32 - Periodontal Infections and Systemic Health

Question 1

Why does it matter that bacterial plaque is a biofilm?

Answer 1

1) Increased resistance of organisms to host destruction by immunoinflammatory response
2) Continual shedding of bacterial products from biofilm

Question 2

Systemic inflammation acts as a risk factor for ____

Answer 2

CVD
DM
Adverse pregnancy outcomes

Question 3

____ conditions are associated with elevated systemic inflammation

Answer 3

Obesity

Question 4

Systemic effects of elevated inflammation? (3)

Answer 4

1) Increased insulin resistance
2) Vascular endothelium - adhesion molecules, platelet aggregation, altered vasodilation, atherogenesis
3) Elevated liver-derived APP (CRP, fibrinogen)

Question 5

Effects of CRP (2)

Answer 5

1) Activates complement

2) Stimulates NP chemotaxis to propagate inflammation

Question 6

Effects of fibrinogen

Answer 6

Increases blood viscosity

Question 7

What in the serum causes increased hepatic CRP production?

Answer 7

IL-6

Question 8

Periodontal infection systemic effects (4)

Answer 8

1) Biofilm in contact w/ bloodstream
2) Greater incidence of bacteremia w/ severe ChP
3) Periodontium reservoir of pro-inflammatory cytokines
4) Periodontitis elicits production of APP from liver

Question 9

Periodontal infection as a risk factor for CVD. OR?

Stronger for stroke or MI?

Answer 9

2-3

Stroke (atherosclerosis)

Question 10

Mechanisms for effect of periodontal disease on CVD

Answer 10

1) Bacteria/toxins in bloodstream and inducing atherosclerosis
2) Elevated serum inflammatory mediators (IL-1,TNF,IL-6) and markers (CRP, fibrinogen)

Question 11

Effect of periodontal treatment on inflammation? MI/stroke?

Answer 11

Decreased serum inflammatory mediators

NO intervention trial showing periodontal treatment reduces risk of MI/stroke

Question 12

Effect of infection on blood sugar

Answer 12

Infections leads to increased insulin resistance

Question 13

Intervention trials for periodontal treatment and diabetes?

Answer 13

SRP + systemic Doxycycline can improve glycemic control in the short term

Mixed results w/ SRP alone

Significant reduction in A1C following periodontal therapy

Question 14

Mechanism of periodontitis affect on diabetes

Answer 14

Periodontitis leads to elevated serum IL1/TNF-a/IL6

TNF-a has role in insulin resistance at receptor level

Question 15

Effect of obesity on diabetes

Answer 15

Elevated serum levels of IL1/TNFa/IL6 because adipocytes are metabolically active

Obesity causes increased size and number of adipocytes leading to increased cytokines

Question 16

What causes PTB

Answer 16

Induction of amniotic prostaglandin

Question 17

Risk factors for PTLBW

Answer 17

• Genitourinary tract infection

- Bacterial vaginosis (direct ascension of gram - organisms/LPS into the chorioamnion (3X risk)

Question 18

Association of periodontitis w/ PTLBW

Answer 18

Severe periodontitis patients with 4-7X risk of PTLBW

Question 19

Intervention trials and PTLBW

Answer 19

SRP during gestation have 5X reduction in risk of PTLBW compared to pregnant women with periodontitis and no treatment

Question 20

Relationship between periodontitis + pneumonia

Answer 20

None established between community acquired pneumonia

Nosocomial pneumonia (aspiration of oropharyngeal bacteria) is associated b/c plaque can be a reservoir of potential respiratory pathogens from the GI tract