Periodontitis is considered a silent epidemic in Malaysia, as it meets the criteria of being both an epidemic and a silent disease. Nearly half the adult population in Malaysia has periodontitis, placing a huge economic burden on the country. Periodontitis patients with diabetes face double jeopardy, as the two diseases exacerbate each other. However, most people are unaware of the relationship between oral and systemic health, and periodontitis often goes undetected until it significantly impacts quality of life. There is an urgent need for education about periodontitis to address this silent epidemic.
Periodontal diseases Classifications and treatmentsRiad Mahmud
Prof. Dr. Md. Zahid Hossain, Division of Periodontology, Department of Preventive Dental Sciences, College of Dentistry, Najran University, Saudi Arabia.Former Professor of Periodontology, City Dental College, Dhaka
explaining about Periodontal disease
The term periodontal disease is used in a general sense to encompass all diseases of the periodontium.
The most common disease is initiated by plaque accumulation in the gingivodental area and is basically inflammatory in character, termed marginal periodontitis or more accurately chronic destructive periodontitis.
The periodontal tissues can also be involved by other nosologic entities and many of these fall into degenerative or neoplastic categories. They are considered as periodontal manifestations of systemic diseases
CHRONIC DESTRUCTIVE PERIODONTITIS
Periodontitis
Marginal periodontitis
Slowly progressing
Rapidly progressing
Refractory
Juvenile form of periodontitis
Generalized form
Localized form
Necrotizing Ulcerative Periodontitis
Trauma from occlusion*
Periodontal atrophy*
Presenile atrophy
Disuse atrophy
MARGINAL PERIODONTITIS
Clinical features: chronic inflammation of the gingiva, pocket formation, and bone loss. Tooth mobility and pathologic migration appear in advanced cases.
Etiology: dental plaque
Types: slowly progressing periodontitis, rapidly progressing periodontitis, refractory periodontitis
Presenile atrophy
reduction in the height of periodontium that is uniform throughout the mouth and without apparent cause
Disuse atrophy
Results when the functional stimulation for the maintenance of the periodontal tissues is markedly diminished or absent.
characterized by thinning of periodontal ligament, thinning and reduction in the number of periodontal fibers and disruption of fiber bundle arrangement, thickened cementum, reduction in height of alveolar bone, and osteoporosis
A periodontal pocket is a pathologically deepened sulcus: it is one of the important clinical features of periodontal disease.
SYMPTOMS:
Localized pain or a sensation of pressure after eating, which gradually diminishes
A foul taste in localized areas.
A tendency to suck material from the interproximal spaces.
Radiating pain “deep in the bone”
A “gnawing” feeling or feeling of itchiness in the gums.
Periodontal diseases Classifications and treatmentsRiad Mahmud
Prof. Dr. Md. Zahid Hossain, Division of Periodontology, Department of Preventive Dental Sciences, College of Dentistry, Najran University, Saudi Arabia.Former Professor of Periodontology, City Dental College, Dhaka
explaining about Periodontal disease
The term periodontal disease is used in a general sense to encompass all diseases of the periodontium.
The most common disease is initiated by plaque accumulation in the gingivodental area and is basically inflammatory in character, termed marginal periodontitis or more accurately chronic destructive periodontitis.
The periodontal tissues can also be involved by other nosologic entities and many of these fall into degenerative or neoplastic categories. They are considered as periodontal manifestations of systemic diseases
CHRONIC DESTRUCTIVE PERIODONTITIS
Periodontitis
Marginal periodontitis
Slowly progressing
Rapidly progressing
Refractory
Juvenile form of periodontitis
Generalized form
Localized form
Necrotizing Ulcerative Periodontitis
Trauma from occlusion*
Periodontal atrophy*
Presenile atrophy
Disuse atrophy
MARGINAL PERIODONTITIS
Clinical features: chronic inflammation of the gingiva, pocket formation, and bone loss. Tooth mobility and pathologic migration appear in advanced cases.
Etiology: dental plaque
Types: slowly progressing periodontitis, rapidly progressing periodontitis, refractory periodontitis
Presenile atrophy
reduction in the height of periodontium that is uniform throughout the mouth and without apparent cause
Disuse atrophy
Results when the functional stimulation for the maintenance of the periodontal tissues is markedly diminished or absent.
characterized by thinning of periodontal ligament, thinning and reduction in the number of periodontal fibers and disruption of fiber bundle arrangement, thickened cementum, reduction in height of alveolar bone, and osteoporosis
A periodontal pocket is a pathologically deepened sulcus: it is one of the important clinical features of periodontal disease.
