For decades, physicians and dentists have paid close attention to their own respective fields, specializing in medicine pertaining to the body and the oral cavity, respectively. However, recent findings have strongly suggested that oral health may be indicative of systemic health. Currently, this gap between allopathic medicine and dental medicine is quickly closing, due to significant findings supporting the association between periodontal disease and systemic conditions such as cardiovascular disease, type 2 diabetes mellitus, adverse pregnancy outcomes, and osteoporosis. Significant effort has brought numerous advances in revealing the etiological and pathological links between this chronic inflammatory dental disease and these other conditions. Therefore, there is reason to hope that the strong evidence from these studies may guide researchers towards greatly improved treatment of periodontal infection that would also ameliorate these systemic illnesses. Hence, researchers must continue not only to uncover more information about the correlations between periodontal and systemic diseases but also to focus on positive associations that may result from treating periodontal disease as a means of ameliorating systemic diseases.

1. 03-July-17 Ragas dental college 1

2. ASSESSMENT OF AWARENESS AMONG THE MEDICAL POST GRADUATES REGARDING
THE SYSTEMIC EFFECTS OF PERIODONTAL DISEASE
- A QUESTIONAIRRE BASED STUDY
PRESENTED BY S. NAGARAJAN, V. NAGARAJAN
RAGAS DENTAL COLLEGE,
UTHANDI.
2

3. SYNOPSIS
Introduction
Systemic effects of periodontal infection
Awareness of medical post graduates
Conclusion
03-July-17 Ragas dental college 3

4. 4
INTRODUCTION
DENTAL MEDICAL

5. CVDs
Strokes
Diabetes
Adverse
pregnancy
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SYSTEMIC EFFECTS OF PERIODONTAL INFECTION
Lung diseases

6. EFFECT ON CARDIOVASCULAR SYSTEM
 CVDs are a common cause of death
 Periodontal disease is associated with CVD
 Link may be due to direct and indirect effects
 DIRECT EFFECT - By bacterial invasion
 INDIRECT EFFECT - By inflammatory mediators
03-July-17 6Periodontal disease and systemic conditions: a bidirectional relationship
Jemin Kim [National Institute of Health Odontology. 2006 SEPT; 94(1): 10–21]

7. DIRECT EFFECT
EFFECT ON CARDIOVASCULAR SYSTEM..(cont)
Periodontal
disease
Systemic bacteria
Bacteria invading
endothelium
Macrophages
activated
Becomes foam
cells
Traps LDL
cholestrol
Atheroma “P. Gingivalis can induce endothelial smooth-cell proliferation”
Oral bacteria associated with
atherosclerosis
T. forsythia 79%,
P. intermedia 53%
P. gingivalis 37%,
A. actinomycetemcomitans 5%
Fimbria-dependent activation of cell adhesion molecule expression in Porphyromonas gingivalis-infected endothelial cells.
Khlgatian M, Nassar H et al [Infect Immun 2002 Jan; 70(1):257-67]
Periodontal pathogens in atheromatous plaques. A controlled clinical and laboratory trial.
Cairo F, Gaeta C, Dorigo [J Periodontal 2004;39:442]

8. INDIRECT EFFECT
EFFECT ON CARDIOVASCULAR SYSTEM..(cont)
Periodontal
infection
↑WBCs,
↑VWB factor
↑Blood
viscosity
CVD
Periodontal
infection
Activation of
lymphocytes
↑Cytokines,
Endothelial
damage
CVD
Periodontal
infection
CRP from
liver
Inhibition
of NO
synthesis
CVD
Weisel RD et al
C-reactive protein upregulates angiotensin type 1 receptors in vascular smooth muscle
Weisel RD, Wang CH, Li SH, et al [Circulation 2003 Apr 8;107(13):1783-90]

9. EFFECT ON CENTRAL NERVOUS SYTEM
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“Atheroma associated with chronic inflammation are
considered unstable and prone to rupture, with increased
risk for cerebrovascular events”

