of focal infection
 Periodontal and coronory heart
 Periodontal disease & Diabetes mellitus
 Role of periodontitis in pregnancy out come
 Periodontal disease & COPD
 Periodontal disease & Acute Respiratory
 Periodontal Medicine In Clinical Practice
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 &
The effect of oral health on the rest of the human
body was proposed by assyrians in the 7th
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
MILLER & WILLIAM HUNTER
given a concept that oral bacteria &
infection were likely to cause most of the
person’s systemic illness.
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
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.
6. Periodontal and coronory
7. Periodontal and coronory
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
Older Male Patients
8. Effect of periodontal infection
 IHD is associated with atherogensis and
 Increased blood viscosity may promote IHD
 Increase in FIBRINOGEN ,WBC
COUNT,VON WILLEBRAND FACTOR
increases the risk of IHD
25% OF ALL STROKE
PATEINTS HAD SIGNIFICANT DENTAL
 Gingivitis and Radiographic bone loss
independently associated with risk of a
cerebral ischemic event
– Active periodontitis increases the prothromotic state
 recurrent bacteremia, platelet activation, increased
11. Periodontitis and Diabetes
– American Diabetes Association recognizes that
periodontal disease is common in diabetic
– Studies have shown:
Diabetes is a risk factor for periodontal disease
 Diabetic control improves the prognosis of
 Treatment of periodontitis improves
13. Periodontal infection associated with
glycemic control in diabetes
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
14. Role of periodontitis in pregnancy
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
15.  This
subcutaneous infection leads to increase in
fetal death and a decrease in fetal birth weight.
16. Periodontal disease and
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
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
is classified as Community
Acquired or Nosocomial.
most common organisms found are S.
pneumoniae and H. influenzae
 How do the bacteria go from the mouth to the
– Hematogenous Spread
 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
 PRP may also orginate in the oral cavity ,with
dental plaque serving as a reservoir of these
 PRPS are commonly isolated from
supragingival plaque and buccal mucosa of the
21. Periodontal medicine in
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