Low-Grade Systemic Inflammation: Interfaces Between Oral Microbiota, Inflammatory Biomarkers, Temporomandibular Disorders, and Musculoskeletal Health

Systemic inflammation is a complex biological process, characterized by the prolonged activation of circulating inflammatory mediators, such as proinflammatory cytokines and acute phase proteins, which affects several tissues and organs in a diffuse manner. This chronic low-grade inflammatory state has been strongly associated with the development and progression of chronic non-communicable diseases (NCDs), such as type 2 diabetes, cardiovascular diseases, osteoarthritis, and sarcopenia, consolidating itself as a central factor in the pathophysiology of these conditions [1]. Recently, it has been understood that systemic inflammation may originate in peripheral sites, including the oral cavity. Chronic periodontitis, an inflammatory condition of bacterial etiology that affects the supporting tissues of the teeth, has been implicated as an important trigger for persistent systemic inflammatory responses. This occurs by the continuous release of bacterial endotoxins and inflammatory cytokines into the bloodstream, establishing a communication pathway between the oral microbiota and the systemic immune system [2].

Changes in the oral microbiota, especially with a predominance of periodontal pathogens such as Porphyromonas gingivalis and Treponema denticola, can unbalance immune homeostasis and induce dysfunction in distant tissues. The relationship between oral dysbiosis and systemic inflammation has been strengthened by studies demonstrating correlations between periodontitis and elevated levels of circulating C-reactive protein, interleukin-6, and TNF-α, biomarkers traditionally associated with cardiovascular risk and other NCDs [3]. In addition, the impact of systemic inflammation on the musculoskeletal system has been increasingly recognized. Chronic exposure to inflammatory cytokines can interfere with muscle metabolism, promoting proteolysis, anabolic resistance, and cellular apoptosis, culminating in loss of muscle mass and strength – a characteristic picture of sarcopenia [4]. These effects are especially relevant in elderly populations, which already have greater physiological vulnerability to functional loss.

Physical therapy, as a science aimed at the maintenance and recovery of musculoskeletal function, has expanded its role in the prevention of systemic diseases mediated by inflammation. The identification of non-traditional etiological factors, such as oral alterations, broadens the scope of therapeutic strategies aimed at modulating inflammation through integrated physical, nutritional, and educational interventions [2]. In this scenario, biomedicine plays a central role in the identification and monitoring of inflammatory biomarkers, being fundamental for the analysis of the molecular pathways involved in the interactions between oral microbiota and functional Musculoskeletal. The quantification of inflammatory proteins, analysis of the oral microbial profile, and investigation of immunological and metabolic pathways are tools that enable the deepening of connections between systems [5]. Dentistry, in turn, is no longer limited to local action, but has become part of the field of systemic health with actions aimed at the prevention and control of chronic inflammation. Strategies such as periodontal treatment and oral microbiota control are recognized as interventions with an impact beyond the oral environment, promoting benefits in systemic and musculoskeletal parameters [6].

Therefore, the articulation between biomedicine, physiotherapy and dentistry configures an interdisciplinary approach necessary for the integrated understanding of systemic inflammatory processes and their functional developments. The interaction between these areas allows for a broader view of etiological factors, molecular mechanisms, and therapeutic strategies aimed at promoting integral health [8] .Therefore, this review article aims to map and critically analyze the available scientific evidence on the connections between the oral microbiota, inflammatory biomarkers, and musculoskeletal changes. The proposal is to explore the intersections between the knowledge of biomedicine, dentistry and physiotherapy, with a focus on identifying gaps, therapeutic potentialities and paths for interdisciplinary action in health.

