong, et al. PMID: 38822160

Education for physicians and care teams.

Webinars and education programs on the oral-systemic link, open to physicians, dentists, and allied health professionals around the world.
Oct 25, 2026
When: Sunday, October 25, 2026 More information
Oct 30, 2026
Learn about cutting-edge advancements at the interface of periodontics and orthodontics in this year’s Future Horizons in Periodontology lecture. This year’s speakers will share the finding…
Oct 30, 2026
Be on the cutting edge of emerging advances in periodontics, including the influence of biological sex on immune responses and periodontitis, strategies for controlling inflammation, and th…
Nov 7, 2026
The Levi-Richman Integration Initiative will reach out to cardiologists and other attendees from a booth at the AHA Scientific Sessions. When: Saturday, November 7, 2026 (Day 1 of 3: Novemb…

Founded by clinicians who have spent their careers on prevention and integration.

Levi-Richman Integration Initiative of the AAP Foundation
Dr. Colin Richman

Dr. Colin Richman

Born and raised in Johannesburg, South Africa, Dr. Richman earned his periodontal certificate from the University of Connecticut and became a leading periodontist in Georgia, presenting more than 350 lectures in the U.S. and abroad.
Collaboration between periodontists and orthodontists has been a major focus of his career — the spirit behind the Richman Family Foundation Perio-Ortho Interface Grants, which began in 2021 through his transformative gift. With this Initiative, he extends that same spirit of integration to colleagues in systemic health.
Patty and Dr. Paul Levi

Patty and Dr. Paul Levi

Patty has supported Paul for nearly sixty years in teaching and practicing periodontology. After his postdoctoral periodontal training at Tufts, Paul practiced in Burlington, Vermont, taught at the University of Vermont Dental Hygiene School for 27 years, and today teaches at the Harvard School of Dental Medicine.
Patty and Paul share a deep commitment to prevention as a lifestyle and philosophy. Their ties to the Spanish periodontal community began when Paul taught in Barcelona for an academic year.
The Initiative is supported by $2.5 million in existing and new investments, with five years of committed support from the AAP Foundation.
Additional major funding provided byPDS Health
#ThePerioLink

From the LRII LinkedIn showcase page.

Oct 15, 2026
The AAP Foundation has expanded the Patty and Paul Levi Research Awards for 2026 to include one award for a predoctoral dental student and now a…
Oct 5, 2026
PerioDash 2026 registrations extended to today, Monday, October 5. Be part of this record-setting year and help raise awareness of #ThePerioLink! …
Jul 30, 2026
“The study, published in npj Biofilms and Microbiomes, reveals the biological mechanism linking oral inflammation to whole-body bone loss,…
Jul 28, 2026
Wall Street Journal highlights the importance of oral health to a longer, healthier life. “As scientists link oral bacteria to heart disease and…
Jul 17, 2026
Regular periodontal evaluations and treatment to establish periodontal health matter for overall health and quality of life. “Researchers found that…
Study identifies obesity as independent risk factor for peri-implantitis.
Jul 9, 2026
Study identifies obesity as independent risk factor for peri-implantitis. Researchers at the Philadelphia VA Medical Center found that obesity…