Periodontal medicine is a branch of periodontology that focuses on the relationship between periodontal health/disease and systemic health/disease. Periodontal disease can influence systemic health through direct effects of infectious agents or indirect host-mediated inflammatory responses. Periodontal disease has been linked to increased risk of cardiovascular disease, diabetes, and preterm low birth weight. Treatment of periodontal infection may help reduce systemic inflammation and improve conditions like diabetes and cardiovascular disease.
PERIODONTAL MEDICINE 1.pptx DIABETES DIABENitika588942
The term periodontal medicine, as first suggested by Offenbacher, that defines a rapidly emerging branch of periodontology focusing on the wealth of new data establishing a strong relationship between periodontal health or disease and systemic health or disease.
This means a two-way relationship in which periodontal disease in an individual may be a powerful influence on an individual’s systemic health or disease as well as the more customarily understood role that systemic disease may have in influencing an individual’s periodontal health or disease.It would be new diagnostic and treatment strategies that recognize the relationship between periodontal disease and systemic disease.
William Hunter, attesting to the influence of oral sepsis on systemic health and disease.
Recently scientists and clinicians have begun to provide an increasing body of scientific evidence suggesting that moderate untreated periodontitis may affect an individual systemically, and may contribute to cardiovascular disease, diabetes and pre-term low birth weight.This is important new information indeed. It appears that not just teeth are at stake in maintaining good oral health.
Rather, oral health is an important component of general health, and individuals with periodontitis may be at risk for other diseases as well.
Evidence has also shed light on the converse side of the relationship between systemic health and oral health: the potential effects of inflammatory periodontal diseases on a wide range of organ systems.Pathogenesis of periodontitis has changed remarkably over last 30 years.
The non-specific accumulation of bacterial plaque was once thought to be the cause of periodontal destruction, but it is now recognized that periodontitis is an infectious disease associated with a small number of predominantly gram-negative microorganisms that exist in a subgingival biofilm.
Furthermore, the importance of the host in disease initiation and progression is clearly recognized.
Although pathogenic bacteria are necessary for periodontal disease, they are not sufficient alone to cause the disease.
A susceptible host is also imperative. In a host who has relatively low susceptibility to disease, bacterial pathogens may have no clinical effect.
This may be due to a particularly effective host immunoinflammatory response that eliminates pathogenic organisms while minimizing destruction of native tissues.
Conversely, in a host with relatively high disease susceptibility, marked destruction of periodontal tissues may result.Acc. To William Hunter in 1900,
Oral microorganism- responsible for systemic conditions
Restoration instead of extraction, trapping of infectious agents
Gingivitis & periodontitis- foci of infection .Acc. To William Hunter in 1900,
Oral microorganism- responsible for systemic conditions
Restoration instead of extraction, trapping of infectious agents
Gingivitis & periodontitis- foci of infection
Acc. To William Hunter in 1900,
Oral microorganism
PERIODONTAL MEDICINE 1.pptx DIABETES DIABENitika588942
The term periodontal medicine, as first suggested by Offenbacher, that defines a rapidly emerging branch of periodontology focusing on the wealth of new data establishing a strong relationship between periodontal health or disease and systemic health or disease.
This means a two-way relationship in which periodontal disease in an individual may be a powerful influence on an individual’s systemic health or disease as well as the more customarily understood role that systemic disease may have in influencing an individual’s periodontal health or disease.It would be new diagnostic and treatment strategies that recognize the relationship between periodontal disease and systemic disease.
William Hunter, attesting to the influence of oral sepsis on systemic health and disease.
Recently scientists and clinicians have begun to provide an increasing body of scientific evidence suggesting that moderate untreated periodontitis may affect an individual systemically, and may contribute to cardiovascular disease, diabetes and pre-term low birth weight.This is important new information indeed. It appears that not just teeth are at stake in maintaining good oral health.
Rather, oral health is an important component of general health, and individuals with periodontitis may be at risk for other diseases as well.
Evidence has also shed light on the converse side of the relationship between systemic health and oral health: the potential effects of inflammatory periodontal diseases on a wide range of organ systems.Pathogenesis of periodontitis has changed remarkably over last 30 years.