The human oral microbiota is a highly diverse community, composed of more than 700 bacterial species, whose balanced composition is essential for the maintenance of oral and systemic homeostasis. In health conditions, this microbiota acts in a symbiotic manner, contributing to the integrity of the oral mucosa, pH control, and prevention of colonization by exogenous pathogens. However, local environmental changes, such as biofilm accumulation and compromised immune response, can promote an ecological imbalance to dysbiosis, favoring the proliferation of bacterial species associated with chronic inflammation, such as Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia [8]. The presence of these periodontopathogenic bacteria at subgingival sites is not limited to local effects. The ability of these microorganisms to invade the gingival epithelium and reach the bloodstream allows the continuous release of lipopolysaccharides (LPS), which activate Toll-like receptors (TLRs) on systemic immune cells, such as monocytes and macrophages. This activation promotes the release of pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6), characterizing a picture of low-grade systemic inflammation [9].

Chronic activation of the immune system by oral pathogens has been associated with the worsening of several chronic noncommunicable conditions. Studies show the correlation between periodontitis and cardiovascular diseases, type 2 diabetes mellitus, rheumatoid arthritis and even sarcopenia in the elderly. In these pathologies, cytokine-mediated systemic inflammation stimulates catabolic processes, insulin resistance, endothelial dysfunctions, and tissue degradation, pointing to the oral cavity as a relevant focus of systemic inflammatory modulation [10]. Particularly in sarcopenia, persistent exposure to inflammatory mediators induced by oral dysbiosis is observed to compromise muscle protein synthesis, favor oxidative stress, and reduce the regenerative capacity of skeletal muscle tissue. This scenario is especially worrisome in elderly populations, in which the immune response is already altered due to immunosenescence, making the control of inflammation a fundamental strategy for preserving functionality [11]. Given the systemic impact of altered oral microbiota, the need for an interdisciplinary approach that integrates knowledge from biomedicine, dentistry, and physiotherapy in the prevention and control of chronic diseases becomes evident. Understanding the mechanisms by which oral dysbiosis contributes to systemic inflammation allows the development of more effective therapeutic strategies, capable of interrupting the inflammatory cascade at its origin and preserving the individual’s overall health.

Chronic low-grade inflammation is recognized as a central factor in the pathophysiology of several chronic non-communicable diseases. In this context, inflammatory biomarkers emerge as valuable tools in early detection, monitoring of progression, and evaluation of the therapeutic response to systemic inflammatory conditions. Substances such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and matrix metalloproteinases (MMPs), especially MMP-8, have been extensively studied for their role indicative of ongoing inflammatory processes, including those originating in the oral cavity [12]. Periodontitis, a chronic inflammatory disease of infectious origin, is strongly associated with the elevation of these biomarkers both in local fluids such as gingival fluid and in systemic compartments, such as peripheral blood and saliva. Evidence indicates that IL-6 and CRP levels increase significantly in individuals with periodontitis, reflecting the potential of oral inflammation to influence the systemic inflammatory response and suggesting their usefulness as risk predictors for cardiovascular, musculoskeletal, and metabolic comorbidities [13].

Saliva, due to its accessibility and composition rich in immune mediators, has been shown to be a promising matrix for the noninvasive detection of inflammatory biomarkers. The correlation between salivarian and serum levels of substances such as CRP and MMP-8 reinforces the diagnostic potential of saliva as a screening tool, especially in vulnerable populations or those with difficult access to health services, offering a viable and less invasive alternative to traditional blood collection [14]. In biomedical practice, sensitive and specific laboratory techniques have been widely used for the quantification of these biomarkers. Enzymelinked immunosorbent assays (ELISA), chemiluminescence-based systems, and reverse-transcription polymerase chain reaction (RT-PCR) stand out for their accuracy in detecting cytokines and inflammatory proteins, allowing quantitative and qualitative analyses in different body fluids. The use of these technologies has significantly expanded the capacity for laboratory diagnosis, especially in the context of biomedicine applied to oral and systemic health [15]. In addition to the detection of active inflammation, the evaluation of inflammatory biomarkers allows the mapping of risks related to musculoskeletal and metabolic changes. In particular, high levels of IL-6 and TNF-α are associated with loss of muscle mass, insulin resistance, and endothelial dysfunctions, and are useful not only for diagnosis, but also for prognostic stratification and clinical follow-up of patients with chronic inflammatory diseases [16].

