Oral systemic

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This short course reveals some of the studies that show how oral health affects systemic health. Inflammation is the root cause of all the trouble, and the mouth is the most under evaluated sources of …

This short course reveals some of the studies that show how oral health affects systemic health. Inflammation is the root cause of all the trouble, and the mouth is the most under evaluated sources of the inflammation.

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  • This course will talk about how poor oral heath contributes to poor health in general. We will attempt to show how oral biofilm interferes with health and why it’s important to reduce oral biofilm. We’ll also show you how to decrease oral biofilm without resorting to brushing and flossing.The most important thing, though, is to understand that people with teeth live longer and better than people without. A number of studies show this to be true.
  • This is just one of the more recent studies that shows that teeth are a good indicator of health. However the teeth must be kept free of oral biofilm as the teeth are an indication, too, of how well a person takes care of themselves. Some people spend thousands of dollars on their teeth and maintaining a healthy mouth, it’s up to us to continue helping them with their maintinance.J Periodontol. 2011 Aug 23. [Epub ahead of print]Number of Teeth is Related to Atherosclerotic Plaque in the Carotid Arteries in an Elderly Population.Holmlund A, Lind L.SourceDepartment of Periodontology, the County Hospital of Gävle-Sandviken.AbstractBackground: Periodontal disease has been associated with cardiovascular disorders with an atherosclerotic background, and number of teeth has been suggested as a possible risk indicator for cardiovascular disease. The objective of this study was to investigate whether number of teeth (NT) was related to the intima-media thickness (IMT) and to atherosclerotic plaque in carotid arteries in an elderly population. Materials and methods: In a population-based study including 1016 subjects aged 70, the number of teeth was self-reported by 947 of the subjects. Carotid artery IMT was evaluated by ultrasound. The occurrence of plaque was also measured. Logistic regression was used to analyze the associations between NT and the number of carotid arteries with plaque. Results: A significant inverse relationship was found between the NT and the number of carotid arteries with plaque following adjustment for age, sex, smoking, BMI, waist/hip ratio, blood glucose, triglycerides, cholesterol, C-reactive protein, leukocyte count, blood pressure and Framingham risk score, with odds ratio 0.89, 95% CI 0.82-0.98, p-value 0.016. The relationship was fairly linear, suggesting a dose-response relationship. When NT was divided into quintiles using the first one as referent, the relationship persisted for all quintiles except for the second one. However, no relationship to IMT was seen. Conclusion: The present study further emphasizes that tooth loss could be an easily obtained risk indicator for atherosclerosis.
  • http://www.jstage.jst.go.jp/article/internalmedicine/50/15/50_1569/_articleIntern Med. 2011;50(15):1569-74. Epub 2011 Aug 1.Inflammatory cytokines, adiponectin, insulin resistance and metabolic control after periodontal intervention in patients with type 2 diabetes and chronic periodontitis.Sun WL, Chen LL, Zhang SZ, Wu YM, Ren YZ, Qin GM.SourceDepartment of Oral Medicine and Periodontology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, China.AbstractOBJECTIVE:To evaluate the effects of periodontal intervention on inflammatory cytokines, adiponectin, insulin resistance (IR), and metabolic control and to investigate the relationship between type 2 diabetes mellitus (T2DM) and moderately poor glycemic control and chronic periodontitis.METHODS AND PATIENTS:A total of 190 moderately poorly controlled (HbA1c between 7.5% and 9.5%) T2DM patients with periodontitis were randomly divided into two groups according to whether they underwentperiodontal intervention: T2DM-NT and T2DM-T group. The levels of serum adiponectin, C-reactive protein(CRP), tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), lipid profile, glucose, insulin, homeostasis model of assessment-insulin resistance (HOMA-IR) and homeostasis model assessment of β-cell function (HOMA-β) were measured at baseline and after 3 months.RESULTS:The levels of clinical periodontal variables, the probing depth, attachment loss, bleeding index, and plaque index were improved significantly in T2DM-T group after 3 months compared to T2DM-NT group (all p<0.01). After 3 months, the serum levels of hsCRP, TNF-α, IL-6, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS) and HOMA-IR index decreased, and adiponectin was significantly increased in T2DM-T group compared to those in the T2DM-NT group (p<0.05 or p<0.01).CONCLUSION:Periodontal intervention can improve glycemic control, lipid profile and IR, reduce serum inflammatory cytokine levels and increase serum adiponectin levels in moderately poorly controlled T2DM patients.