The non-specific accumulation of bacterial plaque was once thought to be the cause of periodontal destruction, but it is now recognized that periodontitis is an infectious disease associated with a small number of predominantly gram-negative microorganisms that exist in a subgingival biofilm.
Furthermore, the importance of the host in disease initiation and progression is clearly recognized.
Although pathogenic bacteria are necessary for periodontal disease, they are not sufficient alone to cause the disease.
A susceptible host is also imperative. In a host who has relatively low susceptibility to disease, bacterial pathogens may have no clinical effect.
This may be due to a particularly effective host immunoinflammatory response that eliminates pathogenic organisms while minimizing destruction of native tissues.
Conversely, in a host with relatively high disease susceptibility, marked destruction of periodontal tissues may result.Acc. To William Hunter in 1900,
Oral microorganism- responsible for systemic conditions
Restoration instead of extraction, trapping of infectious agents
Gingivitis & periodontitis- foci of infection .Acc. To William Hunter in 1900,
Oral microorganism- responsible for systemic conditions
Restoration instead of extraction, trapping of infectious agents
Gingivitis & periodontitis- foci of infection
Acc. To William Hunter in 1900,
Oral microorganism
Oral-systemic link has been termed Periodontal Medicine. Significance: Periodontal disease is preventable and readily treatable, thus providing many new opportunities for preventing and improving several systemic diseases.
FOCAL INFECTION: Localized or Generalized infection caused by dissemination of microorganisms or toxic products from focus of infection.
FOCUS OF INFECTION Confined area that
(1) contains pathogenic microorganisms
(2) can occur anywhere in body
Diseases/Conditions affected by periodontitis
A PREGNANCY, PREECLAMPSIA
B ISCHEMIC HEART DISEASES, STROKE
C DIABETES MELLITUS
D PNEUMONIA, COPD
E OSTEOPOROSIS
F CANCER
G ALZHEIMER’S DISEASE
H. RHEUMATOID ARTHRITIS
Diabetes mellitus is a systemic disease characterized by increased blood glucose levels and abnormalities of lipid metabolism due to absence or decreased level of insulin. It affects all the body organs and their functions either directly or indirectly. Every dentist should have a basic understanding of the etiopathogenesis, oral and systemic manifestations of this disease. The periodontal diseases are a consequence of extension of the gingival inflammation into the underlying supporting structures of the periodontium, initiated by the presence of plaque and its products on the surfaces of the teeth and the adjoining structures. The progression of periodontal disease is influenced by variety of factors like microorganisms, host response, systemic background, and genetic makeup of the host. Amongst them, diabetes mellitus tops the list. Diabetes and periodontitis influence the clinical outcome of each other and control of both influences the clinical improvement of each.
Diabetes mellitus is a systemic disease characterized by increased blood glucose levels and abnormalities of lipid metabolism due to absence or decreased level of insulin. It affects all the body organs and their functions either directly or indirectly. Every dentist should have a basic understanding of the etiopathogenesis, oral and systemic manifestations of this disease. The periodontal diseases are a consequence of extension of the gingival inflammation into the underlying supporting structures of the periodontium, initiated by the presence of plaque and its products on the surfaces of the teeth and the adjoining structures. The progression of periodontal disease is influenced by variety of factors like microorganisms, host response, systemic background, and genetic makeup of the host. Amongst them, diabetes mellitus tops the list. Diabetes and periodontitis influence the clinical outcome of each other and control of both influences the clinical improvement of each.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Oral-systemic link has been termed Periodontal Medicine. Significance: Periodontal disease is preventable and readily treatable, thus providing many new opportunities for preventing and improving several systemic diseases.
FOCAL INFECTION: Localized or Generalized infection caused by dissemination of microorganisms or toxic products from focus of infection.