10. EFFECT ON ENDOCRINE SYSTEM
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 Altered microbial flora
 Defective chemotaxis
 Altered collagen metabolism
 Inflammatory mediators
 Insulin resistance

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EFFECT ON ENDOCRINE SYSTEM..(cont)
Periodontal
treatment
Improved
insulin
sensitivity
Improved
glycemic
control
(GROSSI ET AL)
“ type 2 diabetes was highest among subjects with elevated levels of
both IL-18 and CRP” ..(MONIKA ET AL)
Elevated levels of interleukin-18 predict the development of type 2 diabetes:
MONICA/KORA Augsburg Study [Diabetes 2005 0ct; 54(10):2932PubMed: 16186395]
Assessment of risk for periodontal disease. Risk indicators for attachment loss;
Grossi SG, Zambon Et all [J Periodontol 1994;65:260–7]

12. EFFECT ON REPRODUCTIVE SYSTEM
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PERIODONTAL
INFECTION

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13
“The highest rate of preterm labour(66.7%) was observed among
those
mothers without a protective “red” complex IgG”
Madianos et Al extended work of Socransky et al
PERIODONTAL
INFECTION
IL-1 & TNF-α
IN AMNION
INCREASED
PGE₂
PRETERM
LABOR
EFFECT ON REPRODUCTIVE SYSTEM..(cont)
Chronic Periodontitis and the Incidence of Head and Neck Squamous Cell Carcinoma
Mine Tezal, A.Scannapieco et al [American Association for cancer research (AACR) 2009 SEPT EPI-09-0334]
Maternal periodontitis and prematurity. Part II: maternal infection and fetal exposure.
Madianos PN, Lieff S. [Ann peridontol. 2001 Dec;6(1):175-82]

14. EFFECT ON RESPIRATORY SYSTEM
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RISK FACTORS:
 Smoking
 Low immunity
 Previous lung conditions
PRP IN LUNGS MAY CAUSE:
 COPD
 Hospital acquired pneumonia
 Emphysema
 Bronchitis
“Dental plaque – A reservoir of Potential Respiratory Pathogens(PRP)”

15. A STUDY ON AWARENESS AMONG THE MEDICAL POST GRADUATES
REGARDING THE SYSTEMIC EFFECTS OF PERIODONTAL DISEASE
03-July-17 Ragas dental college 15
AIM: To assess the awareness regarding
the systemic effects of periodontal
disease among medical
postgraduates.
STUDY DESIGN: Questionnaire based survey
SOURCE OF DATA: Total of 150 post graduates
Three medical colleges (CHENNAI)
METHOD OF COLLECTION OF DATA: Questionnaire carrying 20 questions

16. PARTS OF QUESTIONAIRRE
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KNOWLEDGE ON PERIODONTAL
DISEASE
KNOWLEDGE ON ASSOCIATION
WITH SYSTEMIC HEALTH
ATTITUDE TOWARDS DENTAL
REFERRAL AND MANAGEMENT

17. KNOWLEDGE ON
PERIODONTAL
DISEASE
03-July-17 17Ragas dental college

18. KNOWLEDGE ON PERIODONTAL DISEASE
0
50
100
150
Inflammation of pulp inflammation of
gingiva
inflammation of
periodontium
What is periodontitis?
70%
20%
0
20
40
60
Smoking Plaque Genetics All of the above
Periodontitis could be due to________
37%
8%
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10%
37%
18%

19. 0
50
100
150
Once in a day Twice a day once in 2 days
How many times should we brush daily?
74%
0
50
100
150
Yes No
Do you think periodontal diseases can be prevented?
13%
KNOWLEDGE ON PERIODONTAL DISEASE..(cont)
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19
87%
25% 1%