  • One measure that shows us the inflamation level in people with disease is C reactive protein. This protein is made in the liver as a response to inflammation. It is an excellent marker for that however it is not only a marker.Angiology. 2011 Jan;62(1):62-7. Epub 2010 Jun 13.Periodontitis and cardiovascular disease: Floss and reduce a potential risk factor for CVD.El Fadl KA, Ragy N, El Batran M, Kassem N, Nasry SA, Khalifa R, Sedrak H, Isenovic ER.SourceDepartment of Oral Medicine, Periodontology and Diagnosis, Cairo University, Egypt.Retraction inAngiology. 2011 May;62(4):352.AbstractThere is evidence supporting an association between cardiovascular disease (CVD) and periodontitis. We determined whether patients with chronic periodontitis, who are otherwise healthy individuals, have higher serum concentrations of emerging risk markers of CVD such as C-reactive protein (CRP) and interleukin 6 (IL-6) and investigated the effect of subsequent periodontal treatment on the levels of these markers. A total of 40 individuals were included in the study. Serum levels of CRP and IL-6 were estimated twice, once on the initial visits and the other 3 months after periodontal therapy. The mean CRP and IL-6 levels were significantly higher (P < .001) in the patients compared with controls and significantly decreased (P < .001) following periodontal treatment. This study suggests that periodontitis is a potential modifiable risk factor for CVD.
  • Angiology. 2011 Jan;62(1):62-7. Epub 2010 Jun 13.Periodontitis and cardiovascular disease: Floss and reduce a potential risk factor for CVD.El Fadl KA, Ragy N, El Batran M, Kassem N, Nasry SA, Khalifa R, Sedrak H, Isenovic ER.SourceDepartment of Oral Medicine, Periodontology and Diagnosis, Cairo University, Egypt.Retraction inAngiology. 2011 May;62(4):352.AbstractThere is evidence supporting an association between cardiovascular disease (CVD) and periodontitis. We determined whether patients with chronic periodontitis, who are otherwise healthy individuals, have higher serum concentrations of emerging risk markers of CVD such as C-reactive protein (CRP) and interleukin 6 (IL-6) and investigated the effect of subsequent periodontal treatment on the levels of these markers. A total of 40 individuals were included in the study. Serum levels of CRP and IL-6 were estimated twice, once on the initial visits and the other 3 months after periodontal therapy. The mean CRP and IL-6 levels were significantly higher (P < .001) in the patients compared with controls and significantly decreased (P < .001) following periodontal treatment. This study suggests that periodontitis is a potential modifiable risk factor for CVD.
  • Periodontal disease, which is an infection around the teeth, increases the amount of C-RP in the blood. A number of other things cause this number to increase, for instance obesity, arthritis, and many other things that would be considered an inflammatory disease. So, just periodontal disease doesn’t cause this number to be elevated. Although it does contribute to the elevated number. The thing that is still unclear is how much periodontal disease contributes to all the other inflammatory diesease. It is clear that periodontal disease contributes to cardiovascular events by setting up system wide biochemistry that participates in the damage.MinervaStomatol. 2010 May;59(5):271-83.Periodontal therapy and biomarkers related to cardiovascular risk.MouraFoz A, AlexandreRomito G, ManoelBispo C, LuciancencovPetrillo C, Patel K, Suvan J, D'Aiuto F.SourcePeriodontology Unit, Dental School, University of San Paolo, San Paolo, Brazil.AbstractIn the last 15-20 years the association between periodontitis and cardiovascular diseases has received greater attention. Clinical evidence also suggests that periodontitis is associated with a systemic host response and with a low-grade inflammatory state, as assessed by raised serum levels of CRP and endothelial dysfunction. This is a perturbation of the normal function of the endothelial cells that are responsible for a normal vascular function (dilatation, constriction). The objective of this review was to systematically appraise the available evidence on the effect of periodontal therapy on systemic biomarkers related to cardiovascular risk. An electronic search was conducted using MEDLINE via PubMed to identify published literature. The electronic search identified 836 references, of which 643 were considered irrelevant for this review. Full texts of 183 possible relevant articles were assessed, with exclusion of 174. Nine studies were included in the review. The overall effect of periodontal therapy was associated with a reduction in CRP of 0.50 mg/ml (95% CI 0.15, 0.85) (P=0.005). In conclusion, this review supports the hypothesis of an association between periodontitis and systemic inflammation. Further research is needed on the possible impact of periodontitis on cardiovascular disease events.