FOCUS OF INFECTION Confined area that
(1) contains pathogenic microorganisms
(2) can occur anywhere in body
Diseases/Conditions affected by periodontitis
A PREGNANCY, PREECLAMPSIA
B ISCHEMIC HEART DISEASES, STROKE
C DIABETES MELLITUS
D PNEUMONIA, COPD
E OSTEOPOROSIS
F CANCER
G ALZHEIMER’S DISEASE
H. RHEUMATOID ARTHRITIS
Diabetes mellitus is a systemic disease characterized by increased blood glucose levels and abnormalities of lipid metabolism due to absence or decreased level of insulin. It affects all the body organs and their functions either directly or indirectly. Every dentist should have a basic understanding of the etiopathogenesis, oral and systemic manifestations of this disease. The periodontal diseases are a consequence of extension of the gingival inflammation into the underlying supporting structures of the periodontium, initiated by the presence of plaque and its products on the surfaces of the teeth and the adjoining structures. The progression of periodontal disease is influenced by variety of factors like microorganisms, host response, systemic background, and genetic makeup of the host. Amongst them, diabetes mellitus tops the list. Diabetes and periodontitis influence the clinical outcome of each other and control of both influences the clinical improvement of each.
Diabetes mellitus is a systemic disease characterized by increased blood glucose levels and abnormalities of lipid metabolism due to absence or decreased level of insulin. It affects all the body organs and their functions either directly or indirectly. Every dentist should have a basic understanding of the etiopathogenesis, oral and systemic manifestations of this disease. The periodontal diseases are a consequence of extension of the gingival inflammation into the underlying supporting structures of the periodontium, initiated by the presence of plaque and its products on the surfaces of the teeth and the adjoining structures. The progression of periodontal disease is influenced by variety of factors like microorganisms, host response, systemic background, and genetic makeup of the host. Amongst them, diabetes mellitus tops the list. Diabetes and periodontitis influence the clinical outcome of each other and control of both influences the clinical improvement of each.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
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Fitness Regimen
Workout Routine
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. Offenbacher 1996 defines periodontal medicine as a
rapidly emerging branch of periodontology which
focuses on the research of new data establishing a
strong relationship between periodontal health or
disease and systemic health or disease.
3
4. This means a two-way relationship in which periodontal disease in
an individual may have a powerful influence on an individual’s
systemic health or disease .
Non specific accumulation of bacterial plaque was once thought to
be the cause of periodontal destruction, but now it is recognised
that periodontitis is an infectious disease associated with
predominantly gram negative bacteria.
Although pathogenic bacteria are necessary for periodontal
disease, they are not sufficient alone to cause the disease. A
susceptible host is also required.
4
5. There are many systemic conditions that can
modify the host susceptibility to periodontitis.
Patients with immune suppression may not be able
to mount effective host response to subgingival
microorganisms, resulting in more rapid and severe
attachment loss.
5
6. Although the potential impact of many systemic
conditions on the periodontium is well documented,
recent studies done by Seymour et al suggest that
periodontal infection may significantly enhance the risk
for certain systemic condition or alter the course of
systemic condition.
6
7. Acc. To William Hunter in 1900,
◦ Oral microorganism- responsible for systemic
conditions
◦ Restoration instead of extraction, trapping of
infectious agents
◦ Gingivitis & periodontitis- foci of infection
Connection between oral sepsis & resulting systemic
condition could be shown by removal of causative sepsis
through extraction & observation of improvement in
systemic health
7
8. This theory fell into disrepute in 1940’s & 1950’s
when widespread extraction failed to reduce or
eliminate the systemic conditions to which the
supposedly infected dentition has been linked.
8
11. Well known relationship
Study done by Matilla et al found that MI patients had significantly
worse dental health than did the controls.
This association between poor dental health and MI was independent
of the known risk factor for heart disease such as age, hypertension,
chlosterol levels, diabetes.
Malthaner et al also found an increased risk of angiographically
defined CAD in subjects showing greater attachment and bone loss.
However after adjusting for other risk factor for the CAD the
relationship between the periodontal status and CAD was no longer
significant.
11
13. Increased viscosity of blood → increase risk of
thrombus formation → ischemic heart disease &
cerebrovascular accident
Factors affecting blood viscosity
◦ Plasma fibrinogen
◦ Plasma lipoproteins
◦ White blood cell count
◦ von Willebrand factor
◦ Increased plasma fibrinigen level is considered as
risk factor for cardiovascular disease (Lowe et al).
13
14. Systemic or periodontal infection
↑ Fibrinogen, ↑ White blood cell count
↑ von Willebrand factor
↑ Blood viscosity
Ischemic heart disease
14
15. Thrombogenesis
Platelet aggregation plays a major role in
thrombogenesis .