Thus, the integrated study of inflammatory biomarkers in local and systemic samples expands the possibilities of interdisciplinary action between biomedicine, dentistry and other areas of health. This approach contributes to a more comprehensive understanding of the interactions between oral inflammation and systemic repercussions, reinforcing the role of biomarkers as key instruments in promoting integral health.

Chronic systemic inflammation is widely recognized as a central factor in the progressive loss of musculoskeletal function, especially in elderly populations. This sustained inflammatory state, often mediated by pro-inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), causes an imbalance in muscle metabolism, favoring catabolism and inhibiting protein synthesis. As a consequence, a condition of sarcopenia sets in, characterized by loss of lean mass, reduced muscle strength, and impaired mobility [17]. Several longitudinal studies have shown that high concentrations of IL-6 and TNF-α are associated with progressive functional decline, with a direct impact on the quality of life and autonomy of elderly individuals. Such biomarkers have been identified as reliable predictors of physical disability, increased risk of falls, hospitalizations, and mortality from various causes. This scenario highlights the importance of controlling inflammation as a preventive and therapeutic strategy in musculoskeletal health [11,18].

In addition to the systemic origin of inflammation, local factors such as poor oral health also exert a significant influence on the musculoskeletal system. The presence of periodontal diseases, such as gingivitis and periodontitis, contributes to the spread of inflammatory mediators through the bloodstream, amplifying the systemic inflammatory response. Recent studies suggest that individuals with periodontitis have a higher prevalence of sarcopenia, evidencing a possible pathophysiological pathway between oral inflammation and loss of muscle strength [19]. In addition, ineffective chewing due to tooth loss, periodontal pain, or temporomandibular disorder can reduce food intake and limit protein intake, intensifying muscle catabolism. Masticatory dysfunction, in addition to compromising nutritional status, is associated with lower physical activity and generalized functional impairment. Thus, poor oral health not only contributes to systemic inflammation but also acts as a direct risk factor for malnutrition and muscle weakness [20]. From a clinical point of view, the relationship between chronic inflammation and sarcopenia has been increasingly explored in research that integrates biomedicine, physiotherapy and dentistry. The Early identification of inflammation through biomarkers, combined with the assessment of muscle strength and physical functionality, allows a more effective multidimensional approach to the prevention of disability. Strategies that promote oral health and control inflammation gain relevance as measures to promote motor functionality [21].

Thus, it becomes evident that the systemic inflammation– muscle catabolism–motor dysfunction axis must be addressed in an integrated manner. Sarcopenia cannot be understood in isolation, being the result of multiple inflammatory, metabolic and functional factors, in which the oral cavity represents a relevant and still underestimated starting point. Deepening this understanding can contribute to more complete and effective intervention strategies in the care of vulnerable populations. In this scenario, physiotherapy emerges as an essential therapeutic strategy, acting both in the prevention and rehabilitation of musculoskeletal function. Physical therapy interventions based on resistance exercise, functional training and aerobic physical activity have demonstrated a systemic anti-inflammatory effect, promoting the release of myokines such as IL-10 and reducing the expression of pro-inflammatory cytokines [7]. These molecular adaptations contribute to the recovery of muscle function and the improvement of overall functional capacity.

The scientific literature reinforces that supervised physical exercise not only preserves muscle structure, but also positively modulates the inflammatory profile of individuals with chronic diseases, such as osteoarthritis, chronic obstructive pulmonary disease (COPD), and cardiovascular diseases. Clinical trials have shown that regular physical therapy programs reduce inflammatory markers in circulation and are associated with improved strength, balance, and mobility, directly impacting the quality of life of these patients [22]. Therefore, the role of physical therapy transcends the symptomatic approach, acting as a tool for biological modulation in the face of systemic inflammation. Its clinical application, when integrated with biomarker monitoring and multidisciplinary care, represents an effective and evidence-based intervention capable of restoring musculoskeletal function and promoting integral health in different clinical contexts and age groups.

