PERIODONTAL MEDICINEPERIODONTAL MEDICINE

BY M.BHARATH REDDY

OBJECTIVESOBJECTIVES

IntroductionEra of focal infectionPeriodontal and coronory heart

disease/AtherosclerosisPeriodontal disease & Diabetes mellitusRole of periodontitis in pregnancy out comePeriodontal disease & COPDPeriodontal disease & Acute Respiratory

InfectionPeriodontal Medicine In Clinical Practice

INTRODUCTIONINTRODUCTION Advances in the science & technology over the

last centuary have greatly expanded our knowledge of pathogenesis of periodontal disease.

Certain systemic conditions may affect the initiation & progression of gingivitis & periodontitis.

The effect of oral health on the rest of the human body was proposed by assyrians in the 7th centuary.

In the 18th centuary a pennsylvanian physician named Benjamin Rush quoted that arthritis could be treated in some people after they get extracted the infected teeth.

ERA OF FOCAL INFECTIONERA OF FOCAL INFECTIONWD MILLER & WILLIAM HUNTER

given a concept that oral bacteria & infection were likely to cause most of the person’s systemic illness.

This concept became very popular.

This era,which came to be known as “THE ERA OF FOCAL INFECTION”

o However by 1940 medicine & dentistry were realising that there was much more to explain a patients general condition than bacteria in his/her mouth.

o They realised that-

1.extarcting a person teeth donot make their disease go away.

2.people with very healthy mouths also develop systemic disease.

3.people with no teeth & thus no apparent oral infection still develop systemic disease.

FOCAL INFECTION as a primary cause of systemic infection finally came to an end.

Periodontal and coronory Periodontal and coronory heart disease/Atherosclerosisheart disease/Atherosclerosis

Periodontal and coronory Periodontal and coronory heart diseaseheart disease

CHD and CHD RELATED diseases aare the major cause of death.1989 Mattila and colleagues found an increase in caries, periodontal disease, pericoronitits and perapical lesions in patients with recent MI, when compared to controls. Many risk factors for MI were the same for Periodontitis, mainly:

Smoking Older Male Patients Lower SES

Effect of periodontal infection Effect of periodontal infection

ISCHEMIC HEART DISEASE:IHD is associated with atherogensis and

thrombogenesisIncreased blood viscosity may promote IHDIncrease in FIBRINOGEN ,WBC

COUNT,VON WILLEBRAND FACTOR increases the risk of IHD

ATHEROSCLEROSISATHEROSCLEROSIS

STROKESTROKE

OVERALL 25% OF ALL STROKE PATEINTS HAD SIGNIFICANT DENTAL INFECTIONS.

Gingivitis and Radiographic bone loss independently associated with risk of a cerebral ischemic event

How?– Active periodontitis increases the prothromotic state

recurrent bacteremia, platelet activation, increased clotting factors

Periodontitis and DiabetesPeriodontitis and Diabetes

DiabetesDiabetes

– American Diabetes Association recognizes that periodontal disease is common in diabetic patients

– Studies have shown: Diabetes is a risk factor for periodontal disease Diabetic control improves the prognosis of

periodontitis Treatment of periodontitis improves

metabolic/diabetic control

Periodontal infection associated with Periodontal infection associated with glycemic control in diabetesglycemic control in diabetes

Acute bacterial and viral infections have been shown to increase insulin resistance and aggravate glycemic control.

Systemic infections increase tissue resistance to insulin,preventing glucose from entering target cells ,causing elevated blood glucose levels

Pancreatic insulin production increases to maintain normalglycemia

Role of periodontitis in pregnancy Role of periodontitis in pregnancy outcomeoutcome

Periodontitis is a gram-ve infection that play role in low birth weight individuals.

Bacteria and products causes inflammatory response with stimulation of cytokine production in amnion.

P.gingivalis implanted in subcutaneous chambers during gestation caused significant increase in TNF-ALFA and PGE2 levels

This subcutaneous infection leads to increase in fetal death and a decrease in fetal birth weight.

Periodontal disease and Periodontal disease and COPDCOPD

COPD is characterised by airflow obstruction resulting from chronic bronchitis or emphysema.

About 14 million americans have COPD ,tobacco smoking is the primary risk factor.

COPD shares similar pathogenic mechanisms with periodontal disease.

In both diseases ,host inflammatory response is mounted in response to chronic challenge by

bacteria in periodontal disease

cigarette smoking in COPD

Broncial mucosa glands enlarge ,and inflammatory process occurs in which neutrophils and mononuclear inflammatory cells accumulate with in lung tissue.

The resulting neutrophil influx leads to release of oxidative and hydrolytic enzymes that cause tissue distruction .

In current smokers ,however the presence of severe periodontits was associated with increased risk of COPD.

This results suggest that smoking may act as a major “effect modifier” in relationship btw COPD and periodontal disease.

Periodontal disease and acute Periodontal disease and acute respiratory infectionrespiratory infection

Pneumonia is classified as Community Acquired or Nosocomial.

The most common organisms found are S. pneumoniae and H. influenzae

How do the bacteria go from the mouth to the lungs?

– Hematogenous Spread– Aspiration:

45% of healthy people aspirate upper airway substances during sleep

70% of those with impaired consciousness aspirate substances from upper airway

Hospital acquired bacterial pneumonia is usually caused by aspiration of oropharyngeal contents.

Oropharyngeal colonization with potential respiratory pathogens(PRP) increases during hospitalizations.

PRP may also orginate in the oral cavity ,with dental plaque serving as a reservoir of these organisms .

PRPS are commonly isolated from supragingival plaque and buccal mucosa of the patients .

Periodontal medicine in Periodontal medicine in clinical practice clinical practice

Periodontal infection may act as independent risk factor for systemic disease in suseptible individual.

Dentists need to know more about systemic diseases and physicians need to increase their knowledge of oral diseases.

Patient education in this regrad is also very important.

Thank youThank you