SYMPTOMS:
Localized pain or a sensation of pressure after eating, which gradually diminishes
A foul taste in localized areas.
A tendency to suck material from the interproximal spaces.
Radiating pain “deep in the bone”
A “gnawing” feeling or feeling of itchiness in the gums.
Periodontitis as a manifestation of systemic diseasesDr. vasavi reddy
Describes conditions that show periodontal manifestations inherently and primary cause is the disease itself whereas bacterial plaque acts as a secondary factor.
Pericoronitis is defined as inflammation of the oral soft tissues surrounding the crown of a partially erupted tooth. its treatment- operculectomy i.e. removal of the inflammed operculum
Definition of pulpitis, Factors causing injury to the pulp, aerodontalgia, classification of pulpitis, clinical features of various types of pulpitis, histopathology and its treatment are inlisted in this presentation.
Oral diseases: a global public health challenge and Ending the neglect of glo...Karishma Sirimulla
This presentation includes various lacunae faced by low and middle income contries due to the dental health policy and also highlights the areas where the reformation has to be made in order to utilize the dental services equally by all group of people
Periodontitis as a manifestation of systemic diseasesDr. vasavi reddy
Describes conditions that show periodontal manifestations inherently and primary cause is the disease itself whereas bacterial plaque acts as a secondary factor.
Pericoronitis is defined as inflammation of the oral soft tissues surrounding the crown of a partially erupted tooth. its treatment- operculectomy i.e. removal of the inflammed operculum
Definition of pulpitis, Factors causing injury to the pulp, aerodontalgia, classification of pulpitis, clinical features of various types of pulpitis, histopathology and its treatment are inlisted in this presentation.
Oral diseases: a global public health challenge and Ending the neglect of glo...Karishma Sirimulla
This presentation includes various lacunae faced by low and middle income contries due to the dental health policy and also highlights the areas where the reformation has to be made in order to utilize the dental services equally by all group of people
revision and summary of Oral diseases: a global public health challenge.
Marco A Peres, Lorna M D Macpherson, Robert J Weyant, Blánaid Daly, Renato Venturelli, Manu R Mathur, Stefan Listl, Roger Keller Celeste, Carol C Guarnizo-Herreño, Cristin Kearns, Habib Benzian, Paul Allison, Richard G Watt
Diabetes in dependent adults is pervasive. Many are suffering needlessly because their oral health is contributing to glucose management.
Dental hygienists in most states are unable to care for these people without a prescription from a dentist. It's an unnecessary hurdle.
Evaluation of Syrian Diabetics’ Knowledge Regarding the Two-Way Relationshi...semualkaira
Periodontal disease is considered as a serious complication of Diabetes Mellitus. Both diseases have a bidirectional adverse association. Patient’s self-care of oral hygiene and awareness of periodontal complications of diabetes is an important factor in controlling complications of diabetes.
Evaluation of Syrian Diabetics’ Knowledge Regarding the Two-Way Relationship ...semualkaira
Periodontal disease is considered
as a serious complication of Diabetes Mellitus. Both diseases have
a bidirectional adverse association. Patient’s self-care of oral hygiene and awareness of periodontal complications of diabetes is an
important factor in controlling complications of diabetes.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. PERIODONTITIS PATIENTS WITH DIABETES:
A DOUBLE JEOPARDY
Is Periodontitis A Silent Epidemic In Malaysia?
22NDMDASCIENTIFICCONVENTION&TRADEEXHIBITION2015
24TH JANUARY2015
SUNWAYPYRAMIDCONVENTIONCENTRE
TUTI NINGSEH MOHD DOM
BDS, MPH, PhD
Periodontology Research Team, UKM and partners
www.sihatgusi.info
2. • “Periodontitis patients with diabetes: a
double jeopardy?”
• Is it really a double jeopardy?
• Or is there to too much ado over
nothing?
Double jeopardy:
• Punishment of a person twice for the
same offence?
• Considerable danger or trouble from
two sources?
• Twice danger of harm, loss or failure
3. Is periodontitis a silent epidemic?
First of all what does it mean when we say
that a disease is a silent epidemic?
As we can see there are two elements to
this question:
• First, is periodontitis an epidemic?
• And second, is it a silent disease?
4. 1. Is periodontitis an epidemic?
• A disease is said to be of epidemic proportions when its
occurrence is more than would be expected in a
community or region during a given time period.