  • Not only is CRP an indicator, it interferes with healing! All that stuff on your residents teeth, partials and dentures is causing them to have an increased amount of CRP, and that is interfering with their healing abilities. How much does it interfere? We’re not sure yet but it seems prudent to reduce the biofilm so the body doesn’t have to work so hard.© American Heart Association, Inc. Clinical Investigation and ReportsC-Reactive Protein Attenuates Endothelial Progenitor Cell Survival, Differentiation, and Function Further Evidence of a Mechanistic Link Between C-Reactive Protein and Cardiovascular Disease SubodhVerma, MD, PhD; Michael A. Kuliszewski, BSc; Shu-Hong Li, MSc; Paul E. Szmitko, BSc; Liana Zucco, BSc; Chao-Hung Wang, MD; Mitesh V. Badiwala, BSc; Donald A.G. Mickle, MD; Richard D. Weisel, MD; Paul W.M. Fedak, MD; Duncan J. Stewart, MD Michael J.B. Kutryk, MD, PhD From the Division of Cardiac Surgery (S.V., S.-H.L., P.E.S., C.-H.W., M.V.B., D.A.G.M., R.D.W., P.W.M.F.), Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada, and the Division of Cardiology (M.A.K., L.Z., D.J.S., M.J.B.K.), Terrence Donnelly Heart Centre, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada. Correspondence to SubodhVerma, MD, PhD, Division of Cardiac Surgery, Toronto General Hospital, 14EN-215, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4. E-mail subodh.verma@sympatico.caReceived January 28, 2003; de novo received February 17, 2004; revision received March 16, 2004; accepted March 16, 2004.
  • After periodontal treatment patient’s C-reactive protein levels decreased in the entire study. Their Fibrinogen numbers also decrease substantially after treatment. This shows that periodontally involved teeth impact a person’s ability to clot!!
  • Periodontal disease also contributes to respiratory infections, starting with pneumonia and even participating in COPD. Early studies suggest in increased incidence of COPD and periodontal disease in a general population.J Periodontol. 2011 Aug;82(8):1155-60. Epub 2011 Jan 10.Association between respiratory disease in hospitalized patients and periodontal disease: a cross-sectional study.Sharma N, Shamsuddin H.SourceDepartment of Periodontics, Institute of Technology and Science, Center for Dental Studies and Research, Murad Nagar, Ghaziabad, Uttar Pradesh, India.AbstractBackground: Recent research indicated that periodontal infection may worsen systemic diseases, includingpulmonary disease. Respiratory infections, such as pneumonia and the exacerbation of chronic obstructive pulmonary disease, involve the aspiration of bacteria from the oropharynx into the lower respiratory tract. Methods: A group of 100 cases (hospitalized patients with respiratory disease) and a group of 100 age-, sex-, and race-matched outpatient controls (systemically healthy patients from the outpatient clinic, Department of Periodontics, Government Dental College and Hospital, Calicut, Kerala, India) were selected for the study. Standardized measures of oral health that were performed and compared included the gingival index (GI), plaque index (PI), and simplified oral hygiene index (OHI). Data regarding probing depths and clinical attachment levels (CALs) were recorded at four sites per tooth and compared statistically. The χ(2) and Student t tests were used for statistical analyses. Results: The comparison of study-population demographics on the basis of age, sex, education, and income showed no significant differences between groups. Patients with respiratory disease had significantly greater poor periodontal health (OHI and PI), gingival inflammation (GI), deeper pockets, and CALs compared to controls. In the case group, patients with a low income were 4.4 times more prone to periodontal disease compared to high-income patients. Smokers had significantly higher CALs compared to non-smokers in the control group. Conclusion: The findings of the present analysis support an association between respiratory and periodontal disease.