The temporomandibular joint (TMJ) is one of the most complex joints in the human body, responsible for the opening, closing, and laterality movements of the jaw, being essential for vital functions such as chewing, swallowing, phonation, and facial expression. This joint is formed by the head of the mandible (mandibular condyle), the articular disc and the mandibular fossa of the temporal bone, in addition to having ligaments and muscles that promote stability and mobility. Due to its high functional demand and the multisystem coordination involved, TMJ is especially vulnerable to biomechanical overloads and imbalances (Okeson, 2013). Temporomandibular disorders (TMD) comprise a set of clinical conditions that affect the TMJ and/or masticatory muscles, and may have a traumatic origin, muscular, joint, postural or psychosocial. These dysfunctions are characterized by orofacial pain, joint noises (pops and crackles), limitation or asymmetry of mandibular movements, and, in some cases, pain radiating to the head and neck. The prevalence of TMD has increased, especially in young populations and women, and is associated with factors such as stress, bruxism, and dental malocclusion (Manfredini et al., 2011; Schiffman et al., 2014).

From a pathophysiological point of view, many cases of TMD involve chronic inflammatory processes that affect the articular and periarticular tissues, including the articular disc and synovial capsule. The presence of inflammatory mediators, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), contributes to tissue degradation and pain chronicity, creating a cycle of peripheral and central sensitization. This inflammatory condition can also extend to other regions of the musculoskeletal system, promoting postural changes and dysfunctions associated with the cervical spine and facial muscles (Alstergren C Kopp, 2007). TMJ assessment and treatment should involve an interdisciplinary approach that includes dentistry, physiotherapy, and, in some cases, psychology. Adequate diagnosis is based on standardized clinical criteria, such as those proposed by the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), in addition to imaging tests such as magnetic resonance imaging and computed tomography for more complex cases. Treatment can range from conservative measures, such as thermotherapy and therapeutic exercises, to the prescription of occlusal splints and, in refractory cases, surgical interventions (Schiffman et al., 2014; Greene, 2010).

Temporomandibular disorders (TMD) comprise a set of alterations that affect the temporomandibular joint (TMJ), masticatory muscles and adjacent structures, often associated with orofacial pain, joint noises, limitation of mandibular movement and functional impairment. These conditions have a multifactorial etiology, involving biomechanical, neuromuscular, inflammatory, and psychosocial components, integrating the spectrum of musculoskeletal dysfunctions associated with chronic low-grade inflammation (Manfredini et al., 2011). The role of the physiotherapist in the treatment of TMD is based on strategies that aim to restore the functional balance of the TMJ, relieve pain, improve mandibular mobility and re-educate altered muscle patterns. For this, resources such as manual therapy, specific kinesiotherapy, electrothermophototherapy and neuromuscular relaxation techniques are used. Studies have shown that these interventions, when applied in a systematic way, promote significant clinical improvement, in addition to positively influencing local inflammatory markers, contributing to the control of subclinical inflammation (Olivo et al., 2010).

The clinical complexity of TMDs demands an interdisciplinary approach, in which the joint action between physiotherapist and dental surgeon is fundamental. The dentist is the professional trained to diagnose and manage occlusal factors, make intraoral devices and treat associated periodontal conditions. The physiotherapist, on the other hand, works in functional rehabilitation, promoting the restoration of musculoskeletal dynamics and preventing recurrences through specific physical interventions [15]. This collaboration gains relevance in the face of growing evidence that TMD patients may have inflammatory profiles compatible with systemic conditions, such as tension headaches, fibromyalgia, sleep disorders, and sarcopenia. The involvement of the musculoskeletal system of the cervical and craniomandibular region in a chronic inflammatory process reinforces the need to integrate dental and physiotherapeutic care, especially in primary health care settings (Gonçalves et al., 2020).

