Periodontal medicine


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Periodontal medicine

  2. 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. 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. 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. 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. 6. Periodontal and coronory heart disease/Atherosclerosis
  7. 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. 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
  10. 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. 11. Periodontitis and Diabetes
  12. 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. 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. 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. 15.  This subcutaneous infection leads to increase in fetal death and a decrease in fetal birth weight.
  16. 16. Periodontal disease and COPD
  17. 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. 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. 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. 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. 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. 22. Thank you