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Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
Periodontal medicine
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Periodontal medicine

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  • 1. PERIODONTAL MEDICINE BY M.BHARATH REDDY
  • 2. OBJECTIVES  Introduction  Era of focal infection  Periodontal and coronory heart disease/Atherosclerosis  Periodontal disease & Diabetes mellitus  Role of periodontitis in pregnancy out come  Periodontal disease & COPD  Periodontal disease & Acute Respiratory Infection  Periodontal Medicine In Clinical Practice
  • 3. INTRODUCTION     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.
  • 4. ERA OF FOCAL INFECTION  WD MILLER & WILLIAM HUNTER given a concept that oral bacteria & infection were likely to cause most of the person’s systemic illness.  This  This concept became very popular. era,which came to be known as “THE ERA OF FOCAL INFECTION”
  • 5. 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 that1.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. o
  • 6. Periodontal and coronory heart disease/Atherosclerosis
  • 7. Periodontal and coronory heart 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
  • 8. Effect of periodontal infection  ISCHEMIC HEART DISEASE:  IHD is associated with atherogensis and thrombogenesis  Increased blood viscosity may promote IHD  Increase in FIBRINOGEN ,WBC COUNT,VON WILLEBRAND FACTOR increases the risk of IHD
  • 9. ATHEROSCLEROSIS
  • 10. STROKE  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
  • 11. Periodontitis and Diabetes
  • 12. Diabetes – 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 
  • 13. Periodontal infection associated with glycemic 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
  • 14. Role of periodontitis in pregnancy outcome  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
  • 15.  This subcutaneous infection leads to increase in fetal death and a decrease in fetal birth weight.
  • 16. Periodontal disease and COPD
  • 17.  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
  • 18.  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.
  • 19. Periodontal disease and acute respiratory 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
  • 20.  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 .
  • 21. Periodontal medicine in 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.
  • 22. Thank you

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