5. Global epidemiology of periodontal disease
• Most countries > 90% have periodontal disease (Morris et al 2001, Borrell et al 2002)
• 5 – 20% adults affected with severe periodontitis (Petersen & Ogawa 2005)
• Trends:
• Europe: shallow pockets (37%), deep pockets (14%)
(Borrell et al 2002)
• Asia: shallow pockets (8 – 57%), deep pockets (5 –
28%)
(Corbet et al 2002)
6. • Global Burden of Disease Study of 291 diseases and injuries:
• Severe periodontitis is sixth most prevalent (11%)!
(1) Marcenes, W et al 2013. Global Burden of Oral Conditions in 1990-2010: A systematic analysis. J Dent
Res, 92, (7) 592 (2) Kassebaum, E. et al 2014. Global Burden of Severe Periodontitis in 1990-2010: A
systematic review and Meta-regression. JDR 93 (11): 1045
Global Burden of Disease Study, 2014
7. In 2010, about 94.0% of Malaysian adults have periodontal
disease
4.1% have bleeding
41.4% have calculus
30.3% have shallow pockets
18.2% have deep pockets
• This is translated into a total of 48.5% of the adult
population with periodontitis, or an estimated quantum of
11.5 million adults!
Source : National Oral Health Survey of Adults, Malaysia 2010
8. Is periodontitis an epidemic in Malaysia?
• The increase in prevalence and severity of periodontal disease among adults is multiple!
• The increase in prevalence of periodontitis among youngest adults is alarming!
YEAR NOHSA, 2000 NOHSA, 2010
Age group Adult 15-19yrs Adult 15-19yrs
Periodontal disease
(including gum disease and
presence of calculus)
87.2% 74.2% 94.0% 90.4%
Periodontitis
(CPI 3 and 4)
25.2% 3.0% 48.5% 19.8%
Severe periodontitis
(CPI 4 only)
5.5% 0.3% 18.2% 3.0%
Source : National Oral Health Survey Malaysia,2000 and 2010
9. • A silent disease or disorder is one that produces no clinically
obvious signs or symptoms
• Periodontal disease has long been viewed as a silent
disease because of its symptomless nature in the early
stages and during most of its course
• As it is largely painless, most people with periodontal
disease are unaware that they have it
2. Is periodontitis a silent disease?
Does periodontal disease have any impact on people’s quality
of life?
10. Impact of periodontal disease on quality of life:
Evidence from the literature
Clinical Studies
• Reisine et al 1985
• Needleman et al 2004
• Brennan et al 2007
• Cunha-Cruz et al 2007
• Aslund et al 2008
• Patel et al 2008
• Jowett et al 2009
• Araujo et al 2010
• O’Dowd et al 2010
• Tsakos et al 2010
• Tuti NMD 2013
Population Studies
• Ng et al 2006
• Brennan et al 2007
• Lopez & Baelum 2007
• Lawrence et al 2008
• Marino et al 2008
• Bernabe & Marcenes 2010
• Jansson et al 2014
11. Reasons for seeking dental care among patients with
periodontitis
0
5
10
15
20
25
30
35
40%
Source: Economic Burden and Cost-effectiveness Analysis of Periodontitis Management In
Malaysia. PhD thesis 2013.
12. Quality of life impacts among patients with
periodontitis using Oral Health Impact Profile
Source: Economic Burden and Cost-effectiveness Analysis of Periodontitis Management In
Malaysia. PhD thesis 2013.
9 in 10 patients experience functional limitation, physical pain and
psychological discomfort
13. Source: Economic Burden and Cost-effectiveness Analysis of Periodontitis Management In
Malaysia. PhD thesis 2013.
0 10 20 30 40 50 60 70
Mobility
Self-care
Usual activities
Pain/discomfort
Anxiety/depression
EQ-5D descriptive scores for periodontal patients –
percentage with scores 2 (some/ moderate
problems) and/or 3 (extreme problems)
Aggressive periodontitis Chronic periodontitis
Quality of life impacts among patients with
periodontitis using general EuroQoL Index
Pain/discomfort and anxiety/ depression are experienced by up to 65% of periodontitis patients.
These impacts are experienced by more aggressive periodontitis patients.
14. • Periodontal disease may be a silent disease because its
early signs may not be clear to the patient.
• However in due time its subsequent manifestations may
impact the patients’ quality of life in various ways.
• Implication: There is a need to increase people’s
awareness of the early signs of periodontal disease
15. Economic Burden of Periodontitis
• When many people are affected with a particular
disease, huge amount of resources are needed
to treat it.