In addition, the evaluation of masticatory function and muscle condition of the face and cervical can serve as an early indicator of functional changes associated with systemic inflammation. The physiotherapist, in this sense, starts to play a strategic role in the early detection of dysfunctions that transcend the oral cavity, acting as a link between local rehabilitation and the promotion of global health (Fernandes et al., 2022). Therefore, the inclusion of physical therapy in the management of temporomandibular disorders not only increases therapeutic efficacy, but also strengthens the multidisciplinary care model recommended in this article. The integrated performance between physiotherapists and dentists, combined with the diagnostic support of biomedicine, configures a promising approach in coping with inflammatory conditions that compromise musculoskeletal functionality and quality of life of patients [23].

Temporomandibular disorders (TMD) represent a heterogeneous group of conditions that affect the temporomandibular joint (TMJ), masticatory muscles, and adjacent structures, and are often associated with orofacial pain, functional limitation, and relevant psychosocial impacts. From a pathophysiological point of view, many TMDs involve chronic inflammatory processes and musculoskeletal dysfunctions that are in line with the mechanisms discussed in this article, especially with regard to the connection between systemic inflammation and functional loss. The performance of physiotherapy in this context has been consolidated as an effective strategy in pain modulation, improvement of mandibular mobility and muscle rebalancing. Techniques such as manual therapy, electrothermophototherapeutic resources, and motor control exercises are widely used with the aim of restoring joint function and reducing dysfunctional movement patterns. In addition, evidence indicates that physical therapy interventions can reduce local and systemic inflammatory markers, reinforcing their role as an inflammation-modulating agent (Olivo et al., 2010).

Interdisciplinary work between the physical therapist and the dental surgeon is essential for the proper management of TMDs, especially in cases where there is overlap of occlusal, muscular and psychosocial factors. While the dentist is responsible for evaluating dental occlusion, prescribing intraoral devices, and managing associated periodontal conditions, the physiotherapist works in functional rehabilitation, prevention of recurrences, and improvement of the patient’s quality of life.This integration between specialties is even more relevant in view of the evidence that associates TMD with systemic conditions such as headache, sleep disorders, fibromyalgia, and even sarcopenia. Patients with chronic TMJ pain may present with a low-grade inflammatory pattern, which, when left untreated, contributes to musculoskeletal dysfunctions and perpetuation of the cycle of pain and immobility. Therefore, early identification and joint approach are key to interrupting this cycle and restoring global functionality (Manfredini et al., 2011). The inclusion of functional assessment of TMJ and masticatory muscles in the context of interdisciplinary care, especially in elderly populations or those with inflammatory comorbidities, broadens the scope of physical therapy and favors a patient-centered approach. Integrated strategies that combine functional rehabilitation, dental treatment, and laboratory monitoring of biomarkers represent an advance in the promotion of oral and systemic health, as proposed in this article.

Low-grade systemic inflammation has been widely recognized as one of the main pathophysiological mechanisms associated with the development and progression of chronic non-communicable diseases, such as diabetes, sarcopenia, and cardiovascular diseases. In its genesis, several factors are involved, including persistent oral infections, changes in the microbiota, metabolic dysfunction, and physical inactivity. This pathophysiological complexity requires a broad and integrative clinical approach, capable of recognizing multiple etiological factors and proposing synergistic interventions to control inflammation and promote health [24]. In view of this scenario, multidisciplinary care becomes not only recommended, but essential. By bringing together distinct and complementary knowledge, the integration between dentistry, biomedicine, and physiotherapy represents a health care model that allows both the early identification of inflammation and its therapeutic approach on multiple fronts. This collaboration is particularly relevant in vulnerable populations, such as the elderly, in whom chronic inflammation and its functional consequences are more prevalent and impactful [25].