Most cases of acute myocardial infarction are
precipitated by thromboembolism
Oral organisms may be involved in coronary
thrombogenesis
15
16. Thromboembolism mechanism
Platelet binds – Streptococcus sanguis and P. gingivalis
↓
Platelet aggregation – Plalelet Aggregation Associated
Protein
↓
Bacterial strains enters the circulation
↓
Forms thromboemboli
↓
Cardiac & pulmonary changes
16
17. It is a focal thickening of the arterial intima , the
innermost layer lining the lumen of the vessel , and
the arterial media, the thick layer under the arterial
intima consisting of smooth muscle, collagen, and
elastic fibres.
Occur in large & medium sized elastic & muscular
arteries
Intimal lesion is called atheroma or atheromatous or
fibro fatty plaques
Protrude into & obstruct vascular lumina
17
18. Periodontitis & atherosclerosis have many potential
pathogenic mechanism in common
Both have
Complex causation
Genetic & gender predisposition
Share many risk factors, most significant is
smoking status
Periodontitis, which is a chronic inflammation
initiated by microbial plaque can predispose to
atherosclerosis.
18
19. LPS released from microorganisms within the
periodontal pocket- enter the diseased
periodontium.
Monocytes/ Macrophages adheres vascular
endothelium
Ingest circulating LDL & forms foam cell –
atheromatous plaque
Smooth muscle & collagen proliferation – arterial
wall thickening
Narrows lumen & ↓blood flow
19
23. 1. Direct effects of infectious agents in atheroma
formation
2. Indirect or host mediated effects triggered by
infection
3. Common genetic predisposition for periodontal
disease & atherosclerosis
4. Common risk factors such as life style
24. Direct effects of infectious agents in
atheroma formation
Studies done by Tonetti M et al, 2007 show
Porphyromonas gingivalis is found in carotid and
coronary atheromas.
Deshpande and colleagues (1998) conducted a
study and concluded that P. gingivalis can invade
and may proliferate in the endothelial cells
Herzberg and Meyer (1996) showing that P.
gingivalis is able to induce aggregation of
platelets, which is thought to be associated with
thrombus formation.
25. Indirect or host mediated effects triggered by
infection
Periodontitis induces an inflammatory response,
production of acute-phase proteins, such as C-reactive
protein and fibrinogen. C-reactive protein and
fibrinogen are independent risk factors for coronary
artery disease, hence if they are induced by
periodontal infection, this may help explain the link
between periodontal disease and heart disease.
26. A recent study by Wu and colleagues (1999) using the
NHANES III database, found that C-reactive protein and
plasma fibrinogen were related to poor periodontal health,
which provides support for this hypothesis.
27. Common genetic predisposition for periodontal
disease & atherosclerosis
Beck JD and colleagues (1996) have provided
a model proposing that there is a genetically
determined hyper inflammatory macrophage
phenotype in periodontal disease, which
contributes to the susceptibility for
atherosclerosis
28. 28
Potential linkage mechanisms for periodontal disease &
myocardial infarction
Evidence for the role of inflammatory mediators
C-reactive protein (CRP)
Smooth muscle cells proximal to apoptotic cells in the
arterial plaque produce secretory type II phospholipase
which interacts with inverted phospholipid bilayer in the
membrane of an apoptotic cell, thus preparing a nidus for
CRP to bind.
CRP induces local proinflammatory cytokine production &
may bind complement either prior to tissue localisation or
in situ, thereby enhancing removal of dying cell.
Complement activation in turn may precipitate collateral
damage.
29. 29
Tumor Necrosis Factor-α
TNF-α has been shown to increase the synthesis of
triglycerides in the liver and to inhibit lipoprotein
lipase.
This elevated levels of triglyceride rich
glycoproteins and decreased levels of high density
lipoprotein cholesterol has been associated with
coronary heart disease.
Also macrophages and smooth muscle cells
expressing TNF –α are present in atherosclerotic
plaques, suggesting its role in atherogenesis.
30. 30
Fibrinogen
•Fibrinogen is an acute phase protein mainly
synthesized in the liver in response to IL-6.
•Fibrinogen levels increase during infections and
inflammatory conditions including Periodontitis.