16. Average cost in RM
Provider cost Patient cost Total cost
Per patient/
year
2,524 296 2,820
Per outpatient
visit
337 39 376
Periodontal disease is expensive to treat
Tuti et al 2014. Cost analysis of Periodontitis management in public sector specialist dental clinics
BMC Oral Health 14:56a
What the government pays! What society pays!
17. Disease severity
Average Cost
(RM)
Mild 1,757
Moderate 2,545
Severe 3,174
The more severe, the more costly!
Tuti et al 2014. Cost analysis of Periodontitis management in public sector specialist dental clinics
BMC Oral Health 14:56
18. Items Measurement
Number of adults estimated as having
periodontitis nationwide
11,522,627
Cost of managing a periodontitis patient RM 2, 820
Projected economic burden RM 32.5 billion
Economic burden as a percentage of
Malaysia’s *GDP
3.83%
*Malaysia's GDP (Gross Domestic Product), 2011 = RM 847.3 billion
Economic burden on the country is high!
Source: Economic Burden and Cost-effectiveness Analysis of
Periodontitis Management In Malaysia. PhD thesis 2013.
Managing severe periodontitis patients alone would cost the
government about RM 10.9 billion, which was 64.7% of the Ministry
of Health budget (MoH budget, 2011 = RM 16.9 billion)
19. 8/7/2015 19
The double jeopardy?!
Systemic diseases Patients with periodontitis
(n, %)
None 176 (54.0)
Diabetes 88 (27.8)
Cardiovascular diseases 19 (5.8)
Hypertension 92 (28.2)
Others (congenital heart disease,
asthma, gout)
34 (10.4)
Economic Burden and Cost-effectiveness Analysis of Periodontitis Management In
Malaysia. PhD thesis 2013.
20. Most prominent chronic diseases
Chronic diseases are the leading causes of death and disability
worldwide.
Major chronic diseases currently account for about 40% of the
global burden of disease and expected to rise to 60% in 2020
Linked by:
• Common and preventable biological risk factors: notably
high blood pressure, high blood cholesterol and being
overweight
• Related major behavioral risk factors: unhealthy diet and
poor nutrition over a prolonged period of time, physical
inactivity, tobacco use, excessive use of alcohol and
psychosocial stress
Cardiovascular
disease
Cancer
Chronic
obstructive
pulmonary
disease
Type-2
diabetes
21. Periodontal disease - the 6th complication of
diabetes
• In 1997, the American Diabetes Association stated PD as the sixth
complication of DM after retinopathy, nephropathy, neuropathy,
macroangiopathy and delayed wound healing (Furukawa et al. 2007)
• Individuals with type 2 diabetes have approximately threefold
increased odds of having periodontitis compared with those without
diabetes (Shlossman et al 1990, Emrich et al 1991)
• There is a fourfold increased risk of progressive alveolar bone loss in
adults with type 2 diabetes compared with that in adults who did not
have diabetes (Taylor et al 1998)
• Adults with poorly controlled diabetes had an almost threefold
increased risk of having periodontitis compared with that in adult
subjects without diabetes, while subjects with diabetes and good
glycemic control had no significant increase in risk (Tsai et al 2002)
22. Periodontal disease and childhood diabetes
• “Interestingly, in this study
we found that periodontitis
can start in childhood in
diabetes, as early loss of
tooth-supporting structures
was significantly increased
even in our 6 to 11-year-
old subgroup.”
• Lalla E, Cheng B, Lal S, et al.
Periodontal changes in children
and adolescents with diabetes:
A case-control study. Diabetes
Care. 2006;29:295-299.
23. Jeffcoat, M., et. al., Periodontal Therapy Improves Outcomes in
Systemic Conditions, 2014
A considerable amount of medical resources is being used for
managing DM, PD and their several complications that can occur.
A healthy mouth could mean thousands in healthcare savings!
24. Needs and concerns of patients with diabetes
No previous knowledge between
oral health and diabetes
Lack of awareness of relationship
Between oral health and diabetes
Difficulties with reading materials
Do not understand language and
medical terms used
Valerio et al 2010
Care needed overwhelming
25. • Patients with diabetes do not know that periodontal disease is a
highly likely complication of diabetes, and that it may have an impact
on glycemic control
• Patients with periodontitis do not know they have a risk of getting
diabetes
Focus group discussion held in UKM Faculty of Dentistry, November 2014
26.
27. 8/7/2015 27
In reality, many people do not know the signs
and symptoms of periodontal disease
The need to educate people and
health care workers about
periodontal disease is
PRESSING!