Dentistry, in turn, plays a central role in the prevention and treatment of oral dysbiosis, the main risk factor for oral and, consequently, systemic inflammation. Chronic periodontitis, often silent, represents a continuous focus of endotoxin release and proinflammatory cytokines, contributing to the systemic increase of markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Proper dental management of these conditions can directly impact the levels of circulating inflammation [6]. Complementing this care, biomedicine plays a leading role in laboratory diagnosis and clinical monitoring of inflammatory biomarkers. The application of techniques such as ELISA, chemiluminescence, and RT-PCR allows the early and accurate detection of changes in the inflammatory profile, being an essential tool for risk stratification and monitoring of the therapeutic response. In addition, the integrated analysis of local markers (such as in gingival fluid) and systemic markers (such as in serum and saliva) makes it possible to infer Physical therapy, in turn, contributes significantly to the modulation of inflammation through physical exercises with anti-inflammatory properties, which promote the release of beneficial myokines and the reduction of pro-inflammatory cytokines. The performance Physical therapy, especially in patients with functional loss or sarcopenia, has shown positive effects on the preservation of muscle strength, mobility, and quality of life. When combined with the dental approach, it enhances the systemic effect of care, as evidenced in institutionalized older adults who showed a reduction in IL-6 and improved motor function after joint intervention [23].

The adoption of integrated care models allows the implementation of interdisciplinary preventive protocols aimed at maintaining functionality and preventing disabilities. The screening of patients with signs of subclinical inflammation can be carried out in a coordinated manner among professionals, favoring a proactive approach and not just a reactive one. This logic of care is aligned with the principles of primary health care, which advocates promotion, prevention and recovery actions in an articulated and problem-solving way [26]. In addition to the clinical benefits, multiprofessional care contributes to health education, promoting patient engagement in adherence to healthy habits. Simultaneous guidance on oral hygiene, diet, exercise and laboratory monitoring creates an environment of co-responsibility, where the patient is an active agent in maintaining their health. Valuing interprofessionality in this context not only improves clinical outcomes, but also strengthens the health system in its entirety [27].

Therefore, the convergence between dentistry, biomedicine, and physical therapy in coping with systemic inflammation represents an effective and necessary strategy to deal with the complex interactions between inflammation, functional dysfunction, and quality of life. The consolidation of evidence-based interdisciplinary practices favors the personalization of care, clinical efficacy, and sustainability of health services, especially in the face of population aging and the growing burden of chronic inflammatory diseases.

This is a narrative review of the literature with the objective of critically analyzing the available scientific evidence on the relationship between systemic inflammation, oral microbiota, inflammatory biomarkers, and musculoskeletal repercussions, with emphasis on the integrative role of physical therapy, dentistry, and biomedicine. The search was carried out in internationally indexed databases PubMed, Scopus, Web of Science and SciELO due to their relevance and scope in the health area. The controlled descriptors of the MeSH (Medical Subject Headings) and DeCS (Health Sciences Descriptors) vocabularies were used, combined with Boolean operators (AND, OR), including the terms: “periodontitis”, “systemic inflammation”, “inflammatory biomarkers”, “oral microbiota”, “muscle function”, “physiotherapy” and “sarcopenia”.

Studies published between January 2013 and March 2024 were considered eligible, with a time frame justified by the intensification of interdisciplinary research in the last ten years. Experimental and observational articles, randomized clinical trials, systematic reviews, and narratives were included, as long as they presented thematic relevance, clarity in methods, and scientific rigor. The selection was made by two reviewers independently, prioritizing publications in English, Portuguese and Spanish. The methodological quality of the studies was evaluated qualitatively, considering criteria such as study design, sample size, statistical robustness, and impact of journals, according to the recommendations of the scientific literature in narrative reviews [28].

Temporomandibular disorders (TMD) require broader and more personalized therapeutic approaches, considering their multifactorial etiology and the functional and psychosocial impact on patients. The literature points out that the combination of the dental surgeon’s work - focused on the diagnosis and treatment of occlusal factors, use of interocclusal splints, and control of infectious processes - and the physical therapist - responsible for restoring biomechanical and muscular balance - offers more effective and lasting results than isolated interventions [25].Clinical studies show that physical therapy contributes significantly to pain reduction, improved mandibular range of motion, and neuromuscular reeducation in patients with TMD, especially when associated with dental treatment. Protocols that combine therapeutic exercises, manual therapy, and occlusal control promote not only symptomatic relief, but also improve functional parameters, reducing the risk of recurrence (Fernandes et al., 2021; Rodrigues et al., 2022).

