2. Credentials
• Clinical RDH – 16 years experience
• Columnist for RDH Magazine – 4 years
• Corporate Consultant – 2 years
• National Speaker – 3 years
5. Inflammation
• A localized protective reaction of tissue to
irritation, injury, or infection, characterized
by pain, redness, swelling, and sometimes
loss of function.
• Inflammatory disease is one of a number
of diseases characterized by inflammation
6. INFLAMMATORY RESPONSE
When bacteria invade tissue WBC are
dispatched to destroy the threat.
The WBC devour the foreign cells (bacteria)
and secrete oxidants and cytokines to signal
for more WBC.
7. Cytokines and your Heart
• Proinflammatory cytokines – reduce
infection and increase inflammation
• Antiinflammatory cytokines – may be
increased by Vitamin D.
• Suggested link between impaired Vit. D
and chronic heart disease.
Ray Sahelian, M.D
8. Inflammatory Response
• Systemic response to inflammation
• Liver produces C-Reactive Protein
• White blood cells
• Dilation of blood vessels
9. C- Reactive Protein
• Measured in blood to detect infection
• Produced by liver
• High levels in blood associated with
Cardiovascular events, stroke and
diabetes
10. Sed Rate
• Measures how quickly erythrocytes settle
in a vial of blood
• High levels suggest inflammation
• Not site specific and can be elevated by
other causes such as fatigue and diarrhea
11. Systemic Response
• Immune response is essentially the same
regardless of the location of inflammation.
• Often difficult to isolate the cause of
inflammation – diagnosis of inflammatory
diseases is often complicated.
• Inflammatory diseases can/do co-exist
12. INFLAMMATORY RESPONSE
Prolonged high levels of CRP signal a
chronic inflammatory state
Women's Health Initiative states:
increased levels of CRP are linked to
cardiovascular diseases
14. PAD: Peripheral Arterial Disease
• Narrowing or blockage of arteries that
results in poor blood flow to the arms and
legs
• Can cause painful
cramps when
walking or
exercising
15. Possible Causes of PAD
• Build up of plaque inside the walls of the
arteries – atherosclerosis.
• Gradually develops over a lifetime.
• High cholesterol, high blood pressure, and
smoking contribute to atherosclerosis and
peripheral arterial disease.
16. Possible Causes of PAD
• In some cases, peripheral arterial disease
can be unrelated to atherosclerosis and
caused instead by inflammation of the
blood vessels (vasculitis) and old injuries
that damaged blood vessels.
• Decrease in blood flow ‘starves’ tissues
and muscles in the lower body
17. Risk factors for PAD
• High LDL Cholesterol
• High Blood Pressure
• Smoking
• Diabetes
• High Homocysteine levels
18. Symptoms of PAD
• Weak or tired legs
• Difficulty walking or balancing
• Cold/numb feet or toes
• Sores that are slow to heal
• Foot pain while at rest – advancing
disease
• Erectile dysfunction
• Often NO symptoms until very advanced
19. Treatment for PAD
• Diet to lower cholesterol and BP
• Low impact exercise
• Angioplasty
• Medications
20. Medications for PAD
• Antiplatelets – Plavix or aspirin
• Cilostazol – serious side effects
• Statins – lower cholesterol
• HBP medication
21. Oral Complications of PAD
• Slow healing
– Tissue trauma from smoking or biting
• HBP Meds
– Dry mouth
– Tooth decay
– Gingival hyperplasia
22. Dental Treatment Considerations
• Periodic position changes
• Lesions may heal slower
• pH concern from dry mouth
• Increased decay rate
23. Colitis
• Inflammation of the large intestine and
colon
• Bacterial imbalance
• Can be spread from person to person
24. Causes of Colitis
• Clostridium difficile
• Antibiotic therapy
• Infected by another person
• Inadequate immune system
25. Symptoms of Colitis
• Diarrhea
• Cramping
• Fever
• Blood in stool
• Possible abnormal heart beat
26. Oral Complications
• Periodontal inflammation
• Yeast infections
• Erosion from nausea and/or vomiting
• Will not see during acute disease
27. Treatment for Colitis
• Vancomycin and/or metronidazole
• Fluids and electrolytes
• Blood transfusion if severe anemia occurs
• Possible surgery to remove area of
perforations
28. Dental Treatment Considerations
• Repair areas of erosion