• IL-1 is considered as one of the important mediators
in the pathogenesis of periodontal disease and both
fibrinogen and fibrin can stimulate production of IL-1β
and protein by binding to CD18 integrin receptors on
normal human monocytes.
31. 31
ICAM-1 and VCAM-1
Intercellular adhesion molecule-1(ICAM-1) and
vascular cell adhesion molecule-1 (VCAM-1) are
important in the firm endothelial cell attachment and
transendothelial migration of leucocytes, thus
playing a central role in leucocyte recruitment and
their function in inflammatory reactions.
These molecules act as modulators of cell to cell
interactions as activators of certain target cells and
possibly, even as neutrophil chemoattractants. These
soluble factors have been associated with various
inflammatory conditions.
32. Presence of systemic infection before stroke
↓
Greater ischemia & more severe post ischemic
neurologic defect.
32
Stroke patients with a preceding infection had a slightly
higher levels of plasma fibrinogen & CRP than those without
infection
33. Syrjagen et al 1989, found a statistically significant poor level of
oral health in patients with ischemic cerebral infarction as
compared to controls.
Grau & colleagues 1997, reported that poor dental status was
associated with cerebral ischemia.
Beck & colleagues 1996, provided first longitudinal data relating
stroke to oral infections. They found that high mean alveolar bone
loss was predictive of subsequent stroke.
33
34. Complex metabolic disorder characterised by chronic
hyperglycemia.
Diminished insulin secretion, impaired insulin action or
a combination of both result in the inability of
glucose to be transported from the bloodstream into
the tissues which in turn results in high blood glucose
level.
Alteration in lipid or protein metabolism
34
35. 1. Type 1 diabetes (insulin dependent)
2. Type 2 diabetes (non insulin dependent)
3. Gestational diabetes
4. Others
◦ Genetic defects in beta cell function
◦ Genetic defects in insulin action
35
36. Food digestion
↓
↑ blood glucose
↓
↑ Insulin secretion
↓
Muscle increases uptake of glucose
Muscle & liver store glucose as glycogen
Liver prevents glycogen from breaking down into glucose
↓
↓ blood glucose
36
37. Type 1 diabetes Type 2 diabetes
Age of onset Generally < 30 years Generally in adult hood
Most common body type Thin or normal stature Obese
Race White African American,
American Indian
Family history Common More common
Rapidity of clinical onset Abrupt Slow
Pathogenesis Autoimmune beta cell
destruction
Insulin resistance, impaired
insulin secretion, increased
liver glucose production
Endogenous insulin
production
None Decreased, normal or
elevated
Susceptibility to
ketoacidosis
High Low
Treatment may include Diet, exercise, insulin Diet, exercise, oral agents,
insulin
37
38. It is clear from epidemiologic research that diabetes
increases risk for & severity of periodontal disease.
The increased prevalence and severity of
periodontitis typically seen in patients with diabetes,
especially those with poor metabolic control led to
the designation of periodontal disease as sixth
complication of diabetes (Loe et al ).
38
40. Taylor et al conducted a study amongst type 2 diabetes
patients and concluded that severe periodontitis was
associated with significant worsening of the glycemic control
over time.
He concluded that individual with severe periodontitis at
baseline examination were associated with a greater
incidence of worsening glycemic control over a period of 2 to
4 years as compared to those without periodontitis at
baseline examination.
Macrovascular complications were also found to be more
amongst individual with severe periodontitis at baseline.
40
41. In diabetic patients with periodontitis, periodontal therapy
may have beneficial effect on glycemic control.
This is true for patients with with relatively poor glycemic
control and advanced periodontal destruction before
treatment.
Hiltunen et al conducted a study amongst 65 subjects with
type 1 diabetes and chronic periodontitis and found that
although there was overall improvement in periodontal health
after therapy , 35 % of subjects had an improvement in
glycemic control after therapy, 37 % had no significant
change and 28 % showed worsening of glycemic control.
41
42. 42
Effects of periodontal infection on glycemia
•Bacterial infections decrease insulin-mediated glucose
uptake by skeletal muscle and produce whole-body insulin
resistance.
• Acute endotoxemia and cytokine production, mostly
TNF-α and IL-lß, induce insulin resistance and decreased
insulin action.