  • Ann Periodontol. 2003 Dec;8(1):54-69.Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review.Scannapieco FA, Bush RB, Paju S.SourceDepartment of Oral Biology, School of Dental Medicine, University at Buffalo, State University of New York, Buffalo, New York, USA. fas1@buffalo.eduAbstractBACKGROUND:Several recent studies provide evidence that the oral cavity may influence the initiation and/or the progression of lung diseases such as pneumonia and chronic obstructive pulmonary disease(COPD).RATIONALE:Studies have shown that poor oral hygiene and periodontal disease may foster colonization of the oropharyngeal region by respiratory pathogens, particularly in hospital or nursing home patients. If aspirated, these pathogens can cause pneumonia, one of the most common respiratory infections, especially in institutionalized subjects. Other cross-sectional epidemiologic studies point to an association betweenperiodontal disease and COPD. This systematic review examines the literature to determine if interventions that improve oral hygiene reduce the rate of pneumonia in high-risk populations.FOCUSED QUESTION:Do periodontal diseases or other indicators of poor oral health influence the initiation/progression of pneumonia or other lung diseases?SEARCH PROTOCOL:MEDLINE, pre-MEDLINE, MEDLINE Daily Update, and the Cochrane Controlled Trials Register were searched to identify published studies that related variables associated with pneumonia and other lung disease to periodontal disease. Searches were performed for articles published in English from 1966 through March 2002.INCLUSION CRITERIA:Randomized controlled clinical trials (RCTs), longitudinal, cohort, and case-control studies were included. Study populations included patients with any form of pneumonia or chronic obstructive pulmonary disease (COPD) and periodontal disease, as measured by assessments of gingival inflammation, probing depth, clinical attachment level, and/or radiographic bone loss, or oral hygiene indices.EXCLUSION CRITERIA:Limited to studies of humans.DATA COLLECTION AND ANALYSIS:The summary statistics used to analyze the RCTs included weighted mean differences in rates of disease between control and intervention groups. For cohort studies that measured differences in rates of disease between groups with and without oral disease, weighted mean differences, relative risks, or odds ratios were compared. A meta-analysis was performed on the 5 intervention studies to determine the relationship between oral hygiene intervention and rate of pneumonia in institutionalized patients.MAIN RESULTS:Of the initial 1,688 studies identified, 36 satisfied all inclusion criteria and were read. Of these, 21 (11 case-control and cohort studies [study population 1,413] and 9 RCTs [study population 1,759]) were included in the analysis. 1. A variety of oral interventions improving oral hygiene through mechanical and/or topical chemical disinfection or antibiotics reduced the incidence of nosocomial pneumonia by an average of 40%. 2. Several studies demonstrated a potential association between periodontal disease andCOPD.REVIEWERS' CONCLUSIONS:1. Oral colonization by respiratory pathogens, fostered by poor oral hygiene and periodontal diseases, appears to be associated with nosocomial pneumonia. 2. Additional large-scale RCTs are warranted to provide the medical community with further evidence to institute effective oral hygiene procedures in high-risk patients to prevent nosocomial pneumonia. 3. The results associating periodontaldisease and COPD are preliminary and large-scale longitudinal and epidemiologic and RCTs are needed.