• Neutralize pH of oral cavity
• Treat infections locally and early
• May not absorb vitamins/minerals well
29. Dental Treatment Considerations
• Judicious use of systemic medications
• Systemic Flouride not recommended
• Be aware of complexion
• Check with MD during steroid
treatments
30. Rheumatoid Arthritis
• Inflammation in the tissue lining the joints
• Over time destroys tissue in joints and
limits movement
• 2 -3 times more common in women
• Symptoms often begin at 40 -60
31. Causes of Rheumatoid Arthritis
• Exact cause is not known
• Autoimmune disease
• Appears to be some
genetic tendencies
32. Symptoms of Rheumatoid
Arthritis
• Pain, Stiffness and Swelling of joints
• Affects both sides of the body
• Rarely affects eyes, lungs, heart and
nerves
34. Risks for Rheumatoid Arthritis
• Genetic predisposition
• Female
• Between age of 40 – 60
• Cracking your knuckles does NOT cause
or increase symptoms
35. Treatment for Rheumatoid
Arthritis
• Disease-modifying antirheumatic drugs
(DMARDs)
• Corticosteroids
• Weight control / exercise / adequate rest
36. Other Treatments for RA
• Physical Therapy
• Biofeedback
• Breathing exercises
• Acupuncture
37. Oral Complications of RA
• Stiffness of TMJ
• Medication side effects
– Mouth sores – often wide spread and painful
– Dry mouth
– Vomiting – erosion of enamel
38. Dental Treatment Considerations
• Bite block and rest periods
• Higher decay rate
• Warm blanket or pillow around joint
• Short appointments not first thing in day
• May be slow to heal from tissue trauma
39. MSRA
• methicillin-resistant Staphylococcus aureus
• Can cause infection of skin, heart, blood and
bones
• Can be spread person to person
• Can be hospital acquired – esp post surgery
40. Causes of MSRA
• Over population of Staphylococcus
• Injudicious use of antibiotics
• Unsterile surgical environment
• Person to person spread
41. Symptoms of MSRA
• Skin infection that will not heal
• High fever
• Pain and/or edema
• Drainage from wound – not healing
• Fainting
42. Treatment for MSRA
• Antibiotics – intravenous common
• Debridement of wound
• NSAIDs
• Long term monitoring – CRP and Sed Rate
43. Dental Treatment Considerations
• Resistant to antibiotics
• No treatment when CRP is high
• Susceptible to oral inflammation
• Dry Mouth/ sores from NSAIDs
44. Dental Considerations
• Clinician/patient should not be in the office
if MSRA is active
• If outward skin lesions are present, avoid
person to person contact
• No office personnel in office when lesions
are present – not even at desk jobs
46. Causes of Periodontitis
• Periodontal disease is a bacterial infection,
specifically, red complex bacteria (RCB).
• The bacteria associated with periodontal
disease reside within biofilms above and below
the gingival margin.
• Biofilms are dense mixtures of organisms
resistant to natural antibodies and proteins that
the body uses to fight infection.
47. INFLAMMATORY RESPONSE
• Cytokines in Periodontal Disease most
often represented as IL-1 (interleukin 1)
• Additional biomarkers in Periodontal
Inflammation: ICTP (cross-linked carboxy-
terminal telopeptide type 1 collagen)
48. Treatment for Periodontitis
• Mechanical debridement of infected sites
– Scaling and Root Planing (non-surgical
therapy)
• Site specific antibacterial agents
– Arestin/Atridox/Periochip
– Subgingival Irrigation
• Maintenance and monitoring
49. Treatment for Periodontitis
• Systemic anti-inflammatory
– Periostat (low dose doxycycline)
• Occasionally systemic antibiotics
– Stop the inflammatory cascade
– Potent and short-term
50. ARESTIN
Distributed by OraPharma
Minocycline hydrochloride
1 mg prefilled carpule
Adjunct to Scaling and Root
Planing
Easy application
52. LAA Facts
• The LAA ARESTIN® (minocycline hydrochloride)
Microspheres, 1 mg can help eliminate the
bacteria that SRP can leave behind including:
– P gingivalis
– T denticola
– T forsythia
2 x as effective as SRP alone in reducing
RCB
53. Bacterial Reduction with LAA
In a recent
microbiological study
of patients with
moderate-to-severe
periodontitis,
ARESTIN® + SRP:
significantly reduced
the quantity of red
complex bacteria VS
SRP alone.