Despite these advances, there are still few standardized clinical protocols that define integrated flows between physiotherapy and dentistry. The creation of interdisciplinary guidelines, based on robust scientific evidence, can standardize conducts, improve the effectiveness of treatments, and guide the early referral of complex cases. In addition, the use of combined clinical scales (such as the DC/TMD) and inflammatory biomarkers can contribute to the monitoring of therapeutic response in joint interventions (Schiffman et al., 2014; Manfredini et al., 2017). The future of the TMD approach should include interdisciplinary care centers, with multiprofessional teams working in an integrated manner from diagnosis to functional rehabilitation. The inclusion of physiotherapy in the dental routine, especially in public and primary care services, can expand the population’s access to more effective treatments, reducing the chronicity of symptoms and promoting a higher quality of life. Investments in professional training, shared protocols, and multicenter clinical research are essential strategies to consolidate this integration as standard practice in health (Lucena et al., 2021).

Despite scientific advances that reinforce the interdependence between systemic inflammation, oral health, and musculoskeletal function, there are still significant gaps in the literature that limit the integrated clinical application of these findings. One of the main shortcomings is the scarcity of clinical trials with a longitudinal design capable of establishing a robust causal relationship between changes in the oral microbiota, especially in periodontitis conditions, and musculoskeletal outcomes such as sarcopenia, loss of strength, and functional mobility [19]. Most of the existing studies still have a cross-sectional design, which makes it difficult to understand the temporal effects of systemic inflammatory effects originating in the oral cavity. Another critical point refers to the lack of standardization in the panels of inflammatory biomarkers used in different studies. The variability in the choice and methods of measurement of markers such as IL-6, TNF-α, MMP-8, and PCR compromises the comparability of results and hinders the formulation of universal clinical protocols [12]. This methodological heterogeneity highlights the urgency of interdisciplinary consensuses that define key biomarkers and reproducible laboratory methodologies, enabling a more effective integration between biomedicine, dentistry, and physiotherapy.

In the context of primary health care, the literature still lacks structured models that propose multiprofessional protocols for the screening and management of systemic inflammation based on the triad: oral health, laboratory markers, and motor functionality. The implementation of interdisciplinary strategies that involve the dentist, the biomedical doctor, and the physiotherapist in a coordinated manner can represent an advance in comprehensive care, especially in elderly and vulnerable populations [25]. In addition, new digital technologies, such as artificial intelligence (AI), offer a promising field that is little explored in current research. Tools based on machine learning have the potential to cross-reference clinical, laboratory, and functional data, allowing the prediction of clinical outcomes related to chronic inflammation with greater accuracy. However, the application of AI in the integration of data between oral microbiota, inflammatory biomarkers, and musculoskeletal performance is still incipient and demands more robust and collaborative investigations [29].

Future research should also consider modulating factors such as nutritional status, polypharmacy, level of physical activity, and associated comorbidities, which may interfere with the relationship between systemic inflammation and muscle function. The inclusion of these factors in multivariate analyses can refine the understanding of the mechanisms involved and guide more personalized interventions [30]. Therefore, there is an urgent need for integrative clinical studies, with standardized methodologies and multiprofessional approaches, capable of translating laboratory findings into care strategies applicable in clinical routine. This gap in the literature represents not only a challenge but also an opportunity to develop innovative evidence-based health care models centered on the prevention of functional loss associated with systemic inflammation.

Low-grade systemic inflammation is a multifactorial pathological process, influenced by metabolic and functional conditions, and especially by changes in the oral microbiota. The current literature shows that disorders such as chronic periodontitis not only affect local tissues, but have the potential to trigger systemic inflammatory responses, with direct repercussions on muscle metabolism, physical strength, and functional mobility of individuals [12]. In this scenario, the oral cavity presents itself as a relevant focus in understanding the genesis of systemic inflammation. The continuous release of endotoxins by periodontopathogenic microorganisms, such as Porphyromonas gingivalis, activates systemic immune pathways that amplify the chronic inflammatory state and, consequently, accelerate catabolic processes in muscle tissue. This connection between oral health and integrity musculoskeletal reinforces the need to include dental evaluation in the screening for inflammatory risk factors [19].