  • This review was published in the Annals of Periodontology in 2003. The researchers looked at 36 studies evaluating the correlations. Ann Periodontol. 2003 Dec;8(1):54-69.Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review.Scannapieco FA, Bush RB, Paju S.SourceDepartment of Oral Biology, School of Dental Medicine, University at Buffalo, State University of New York, Buffalo, New York, USA. fas1@buffalo.eduAbstractBACKGROUND:Several recent studies provide evidence that the oral cavity may influence the initiation and/or the progression of lung diseases such as pneumonia and chronic obstructive pulmonary disease(COPD).RATIONALE:Studies have shown that poor oral hygiene and periodontal disease may foster colonization of the oropharyngeal region by respiratory pathogens, particularly in hospital or nursing home patients. If aspirated, these pathogens can cause pneumonia, one of the most common respiratory infections, especially in institutionalized subjects. Other cross-sectional epidemiologic studies point to an association betweenperiodontal disease and COPD. This systematic review examines the literature to determine if interventions that improve oral hygiene reduce the rate of pneumonia in high-risk populations.FOCUSED QUESTION:Do periodontal diseases or other indicators of poor oral health influence the initiation/progression of pneumonia or other lung diseases?SEARCH PROTOCOL:MEDLINE, pre-MEDLINE, MEDLINE Daily Update, and the Cochrane Controlled Trials Register were searched to identify published studies that related variables associated with pneumonia and other lung disease to periodontal disease. Searches were performed for articles published in English from 1966 through March 2002.INCLUSION CRITERIA:Randomized controlled clinical trials (RCTs), longitudinal, cohort, and case-control studies were included. Study populations included patients with any form of pneumonia or chronic obstructive pulmonary disease (COPD) and periodontal disease, as measured by assessments of gingival inflammation, probing depth, clinical attachment level, and/or radiographic bone loss, or oral hygiene indices.EXCLUSION CRITERIA:Limited to studies of humans.DATA COLLECTION AND ANALYSIS:The summary statistics used to analyze the RCTs included weighted mean differences in rates of disease between control and intervention groups. For cohort studies that measured differences in rates of disease between groups with and without oral disease, weighted mean differences, relative risks, or odds ratios were compared. A meta-analysis was performed on the 5 intervention studies to determine the relationship between oral hygiene intervention and rate of pneumonia in institutionalized patients.MAIN RESULTS:Of the initial 1,688 studies identified, 36 satisfied all inclusion criteria and were read. Of these, 21 (11 case-control and cohort studies [study population 1,413] and 9 RCTs [study population 1,759]) were included in the analysis. 1. A variety of oral interventions improving oral hygiene through mechanical and/or topical chemical disinfection or antibiotics reduced the incidence of nosocomial pneumonia by an average of 40%. 2. Several studies demonstrated a potential association between periodontal disease andCOPD.REVIEWERS' CONCLUSIONS:1. Oral colonization by respiratory pathogens, fostered by poor oral hygiene and periodontal diseases, appears to be associated with nosocomial pneumonia. 2. Additional large-scale RCTs are warranted to provide the medical community with further evidence to institute effective oral hygiene procedures in high-risk patients to prevent nosocomial pneumonia. 3. The results associating periodontal disease and COPD are preliminary and large-scale longitudinal and epidemiologic and RCTs are needed.
  • The researchers will came to the following conclusions. That improving oral hygiene can reduce the incidence of pneumonia by 40% and that a number of studies show a correlation between the two.Ann Periodontol. 2003 Dec;8(1):54-69.Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review.Scannapieco FA, Bush RB, Paju S.
  • Respir Med. 2011 Jan;105(1):67-73. Epub 2010 Jul 13.Periodontal health and quality of life in patients with chronic obstructive pulmonary disease.Zhou X, Wang Z, Song Y, Zhang J, Wang C.SourceDepartment of Stomatology, Beijing ChaoYang Hospital affiliated to Capital Medical University, Beijing, China.AbstractOBJECTIVE:To evaluate the association of periodontal health and parameters of quality of life assessed in 306 Chinese patients with chronic obstructive pulmonary disease (COPD).METHODS:Periodontal status and respiratory function in 306 COPD patients were clinically evaluated and their quality of life was assessed using the standardized St George's Respiratory Questionnaire (SGRQ).RESULTS:The SGRQ scores were all significantly correlated with major lung function parameters (r(2) = -0.37 to -0.28; all p < 0.0001) and Medical Research Council dyspnoea scale (r(2) = 0.23 to 0.30; all p < 0.0001). The SGRQ scores also correlated with the 6-min walk test (r(2) = -0.15 to -0.13; all p < 0.05). Ofperiodontal health parameters, missing tooth number and plaque index appeared to be related to the scores of quality of life. The age- and gender-adjusted Pearson's correlation coefficients between missing teeth and total score, symptoms score, and activity score were 0.09, 0.12, and 0.12, respectively (all p < 0.05). The Pearson's correlation coefficients between plaque index and symptoms score and activity score were 0.09 and 0.09 (p < 0.05). After adjusting for age, gender, body mass index, and smoking status, missing teeth remained significantly associated with symptom score (p = 0.030) and activity score (p = 0.033) while plaque index was significantly associated with symptom score (p = 0.007).CONCLUSIONS:Poor periodontal health as reflected by missing teeth and plaque index was significantly associated with lower quality of life in COPD patients. Our findings indicate the importance of promoting dental care in current public health strategies to improve the quality of life in COPD patients.