20. 0
50
100
150
Improves the health of the
gingiva
Causes the receding gums Causes loosening of teeth
Frequent scaling__________
0
20
40
60
80
2-3 months 6 months 12 months
One should visit dentist once in _______
50%
KNOWLEDGE ON PERIODONTAL DISEASE..(cont)
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80%
15% 5%
37% 13%

21. KNOWLEDGE ON
ASSOCIATION WITH
SYSTEMIC HEALTH
03-July-17 21Ragas dental college

22. 0
50
100
150
Yes No
Do you think oral disease is an indicator of systemic
disease?
80%
0
20
40
60
80
100
Systemic disease
may lead to
periodontal disease
Periodontal disease
may lead to
systemic diseases
Two way process Oral cavity is a
remote cavity, so no
relationship
Relationship between systemic and periodontal disease
______
57%
23% 20%
KNOWLEDGE ON ASSOCIATION WITH SYSTEMIC HEALTH
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22
20%

23. 0
10
20
30
40
Cadiovascular
system
Endocrine
system
Reproductive
system
Respiratory
system
All of the above
Which of the following system have a link with periodontal
disease______
0
50
100
Increased atherosclerosis Increased myocardial
infarction
Both a & b
Patient with periodontal disease are more likely to
have __________
KNOWLEDGE ON ASSOCIATION WITH SYSTEMIC HEALTH..(cont)
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23
25%
60%
23% 20%
7%
25%
23%
17%

24. 0
20
40
60
80
100
120
1st 4th 6th
Periodontitis is _________complication of diabetes mellitus
13%
0
50
100
150
Periodontal abscess Bleeding gums Ulcers
Which is the most common periodontal manifestations seen in
uncontrolled diabetes patient
KNOWLEDGE ON ASSOCIATION WITH SYSTEMIC HEALTH..(cont)
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24
80%
70%
17%
13% 7%

25. 0
50
100
150
Yes No
Do you think periodontal disease a possible risk for
adverse pregnancy outcome_______
87%
13%
KNOWLEDGE ON ASSOCIATION WITH SYSTEMIC HEALTH..(cont)
03-July-17
Ragas dental college
25
0
20
40
60
80
Deformed child Autistic child Preterm low birth
weight child
Not responded
If yes, pregnant women with periodontal disease can
have_________
50%
30% 13% 7%

26. KNOWLEDGE ON ASSOCIATION WITH SYSTEMIC HEALTH..(cont)
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0
50
100
150
Yes No
Does smoking affect the healing of periodontal
disease?
87%
13%
0
50
100
150
Yes No
Did you know that there is association between
periodontal disease and hospital acquired pneumonia
73%
27%

27. THEIR ATTITUDE
TOWARDS DENTAL
REFERRAL AND
MANAGEMENT
03-July-17 27Ragas dental college

28. THEIR ATTITUDE TOWARDS DENTAL REFERRAL AND
MANAGEMENT
0
50
100
Yes No
Have you referred a patient with oral manifestation of
systemic disease to dentist?
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57% 43%
0
50
100
Yes No
Are you aware that LASER is used for the treatment of
periodontal disease?
57% 43%

29. THEIR ATTITUDE TOWARDS DENTAL REFERRAL..(cont)
0
20
40
60
80
Dental practitioners Internet & Media Books Experience
Where did you get this information?
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20%
50%
13% 17%
0
50
100
150
Poor Average Excellent
How do you rate your knowledge about the periodontal
disease and its association with systemic
73%27%

30. INTERPRETATION
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KNOWLEDGE ON PERIODONTAL
DISEASE
KNOWLEDGE ON ASSOCIATION
WITH SYSTEMIC HEALTH
ATTITUDE TOWARDS DENTAL
REFERRAL AND MANAGEMENT 57.3%
61.4%
66.4%

31. 03-July-17 Ragas dental college 31
CONCLUSION
61.7%
 Conducting CME programs
 Integrated teaching of medical and dental sciences
Medical post graduates had an average awareness regarding the
systemic effects of periodontal disease

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REFERENCE

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REFERENCE

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