•The insulin receptor tyrosine kinase, and the action of
protein kinase C may, either individually or in combination,
mediate some of the insulin effects such as translocation
and activation of glucose-transporting proteins.
43. 43
•TNF-α has been suggested as the mediator of
insulin resistance in infection by suppressing insulin
induced tyrosine phosphorylation of insulin receptor
substrate-1 (IRS-1), thus impairing insulin action.
46. Treatment with scaling & root planing, surgery,
selected tooth extraction & systemic antibiotics
resulted in decreased insulin demand.
Miller et al 1992, evaluated that scaling & root
planing combined with systemic doxycycline therapy
for 2 weeks, when given in type I diabetic patients
with improved periodontal health also had significant
improvement in glycemic control.
46
47. Tetracycline can also be given as tetracycline is known to
suppress glycation of proteins & to decrease activity of
tissue- degrading enzymes such as MMPs.
Diabetes is associated with greatly elevated production of
collagenase, low dose doxycycline has been used in
treatment of periodontitis in diabetic subjects.
Al-Ghazi et al 2003 & Engerbretson et al 2003,
reported short term improvements in glycemic control
with combination therapy, whereas no change was seen
with mechanical therapy alone.
47
48. The international definition of low birth weight
adopted by the Twenty-ninth World Health Assembly
in 1976 is a birth weight of ‘‘less than 2500 g’’
Low birth weight can be as a result of both a short
gestational period and retarded intrauterine growth.
48
49. Causes
◦ Preterm labor or premature rupture of membranes
◦ Smoking, alcohol or drugs use during pregnancy
◦ Inadequate prenatal care
◦ Race, low socioeconomic status
◦ Hypertension, diabetes
◦ High or low maternal age
◦ Genitourinary tract infection
◦ Maternal stress & genetic background
◦ Periodontal disease
49
50. Labor is characterized by coordinated uterine
contractions leading to cervical dilatation, and finally
expulsion of the fetus.
In term (‘‘normal’’) labor, rupture of the membranes
occurs after initiation of contractions.
50
51. 51
•The earliest identified events in labor are increases in
the bioavailability of prostaglandin E2, and in the
concentration of receptors for the hormone oxytocin.
• The increase in oxytocin receptors during labor induces
the stretching of the cervix and myometrium which is
thought to initiate a neurogenic reflex to the
neurohypophysis of the pituitary gland, which acts as
positive feedback for oxytocin production.
52. Remote gram- negative infection may play a role in
LBW infants
Periodontopathic organisms & their products may
mediate host cytokine production in target tissues.
Collins et al 1994, reported that P.gingivalis during
gestation causes significant increase in TNF- a &
PGE2.
52
53. Significant correlation between both TNF- a & PGE2
levels, as well as fetal death & growth retardation.
Collins et al also evaluated that there was
decreased fetal birth weight & increased fetal death
after intravenous injections with LPS derived from
P.gingivalis.
Offenbacher et al 1996 found that women having
LBW infants had greater clinical attachment loss
than women having NBW infants.
53
54. In a cross sectional study, women having LBW infants
had significantly higher levels of A.A, Bacteroides
forsythus, P. gingivalis and Treponema denticola in
their subgingival plaque.
Lopez et al 2002 found that women who received
SRP before 28 weeks of gestation, followed by
prophylaxis every 2 weeks until parturition, had a
LBW rate of 1.8% as compare to women who did not
receive periodontal therapy who had LBW rate of
10.1%
54
55. 55
•Periodontal infections, serve as reservoirs for Gram-
negative anaerobic organisms, lipopolysaccharide (LPS,
endotoxin), and inflammatory mediators.
•Exposure to oral LPS down-regulates E-selectin
expression on endothelial cells and thereby prevents the
normal leukocytic margination and diapedesis which would
occur in response to a secondary enteric LPS challenge.
•This raises the possibility that systemic challenge with
oral LPS may inhibit normal neutrophil clearance of
enteric organisms that may permit a selective
overgrowth or invasion of Gram-negative organism within
the genitourinary tract. including PGE2 and TNF-α, may
pose a potential threat to the fetal-placental unit.
56. 56
Bacterial Vaginosis
Caused by changes in the vaginal microflora in which
normally predominant facultative lactobacilli are
replaced by Gardnerella vaginalis; anaerobic
organisms, including species of the genera Prevotella,
Bacteroides, Peptostreptococcus, Porphyromonas,
and others.
