periomedicine-210520134541.Systemic health.ppt
- 1. PERIOMEDICINE-THE ORAL – SYSTEMIC LINK DR. SNOPHIA SURESH MDS PhD
- 2. Introduction Periodontitis is one of the most prevalent diseases of the oral cavity. Nowadays periodontitis has been recognized as a contributing factor for many of the systemic diseases. The maintenance of oral health has become an integral part of general health. It is definitely the responsibility of the dentist to reduce the inflammatory burden in the oral cavity ….
- 3. Periodontal Medicine is 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. OFFENBACHER 1996
- 4. Focal Infection Theory Local infection affecting a small area of the body can lead to subsequent infection or symptom in other parts of the body due to spread of the infecting agent itself or toxins produced by it. It probably would be better defined as a metastatic infection.. WD MILLER 1890
- 5. Oral Cavity as Foci of infection was proposed by W D Miller &William Hunter. ((1900- 1950) They practiced preventive and therapeutic edentulation and advocated extraction of caries teeth, gingivitis and periodontitis to eliminate the source of sepsis
- 6. Failure Of Focal Infection Theory William Hunter’s concept of oral cavity as focus of infection was discarded since it was not based on sound scientific knowledge
- 7. Resurgence of focal infection theory was seen in the form of Periodontal Medicine when Kimmo Matilla et al. in 1989 examined a possible relationship of oral infection in contributing to an individual's risk for systemic disease
- 8. HOW PERIODONTAL DISEASE CAN CAUSE SYSTEMIC DISEASE?
- 9. Periodontal disease Periodontal disease is an immuno inflammatory disease initiated by micro- organisms and characterized by the destruction of the supporting tissues of the tooth
- 10. Periodontal Disease Model PAGE R C 1991
- 11. Spread Of Periodontal Infection Bacteria & products Proinflammatory Cytokines THODEN VAN VELZEN et al.
- 12. • Gingival Micro capillaries • Dental procedures • Daily life activities • Survival in the immune cells Bacteremia TAKEUCHI et al 2011,TOMASet al 2012, CARRION et al 2012
- 13. Periodontal Disease associated With Systemic Diseases CARDIO-VASCULAR DISEASES ADVERSE PREGNANCY OUTCOMES DIABETES MELLITUS RHEUMATOID ARTHRITIS PNEUMONIA OBESITY CANCER
- 15. Criteria for Causal Association Epidemiological Association Impact of Intervention Biological Plausibility BRADFORD HILL
- 16. Periodontitis And Ischemic Heart disease Thrombogenesis Atherosclerosis
- 17. Blood Viscosity Increases IHD Fibrinogen, WBC count, Von wille brand factor increases Systemic or periodontal infection Blood Viscosity KWEIDER et al 1993
- 18. Oral Bacteria & Thrombogenesis • Platelet Aggregation association protein (PAAP)-Streptococcus sanguis,P. gingivalis HERZBERG MC & MEYER 1996
- 19. Oral Bacteria & Atherosclerosis GIACONA et al 2004
- 21. Periodontal infection Gram-negative bacteremia / LPS Endothelial damage Platelet adhesion/aggregation Monocyte infiltration / proliferation Cytokine / growth factor production Thrombus formation Atheroma formation Vessel wall thickening Thromboembolic events
- 22. Diabetes Mellitus Diabetes mellitus is a complex metabolic disorder characterized by chronic hyperglycemia. Type 1 – defect occurs at level of beta cells Type 2 – defect at level of insulin receptor or molecule.
- 23. Diabetes & Periodontal disease Periodontitis Impaired PMN leukocyte function Altered subgingival microbiota Altered Collagen metabolism Oxidative Stress
- 24. Complications LOE 1993 Retinopathy Nephropathy Neuropathy Macro vascular Disease Altered wound Healing Periodontal disease
- 25. Periodontal Disease & Diabetes Periodontal disease – pro- inflammatory cytokine Inhibtion of tyrosine phosphorylation of insulin receptor Increased Insulin resistance – Poor glycaemic control GROSSI et al 1997
- 26. Gram negative periodontal infection Increased insulin resistance Worsened glycemic control Improved glycemic control Improved insulin sensitivity Periodontal treatment Potential effects of periodontal infection and periodontal therapy on glycemia in patients with diabetes. SIMPSON et al 2010
- 27. Periodontitis on Adverse Pregnancy Outcome Preterm - < 37 weeks LBW infants-<2500gms of weight Preeclampsia
- 28. Periodontitis on Adverse Pregnancy Outcome Increase in hormonal levels initiate the process of parturition by inducing placental cells to secrete prostaglandins, that cause smooth muscle of the uterine wall to contract. As the pregnancy advances the level of PGE2 in amniotic fluid rises steadily till the critical threshold level is reached to induce labour.
- 29. Bacterial infection of chorioamnion- Bacterial products in amnion Infl. response with cytokine production in amnion Increased amniotic PG (PGE2 & PGF2a)production-Pre term labour OFFENBACHER et al 1998
- 30. • Periodontal bacteria disseminate to the foeto- placental unit via Hematogenous spread • F. nucleatum , Capnocytophaga HILL et al 1998
- 31. Pneumonia is an infection of the lungs caused by bacteria, viruses or fungi. Oropharyngeal colonization of potential respiratory pathogens (PRPs) increases during hospitalization. Periodontitis And Pneumonia
- 32. Oral Bacteria & Pneumonia Salivary enzymes modify mucosal surfaces to allow colonization by PRP Salivary enzymes destroy salivary pellicles on pathogenic bacteria to hinder their clearance from mucosal surface Cytokines originating from periodontal tissues may alter respiratory epithelium to promote infection by respiratory pathogen SCANNAPIECO 1999
- 33. Periodontitis And Obesity Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health WANG et al 2011
- 34. Oral Bacteria and Obesity Metabolic Efficiency Increases Appetite Redirect energy metabolism GOODSON et al 2009
- 35. Periodontitis And Rheumatoid Arthritis Rheumatoid arthritis is an autoimmune disease characterized by persistent synovial inflammation and associated damage to articular cartilage and underlying bone SCOTT et al 2010
- 36. LIAO et al 2009
- 38. Periodontitis And Oral Cancer Chronic or dysregulated inflammation has long been appreciated as contributing to tumor development. Both P. gingivalis and F. nucleatum establish chronic infections that involve intracellular persistence within epithelial cells and have well-characterized immune disruptive properties RAKOFF-NAHOUM 2006
- 39. Oral Bacteria & Cancer MAO et al 2007 RUBINSTEIN et al 2013
- 41. Strong association occur between periodontitis with cardiovascular disease, adverse pregnancy outcome, diabetes and pneumonia The association between periodontal disease with Obesity, rheumatoid disease, and cancer do not imply causality European Federation of periodontology & Americal academy of Periodontology
- 42. Conclusion Periodontal medicine is still in its infancy and one needs to conduct further research to know the exact role of periodontal infections in the pathogenesis of systemic diseases. Considering the strength of association between the two, it seems justified to state that good oral health is important not only to prevent oral disease but also to maintain good general health.