The interaction between systemic inflammation and musculoskeletal dysfunctions, such as sarcopenia and chronic pain, reinforces the need for integrated care strategies. The temporomandibular joint (TMJ) emerges as a key structure in this scenario, directly connecting oral and musculoskeletal functions. Its dysfunctions, when not properly addressed, perpetuate inflammatory conditions, chronic pain and functional losses. Understanding TMJ as an integral part of the musculo-articular system with systemic repercussions expands therapeutic and prevention possibilities (Manfredini et al., 2017). In view of this complexity, the relevance of joint action between physiotherapists and dentists in the management of temporomandibular disorders is highlighted. The association between functional rehabilitation, occlusal control, and health education enhances the anti-inflammatory effects of physical therapies, while promoting improvement in mandibular mobility, pain relief, and quality of life of patients. This integration represents a promising model for the treatment of TMD, especially when supported by collaborative, evidence-based clinical protocols (Fernandes et al., 2021; Rodrigues et al., 2022). Musculoskeletal dysfunction associated with inflammation, especially in the elderly, has a direct impact on functional independence, increasing the risk of falls, hospitalizations, and mortality. Markers such as IL-6, TNF-α, and CRP have been shown to be consistent predictors of functional decline, being useful in clinical risk stratification. Thus, its routine measurement in the context of primary care can offer subsidies for early interventions [11].

The role of biomedicine is fundamental in this process, especially in the detection and laboratory monitoring of inflammatory biomarkers. The use of sensitive techniques, such as ELISA and RTPCR, enables an accurate analysis of inflammatory activity, allowing greater accuracy in the diagnosis and clinical follow-up of patients with chronic diseases [15]. The interface between laboratory analysis and clinical evaluation increases the predictive power of care models. Physiotherapy, in turn, represents an effective therapeutic tool in combating the effects of inflammation on the musculoskeletal system. Interventions based on structured physical exercise have proven anti-inflammatory properties, contributing to the preservation of muscle strength and mobility. When integrated with oral health promotion actions and laboratory monitoring, these strategies strengthen longitudinal and multidimensional care [23]. Integrated care models, which articulate dentistry, biomedicine and physiotherapy, represent an effective response to the complexity of chronic inflammation. This approach broadens the view of the inflammatory process, understanding it as a systemic phenomenon that requires coordinated responses, both in prevention and clinical intervention. Such models are especially relevant in the care of aging populations with multiple comorbidities [24]. In addition to clinical practice, there is an urgent need for investment in collaborative and interdisciplinary research, capable of deepening the understanding of the mechanisms that interconnect the oral microbiota, inflammatory biomarkers, and musculoskeletal outcomes. Longitudinal clinical trials, standardized protocols, and emerging technologies such as artificial intelligence may contribute to the personalization of care and the prediction of more accurate clinical outcomes [28].

Therefore, the confrontation of chronic inflammatory diseases requires a more preventive, integrative, and patient-centered care paradigm. The convergence between dental, laboratory, and physical therapy practices is a promising strategy to promote healthy aging and reduce the functional impacts of systemic inflammation, with individual and collective benefits of high relevance in public health. Finally, addressing the effects of systemic inflammation on human functionality requires a paradigm of preventive, interdisciplinary, and patient-centered care. The union between dentistry, physiotherapy and biomedicine allows for early identification of inflammatory foci, monitoring relevant biomarkers and applying interventions based on personalized strategies. The consolidation of this collaborative practice, combined with the advancement of diagnostic technologies and the strengthening of primary care, is an essential tool in promoting healthy aging and reducing the functional burden associated with chronic diseases (Lucena et al., 2021; [23, 31]..

None.

No conflict of interest.

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