The mysterious link


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The link between periodontal disease and systemic disease

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The mysterious link

  1. 1. The mysterious link A tragic Drama The association between Periodontal disease and systemic diseases
  2. 2. Starring…Periodontal Disease
  3. 3. Co-Starring…Inflammation
  4. 4. With help from… Inflammatory mediators C-reactiveFibrinogen protein Serum amyloid A
  5. 5. Special Guest Stars…Diabetes
  6. 6. Rheumatoid Arthritis
  7. 7. Respiratory Disease
  8. 8. AdversePregnancy Outcome
  9. 9. Alzheimers
  10. 10. And a likely appearance by…CardiovascularDisease
  11. 11. Periodontal Periodontal Pathogens Infection Immune Bacteremia Response Inflammatory Mediators (IL-1, IL- 6, TNF ) Liver C-reactive protein Serum amyloid A Fibrinogen Antibodies to bacteria, Cross-reactive antigens,Platelet aggregation, T-cell sensitisationEndothelial invasion Cardiovascular disease
  12. 12. Inflammatory mediators Cytokines:Interleukin-1: Responsible for the production of inflammation, as well as the promotion of fever and sepsis.Produced mainly by macrophages and neutrophils.Involved in regulation of the immune response..
  13. 13. Inflammatory mediatorsInterleukin-6:Released in response to infection.Acts as both a pro-inflammatory and anti- inflammatory cytokine. Secreted by T-cells and macrophages to stimulate immune response.
  14. 14. Inflammatory mediatorsTNF- Tumor necrosis factor) involved in systemic inflammation and is a member of a group of cytokines that stimulate the acute phase reaction.Regulates immune cells, induces fever, apoptotic cell death, sepsis, inflammation and inhibit tumorigenesis and viral replication.
  15. 15. Periodontal Periodontal Pathogens Infection Immune Bacteremia Response Inflammatory Mediators (IL-1, IL- 6, TNF ) Liver C-reactive protein Serum amyloid A Fibrinogen Antibodies to bacteria, Cross-reactivePlatelet aggregation, antigens, T-cellEndothelial invasion Cardiovascular disease sensitisation
  16. 16. C-reactive proteinSynthesized by liverFound in the bloodIncreased in response to inflammationPatients with a high CRP are more likely todevelop diabetes, hypertension andcardiovascular disease.
  17. 17. Serum amyloid AReleased in response to inflammatory stimuli.Implicated in several chronic inflammatory diseases, such as amyloidosis, atherosclerosis, and rheumatoid arthritis.
  18. 18. FibrinogenSynthesized in the liver.Converted by thrombin into fibrin, which plays a role in the inflammatory response AND the development of rheumatoid arthritis.
  19. 19. Patient educationWhat might your patients know?
  20. 20. Discussion:• What studies, if any, show a link between PD and systemic diseases?• Does the article come to a definite conclusion of any kind?• Anything of interest in your article.
  21. 21. Why is it a mystery?“The difficulty in drawing a cause and effect relationship between periodontitis and cardiovascular disease stems from the fact that the two groups of diseases share many risk factors” J Periodontol, 2012 May 25
  22. 22. In Conclusion…“As the ongoing studies report and confirm thestrength of the association between periodontaldisease and cardiovascular disease, in the nexttwo decades, the oral healthcare professionalsand the medical professionals have to preparefor better planning of prevention programs. Itseems from the scientific evidence gathered sofar that interventional periodontal care remainsinvaluable not only for oral health but forgeneral health as well.”J Indian Soc Periodontol, 2010 Jul-Sep; 14(3): 148-154