  • These are some examples of periodontal pathogens inter other parts from the body and causing some problems. Feel free to elaborate on some of these examples. All are major elements of periodontal biofilm infection. The infectious components create a stew in the pocket and the chemistry that is created from all those bacteria start to break things down.
  • Those bacteria love not only on the teeth they also live on the tongue. Bacteria, virus and yeast grow in between the taste buds, and on the teeth as well as in that little moat around the teeth.
  • Volatile sulfur compounds also stimulate bacterial growth. And they have effect on the cells too. As the biofilm accumulates on the teeth and on the tongue proteins break down and release volatile sulfur compounds that smell bad, and are often called halitosis.
  • These are examples from MSDS sheets from hydrogen sulfide. The gas produced by necrotic tissue increases the space between the cells that make up the gums not the pocket, but the soft tissue wall of the pocket. As that space increases more bacteria can enter into the blood system and travel around.
  • The soft tissue wall of the pocket is still epithelium, however once the biofilm grows in there the pocket wall becomes permeable and stimulates the inflammatory cascade. White blood cells are called into action however because the biofilm is present they are impotent. The liver starts to make C-reactive proteins in and effort to help the situation but CRP blocks the ability of blood vessels to heal all over the body, not just around the teeth.
  • All of this trouble, and drama comes from a complex organism called a biofilm. Treating just one organism in the biofilm won’t help. A biofilm protects its inhabitants that include bacteria, as well as virus and fungus. Dental scientists are looking at the amount of yeast in the oral biofilm and how that yeast contributes to the decay in teeth.
  • This is a picture of a typical resident in a nursing home. The blue plaque is over 24 hours old. The light blue is plaque that is so massive that the stain didn’t penetrate. The sticky mass contains all the components of a pneumococcal infection of the lungs. The condition of the gingivae is a tell tale sign that this biomass has not been attended to in many days. The CNA at this facility love their residents, they are long term employees of this facility and care very deeply what happens to the residents.It’s hard to get in there to clean. This resident knew we were going to take a picture but still his lips had to be pried and he could not co operate fully with the attempts. This is not a reason to give up. It’s a reason to try another way to access the mouth.
  • The soft tissue wall of the pocket is still epithelium, however once the biofilm grows in there the pocket wall becomes permeable and stimulates the inflammatory cascade. White blood cells are called into action however because the biofilm is present they are impotent. The liver starts to make C-reactive proteins in and effort to help the situation but CRP blocks the ability of blood vessels to heal all over the body, not just around the teeth.
  • Insurance companies have been following the science and doing their own studies looking at the people in their system. They have found that people with diabetes, for instance, have lower medical costs if they have their teeth and mouth healthy as measured by dental visits.
  • Reducing the oral biofilm is a key component to having a healthy resident. This is a dental hygienist going in to brush the teeth of one of her patients who cannot come to the office any longer. He is in a care facility and she stops by twice a week for 5 or 6 minutes to brush his teeth. As measured by the amount of bleeding he had with brushing before she started and after she brushed his teeth for a few weeks he’s doing much better.
  • These two pictures represent two servings of xylitol per day, and two applications of MI Paste per day. Compliance rate of CNA was 78%. Brushing was not stressed, they were asked to brush as usual.
  • These functional foods have been shown to help reduce the ability of early bacterial colonizers to attach. Without attachment there is no biofilm.

Transcript

  • 1. Oral Systemic
    How oral health contributes to overall health
  • 2. People with clean teeth live better and healthier
  • 3. Number of Teeth is Related to Atherosclerotic Plaque in the Carotid Arteries in an Elderly Population.
    Conclusion:
    The present study further
    emphasizes that tooth loss
    could be an easily obtained
    risk indicator for atherosclerosis.
    J Periodontol. 2011 Aug 23.
  • 4. Periodontal intervention
    can improve glycemic control,
    lipid profile and IR, reduce serum
    inflammatory cytokine levels
    and increase serum adiponectin
    levels in moderately poorly
    controlled T2DM patients.
    Intern Med. 2011;50(15):1569-74.
  • 5. 2011
    C – Reactive Protein
    Marker for cardiovascular disease. People with inflammation have higher levels of C-RP in their systems than those who don’t. And people with periodontal infections have higher levels of C-RP in their blood.