54. Citations
• Williams RC, Paquette DW, Offenbacher
S, et al. Treatment of periodontitis by
local administration of minocycline
microspheres: a controlled trial. J
Periodontol 2001;72:1535-1544
• American Academy of Periodontology
Research, Science, and Therapy
Committee. Guidelines for periodontal
therapy. J Periodontol 2001;72:1624-
1628.
56. ATRIDOX
• An important option in the treatment of
chronic adult periodontitis.
- Flows to the bottom of pocket, readily
adapting to root morphology
- Controlled release of doxycycline for a
period of 7 days
- Bioabsorbable- removal may still be needed
- Takes only minutes to prepare and administer
57. ATRIDOX
Solidifies to a wax-like substance in minutes
- Patient friendly - no anesthesia required
Provides dosing flexibility.
- Can effectively treat multiple sites with a
single syringe.
www.atridox.com
58. PERIO CHIP
Chlorhexidine gluconate 2.5 mg in a
matrix of hydrolyzed
gelatin/glutaraldehyde
Broad spectrum anti microbial
Single dose chip placed in pocket
59. Perio Chip at 9 month check
• Twice as many patients (30.3%)
receiving PerioChip and SRP, had a PD
reduction of 2mm or more (vs. control:
13.5%)
• Control = SRP alone (or with Placebo
chip) vs. SRP & PerioChip.
• Chip was placed 1 hour after Scaling and
Root Planing, and repeated at 3 and/or 6
months if PD remained 5mm or more.
60. SUBGINGIVAL IRRIGATION
Place antimicrobial solution into
pocket
- blunt end syringe
- endo type syringe
- powered irrigation device
+ allows for pulsating action
+ cannulas to reach deeper
61. Inflammatory Diseases and
Women
• Be an advocate for early detection
• Insist on testing for unhealed or slow
healing lesions or edema
• Encourage the women in your life to be
proactive
62. IBC
• Often misdiagnosed as skin infection
• Systemic complications from inflammation
• Lowest 5 year survival rate
• Insist on testing for unhealed skin lesions
63. Pelvic Inflammatory Disease
• Infection of uterus, fallopian tubes and
other reproductive organs
• Serious complication of some STDs
• Inflammation often goes undiagnosed for
years – patients don’t seek medical care
64. PID in the United States
• 1million women experience acute PID
yearly in the US alone
• 100,000 become infertile each year from
PID
• 150 women die yearly from PID
complications
65. PID
• Associated with gonorrhea and chlamydia
• Many sexually transmitted bacteria can
lead to PID
• Number of sex partners associated with
PID - both of the woman and her partner
66. PID Symptoms
• Unrecognized by health care professionals
2/3 of the time
• Abdominal pain
• Discharge
• Foul odor
• Irregular vaginal bleeding
67. PID Diagnosis
• Ultrasonic evaluation
• Bacterial testing – blood and discharge
• Laprascopy often required
68. PID Treatment
• At least two antibiotics simultaneously
• Woman and her partner both treated
• Surgery for abscesses or scarring occurs
69. PID Consequences
• In untreated can lead to
– Ectopic pregnancy
– Severe Pain
– Internal bleeding
– DEATH
70. Inflammatory Diseases
• Localized manifestation of systemic
condition
• Often undiagnosed until later stages
• Increased risk for cardiovascular events
71. Our Role
• Health Care Provider
• Screenings provide valuable information
– BP
– Oral Cancer Screening
• Recommend further evaluation
72. Where to Look
• PubMed
• Web MD
• Kaiser – www. kp. org
• Amy’s List
– AmyRDH.com
