# Brain Structures, Circuits, and Networks Involved in Immune Regulation, Periodontal Health, and Disease

## TL;DR

This paper explores how the brain regulates the immune system to maintain periodontal health and prevent disease, highlighting the role of brain circuits and stress.

## Contribution

It introduces new insights into how brain-immune interactions influence periodontal health and link to neurodegenerative diseases.

## Key findings

- The brain modulates immune responses to maintain periodontal homeostasis.
- Emotional stress and poor coping strategies disrupt immune regulation in the brain.
- Pathobionts and stress can trigger neurodegenerative diseases.

## Abstract

The interaction between microorganisms in the dental microfilm (plaque) at the gingival margin, the immune system, and the brain is vital for gingival health. The brain constantly receives information regarding microbial composition and inflammation status through afferent nerves and the bloodstream. It modulates immune responses via efferent nerves and hormonal systems to maintain homeostasis. This relationship determines whether the gingiva remains healthy or develops into gingivitis (non-destructive inflammation) or periodontitis (a destructive condition), collectively referred to as periodontal disease. Factors associated with severe periodontitis heighten the responsiveness of this homeostatic system, diminishing the adaptive immune system’s defence against symbiotic microorganisms with pathogenic properties, known as pathobionts. This leads to excessive innate immune system activation, effectively preventing infection but damaging the periodontium. Consequently, investigating the microbiota–brain axis is vital for understanding its impact on periodontal health and disease. Herein, we examine recent advancements in how the defence against pathobionts is organised within the brain, and how it regulates and adapts the pro-inflammatory and anti-inflammatory immune balance, controlling microbiota composition. It also discussed how pathobionts and emotional stress can trigger neurodegenerative diseases, and how inadequate coping strategies for managing daily stress and shift work can disrupt brain circuits linked to immune regulation, weakening the adaptive immune response against pathobionts.