The document discusses the bidirectional relationship between oral health and systemic health. It outlines how the oral cavity can become a source of infection that affects other parts of the body if tissues are breached, using periodontitis as an example. It also explains how periodontal disease can potentially affect various organ systems, focusing on its relationship to cardiovascular disease. Specifically, it describes how certain periodontal pathogens may increase the risk of atherosclerosis and CVD through direct infection of blood vessels or by triggering inflammation. Treating periodontal disease is shown to reduce inflammation and improve endothelial function, both of which are linked to decreased cardiovascular risk.

1. A Bidirectional Relationship
*

2. * The oral cavity is a major entry point to the body with
mechanisms to defend against toxins or invading pathogens.
If integrity of oral tissues is breached, the oral cavity can become
a source of disease affecting other parts of the body
*Periodontitis: “An inflammatory disease of the
supporting tissues of the teeth caused by specific
microorganisms or groups of specific
microorganisms, resulting in progressive destruction
of the periodontal ligament and alveolar bone with
pocket formation, recession, or both”.
*Evidences also show the converse sides of
relationship between systemic health & oral health
i.e., the potential effect of periodontal disease on a
wide range of organ system.

4. *CARDIOVASCULAR
DISEASE
*CVD caused by
atherosclerosis:
•Coronary heart disease
(myocardial infarction)
•Cerebrovascular disease
(stroke)
•Peripheral vascular disease
•Hypertension (high blood
pressure)
*Other CVD:
•Congenital heart disease
•Rheumatic heart disease
•Cardiomyopathy
•Cardiac arrhythmias

5. * Direct association between an increased risk of atherosclerosis and the
presence of periodontal pathogens such as:
- C. rectus
- P. micros
- A. actinomycetemcomitans
- P. gingivalis
- T. denticola
- T. forsythensis

6. * Periodontal bacteria increase risk for
CVD through several possible
mechanisms:
*Bacteria or viruses from the mouth directly infect
blood vessel walls and contribute to development of
plaques and atherosclerosis.
*Bacteria or viruses interact with WBC’s or platelets
and trigger release of proinflammatory cytokines,
prostaglandins, and TNF-α CV plaques
*Bacterial products in the blood may stimulate liver
production of proinflammatory or pro-coagulant
molecules such as C-reactive protein and fibrinogen.

8. Atheromatous plaque
Periodontal disease
Blood vessel
Blood vessel Atheromatous plaque
formation
Atheromatous plaque
maturation
Vascular subendothelium
Periodontal bacteria (P. gingivalis, F.nucleatum…)
Proinflammatory signals (Cytokines IL6, IL8, etc.)
Medium
layer
Inner
layer
Bloodvessellumen

9. *BENEFITS FROM
PERIODONTAL TREATMENT
* Locally:
Restores health of gums and teeth
Systemically:
Reduces systemic inflammation: by lowering
levels of C-reactive protein
Improves clinical levels of endothelial function
*Both parameters are related to an increased risk for
future cardiovascular episodes.

10. *
*"The two appear to go hand-in-
hand,"
*"Treating gum disease may lessen
the burden of heart disease."

11. *