  • 6. 2011
    C – Reactive Protein
    This study suggests that periodontitis is a potential modifiable risk factor for CVD.
    Angiology. 2011 Jan;62(1):62-7
  • 7. 2010
    C – Reactive Protein
    In conclusion, this review supports the hypothesis of an association between periodontitis and systemic inflammation. Further research is needed on the possible impact of periodontitis on cardiovascular disease events.
    Minerva Stomatol. 2010 May;59(5):271-83.
  • 8. CRP inhibits Endothelial Progenitor Cell
    (EPC) which plays a critical role in endothelium repair.
    SubodhVerma, MD, PhD; Michael A
    Clinical Investigation and Reports C-Reactive Protein Attenuates Endothelial Progenitor Cell Survival, Differentiation, and Function: Further Evidence of a Mechanistic Link Between C-Reactive Protein and Cardiovascular Disease
  • 9. Integrating Oral Health and Systemic Health
  • 10. 2011
    The findings of the present analysis support an association between respiratory and periodontal disease.
    J Periodontol. 2011 Aug;82(8):1155-60
  • 11. 2003
    Associations between periodontal 
    disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review.
    Ann Periodontol. 2003 Dec;8(1):54-69
  • 12. 2003
    36 studies satisfied all inclusion criteria
    21 (11 case-control and cohort studies [study population 1,413] and
    9 RCTs [study population 1,759]) were included in the analysis.
  • 13. 2003
    A variety of oral interventions improving oral hygiene through mechanical and/or topical chemical disinfection or antibiotics reduced the incidence of nosocomial pneumonia by an average of 40%.
    Several studies demonstrated a potential association between periodontal disease and COPD.
  • 14. 2011
    Poor periodontal health as reflected by missing teeth and plaque index was significantly associated with lower quality of life in COPD patients. Our findings indicate the importance of promoting dental care in current public health strategies to improve the quality of life in COPD patients.
    Respir Med. 2011 Jan;105(1):67-73.
  • 15.
  • 16. Not Healthful
  • 17. Volatile Sulfur Compounds from gums breaking down
  • 18. VSC
    • Significant H2S poisoning usually occurs by inhalation.
    • 19. Local irritant effects, along with arrest of cellular respiration, may follow.
    • 20. Effects similar to cyanide toxicity.
    • 21. Easily penetrates biologic membranes.
    Hydrogen sulfide
  • 22. The epithelium becomes permeable
  • 23. All Due to Biofilm
  • 24.
  • 25. The biofilm is growing on the soft tissue wall blocking healing
    Image courtesy of Patterson Technology
  • 26. Plaque formation is enhanced at tooth surfaces adjacent to inflamed gingiva
    Sekino S et al. J ClinPeriodontol. 2005;32(2):182-187.
  • 27. “Analysis indicated that periodontal care appeared to have a positive effect on the cost of medical care… Members with periodontal treatment also had lower retrospective risk for their chronic condition (diabetes, CAD, CVD).”
    Mary Lee Conicella, DMD, FAGD, National Director of Clinical Operations for Aetna Dental.
  • 28. Reducing oral biofilm
    Brushing is just one way to remove oral biofilm.
    Flossing is another.
    Foods have been identified to reduce oral biofilm too.
  • 29. Reducing oral biofilm
    Xylitol can reduce oral biofilm when offered to residents up to five times per day.
  • 30. Nobody doesn’t like candy
    Shirley Gutkowski, RDH, BSDH, FACE
  • 31. Reduce oral biofilm
  • 32. Conclusion
    C-RP interferes with healing
    Oral biofilm stimulates C-RP and other inflammatory markers
    Oral biofilm reduction is important to COPD
  • 33. Find out the laws restricting dental hygienists in your state!
    Mandating a dental hygienist on the staff of all Medicaid funded care facilities can save millions of dollars a year just in people with diabetes.
  • 34. Credits
    PowerPoint designed by
    Cross Link Presentations, LLC
    Presentation design
    Shirley Gutkowski, RDH, BSDH, FACE
    crosslinkpresent@aol.com
    ScriptShirley Gutkowski, RDH, BSDH, FACE
    Photos: Dreamstime, Gutkowski, StoneCharacters: PresenterMedia
    Copyright 2011 Exploring Transitions, LLC