Bacterial vaginosis is a known risk factor for
preterm labor, premature rupture of membranes, and
LBW.
.
57. 57
The primary mechanism has traditionally been thought
to be ascending infection from the vagina and
endocervix.
Endotoxin & bioactive enzymes by many organisms
associated with vaginosis may directly injure tissue, as
well as induce release of proinflammatory cytokines
and prostaglandins.
58. 58
•Throughout normal gestation, amniotic prostaglandin levels
rise steadily until a sufficient threshold is reached that
induces labor and delivery.
•Maternal infection may cause increased prostaglandin
production and may result in labor- inducing levels being
•achieved before full gestation
•Various pro-inflammatory cytokines such as IL-1, IL-6, and
TNF α have been found in the amniotic fluid of women with
preterm labor.
•Women with preterm labor often have culture-positive
amniotic fluid, even in the absence of clinical infection. Of
culture-positive patients, the most commonly isolated
species is Fusobacterium nucleatum.
59. Airflow obstruction resulting from chronic bronchitis
or emphysema.
Bronchial mucosal gland enlarge & inflammatory
process occurs in which neutrophils & mononuclear
inflammatory cells accumulate within the lung tissue.
59
61. Share similar pathogenic process
Host inflammatory response mounted in response to
chronic challenge
◦ By bacteria in periodontal disease
◦ By factors like cigarette smoke in COPD
Neutrophil influx → release of oxidative & hydrolytic
enzymes → tissue destruction directly.
61
62. Recruitment of monocytes & macrophages leads to
further release of proinflammatory cytokines.
Hayes et al (1998) found a positive correlation
between advanced alveolar bone loss and COPD.
Scannapieco et al 1998, individuals with poor oral
hygiene have been found to be at increased risk for
chronic respiratory diseases such as bronchitis &
emphysema.
62
63. Infection of the lungs caused by
63
Bacteria
Viruses
Fungi
Mycoplasma
65. Caused by
◦ Inhalation of infectious aerosol
◦ Aspiration of oropharyngeal organism
Streptococcus pneumoniae & H.influenzae
Antibiotic therapy is highly successful in resolution
of the cases of community acquired pneumonia.
Till now no association between periodontal disease &
community acquired pneumonia has been found
65
66. Nosocomial pneumonia
Gram- negative aerobic organism
Many cases by anaerobic bacteria, subgingival
environment
It is usually caused by the aspiration of
oropharyngeal contents, potential respiratory
pathogens (PRPs)
66
67. Selective decontamination to eradicate PRPs- systemic
antibiotics + orally administered nonabsorbable antibiotics
PRPs may also originate in oral cavity, dental plaque serve
as a reservoir
Subgingival plaque harbor PRPs & periodontal pathogens,
associated with nosocomial pneumonia.
Furthermore, anaerobic organisms from periodontal
pocket may serve as a inoculum for suppurative
respiratory diseases.
67
68. Scannapieco et al 2003, concluded that
interventions used to improve oral hygiene, such as
mechanical tooth brushing & chemical antimicrobials
rinses, have a potential to decrease the risk of
nosocomial pneumonia in high-risk patients, such as
those in intensive care units or those on ventilators.
68
69. 1. Oral pathogens may be aspirated into lung to cause
infection
2. Periodontal disease- associated enzymes in saliva may
modify mucosal surfaces to promote adhesion &
colonization by respiratory pathogens
3. Periodontal disease- associated enzymes may destroy
salivary pellicles on pathogenic bacteria
4. Cytokines originating from periodontal tissues may alter
respiratory epithelium to promote infection by
respiratory pathogens
69
70. Periodontal disease may affect the host’s susceptibility to
systemic disease through subgingival biofilms, acting as
reservoirs of Gram negative bacteria, transient
bacteremia, release of microbial toxins & as a reservoir of
inflammatory mediators.
More research is needed to these systemic diseases, &
then develop appropriate interventions
More research is needed before recommendations can be
made to treat periodontal disease as a strategy to prevent
or treat CVD, diabetes mellitus, pre-term birth & other
adverse pregnancy outcomes & also respiratory diseases.
70