This document discusses the relationship between periodontal disease and various systemic conditions. It begins by providing historical context on how the link between oral and systemic health has been understood over time. Key points discussed include: the era of focal infection theory in the 18th-19th centuries; associations found between periodontitis and coronary heart disease/atherosclerosis, diabetes, pregnancy outcomes, COPD, and acute respiratory infections; and how periodontal medicine knowledge can be applied in clinical practice through interprofessional collaboration and patient education.

1. PERIODONTAL MEDICINE
BY
M.BHARATH REDDY

2. OBJECTIVES
 Introduction
 Era
of focal infection
 Periodontal and coronory heart
disease/Atherosclerosis
 Periodontal disease & Diabetes mellitus
 Role of periodontitis in pregnancy out come
 Periodontal disease & COPD
 Periodontal disease & Acute Respiratory
Infection
 Periodontal Medicine In Clinical Practice

3. INTRODUCTION




Advances in the science & technology over the
last centuary have greatly expanded our
knowledge of pathogenesis of periodontal disease.
Certain systemic conditions may affect the
initiation & progression of gingivitis &
periodontitis.
The effect of oral health on the rest of the human
body was proposed by assyrians in the 7th
centuary.
In the 18th centuary a pennsylvanian physician
named Benjamin Rush quoted that arthritis could
be treated in some people after they get extracted
the infected teeth.

4. ERA OF FOCAL INFECTION
 WD
MILLER & WILLIAM HUNTER
given a concept that oral bacteria &
infection were likely to cause most of the
person’s systemic illness.
 This
 This
concept became very popular.
era,which came to be known as “THE
ERA OF FOCAL INFECTION”

5. However by 1940 medicine & dentistry were
realising that there was much more to explain a
patients general condition than bacteria in his/her
mouth.
o They realised that1.extarcting a person teeth donot make their
disease go away.
2.people with very healthy mouths also
develop systemic disease.
3.people with no teeth & thus no apparent oral
infection still develop systemic disease.
FOCAL INFECTION as a primary cause of
systemic infection finally came to an end.
o

6. Periodontal and coronory
heart disease/Atherosclerosis

7. Periodontal and coronory
heart disease
CHD and CHD RELATED diseases aare the
major cause of death.
1989  Mattila and colleagues found an
increase in caries, periodontal disease,
pericoronitits and perapical lesions in patients
with recent MI, when compared to controls.
 Many risk factors for MI were the same for
Periodontitis, mainly:



Smoking
Older Male Patients
Lower SES

8. Effect of periodontal infection
 ISCHEMIC
HEART DISEASE:
 IHD is associated with atherogensis and
thrombogenesis
 Increased blood viscosity may promote IHD
 Increase in FIBRINOGEN ,WBC
COUNT,VON WILLEBRAND FACTOR
increases the risk of IHD

10. ATHEROSCLEROSIS

11. STROKE
 OVERALL
25% OF ALL STROKE
PATEINTS HAD SIGNIFICANT DENTAL
INFECTIONS.
 Gingivitis and Radiographic bone loss
independently associated with risk of a
cerebral ischemic event
 How?
– Active periodontitis increases the prothromotic state
 recurrent bacteremia, platelet activation, increased
clotting factors

12. Periodontitis and Diabetes

13. Diabetes
– American Diabetes Association recognizes that
periodontal disease is common in diabetic
patients
– Studies have shown:
Diabetes is a risk factor for periodontal disease
 Diabetic control improves the prognosis of
periodontitis
 Treatment of periodontitis improves
metabolic/diabetic control


14. Periodontal infection associated with
glycemic control in diabetes
 Acute
bacterial and viral infections have
been shown to increase insulin resistance
and aggravate glycemic control.
 Systemic infections increase tissue
resistance to insulin,preventing glucose
from entering target cells ,causing elevated
blood glucose levels
 Pancreatic insulin production increases to
maintain normalglycemia

16. Role of periodontitis in pregnancy
outcome
 Periodontitis
is a gram-ve infection that
play role in low birth weight individuals.
 Bacteria and products causes inflammatory
response with stimulation of cytokine
production in amnion.
 P.gingivalis implanted in subcutaneous
chambers during gestation caused
significant increase in TNF-ALFA and
PGE2 levels

17.  This
subcutaneous infection leads to increase in
fetal death and a decrease in fetal birth weight.

18. Periodontal disease and
COPD

19.  COPD
is characterised by airflow
obstruction resulting from chronic
bronchitis or emphysema.
 About 14 million americans have COPD
,tobacco smoking is the primary risk factor.
 COPD shares similar pathogenic
mechanisms with periodontal disease.
 In both diseases ,host inflammatory
response is mounted in response to chronic
challenge by
bacteria in periodontal disease
cigarette smoking in COPD

20.  Broncial
mucosa glands enlarge ,and
inflammatory process occurs in which
neutrophils and mononuclear inflammatory
cells accumulate with in lung tissue.
 The resulting neutrophil influx leads to
release of oxidative and hydrolytic enzymes
that cause tissue distruction .
 In current smokers ,however the presence of
severe periodontits was associated with
increased risk of COPD.
 This results suggest that smoking may act
as a major “effect modifier” in relationship
btw COPD and periodontal disease.

21. Periodontal disease and acute
respiratory infection
 Pneumonia
is classified as Community
Acquired or Nosocomial.
 The
most common organisms found are S.
pneumoniae and H. influenzae
 How do the bacteria go from the mouth to the
lungs?
– Hematogenous Spread
– Aspiration:
 45% of healthy people aspirate upper airway
substances during sleep
 70% of those with impaired consciousness
aspirate substances from upper airway

22.  Hospital
acquired bacterial pneumonia is usually
caused by aspiration of oropharyngeal contents.
 Oropharyngeal colonization with potential
respiratory pathogens(PRP) increases during
hospitalizations.
 PRP may also orginate in the oral cavity ,with
dental plaque serving as a reservoir of these
organisms .
 PRPS are commonly isolated from
supragingival plaque and buccal mucosa of the
patients .

23. Periodontal medicine in
clinical practice
 Periodontal
infection may act as
independent risk factor for systemic
disease in suseptible individual.
 Dentists need to know more about systemic
diseases and physicians need to increase
their knowledge of oral diseases.
 Patient education in this regrad is also very
important.

24. Thank you