6. Periodontal-Systemic Relationships Flashcards
How Dose Systemic Diseases Influence Periodontitis?
This is a very important picture. It gives an overview of how periodontal disease starts.
You need to have bacteria first (or virus) but mainly ____. Bacteria have antigens and byproducts (LPS) that trigger ____ system.
The second part is the host immune system. This contributes to future disease breakdown.
When bacteria attacks host, the host will have ____ or ____ and ____ immune system to fight bacteria. The host tries to protect itself, but PMNs also release cytokines and mediators of inflammation that traumatize the tissue and cause connective tissue breakdown. [For example] ____ is mainly secreted by neutrophil that can be detrimental for the host itself. This ____ break down eventually leads to periodontitis.
But for today, I am only going to focus on the yellow boxes. I am going to talk about these risk factors and how they affect host immune system and inflammatory status.
bacteria
host immune
antibody innate adaptive MMP tissue
WE KNOW THAT…
Systemic conditions and diseases can affect ____ (e.g. HIV, Down syndrome, immune disorders, diabetes, malnutrition etc)
WE DO NOT KNOW AS MUCH…
The consequences of diseased periodontium on ____ health
Immune system affects periodontal disease. If you have ____, your periodontal disease will get worse. We will talk a lot about diabetes today. All of these factors will influence periodontal disease.
However, we don’t know how periodontitis influences ____ health. This is a hot topic of research right now.
periodontium
systemic
HIV
systemic
Systemic Diseases Chronic Periodontitis Has Been Linked to
* \_\_\_\_ is most important * \_\_\_\_ is the common factor among all diseases including periodontitis
[READ ALL OF THESE!!]
diabetes
inflammation
How Did It all Start?
• ____ infection theory: a pathological process, in any given body site, can be the cause of the beginning or setting of a new pathology in a different part of the body of same individual (William Hunter 1910)
In 1940s and 50s, this theory fell out of fashion due to lack of ____
Late 1980’s
Theory has been ____
Possible relationship between ____ infection
and ____ disorder
• Bacteria in mouth will spread via \_\_\_\_ and reach distant organ
focal evidence revived oral systemic circulation
How Periodontal Disease Could Contribute to Systemic Disease?
Direct mechanism (____) : As chronic periodontitis progresses, the epithelium lining periodontal pockets becomes ____ providing a direct entry point for periodontal ____ into the systemic circulation. The circulating bacteria could then have direct effects on certain organs
Indirect mechanism (____): The inflammatory response to periodontal bacteria or their by-products may have indirect systemic effects. It is now well recognized that inflammation itself is involved in the pathogenesis of many chronic illnesses such as ____ disease, ____, and ____
Indirect
- This is related to inflammation. Bacteria cause local inflammation. ____ are
secreted to the local area. The mediators will also travel thru body and cause more systemic inflammation.
infection
ulcerated
bacteria
inflammation
cardiovascular
type 2 diabetes
rheumatoid arthritis
cytokines
Subgingival Environment as a Reservoir for Bacteria
The periodontium may serve as a ____ of bacteria, bacterial products, and inflammatory and immune mediators which can interact with other organs, increasing the risk for certain conditions by contributing to disease pathogenesis
Pocket epithelium in contact with biofilms in a patient with moderate to severe periodontitis = ____ of palm
reservoir
size
Periodontitis Associated Systemic Disease
Direct
- You can also see biofilm is in subgingival area, and pass thru junctional pocket
epithelium and spread out. This is the direct pathway. It can go to the heart and cause ____.
- It can also go to uterus and placental membrane and cause ____ birth.
- When we swallow oral bacteria, we can cause ____ in the gut. There may be an association here with ____ cancer based on some research I did at Columbia.
Indirect
- You can see how the byproduct like TNF, IL1B, IL6 will cause ____ phase response in liver. This severe ____ will help progression of the ____ disease and ____ birth I just mentioned.
artherosclerosis
preterm
dysbiosis
colon
acute
inflammation
heart
pre-erm
Difficulties - Confounding and Causality
Confounding: The risk factors for many systemic diseases overlap with those associated with periodontitis such as ____, gender, ____, obesity, ____ status, etc.
Cause and effect relationships
Cause and effect
- In a study, you need to have a strict ____ sequence to determine which disease
happened first. You also need a ____ study to see if the other disease increased.
You can also use ____ trials. For example if you treat periodontitis, will that help blood sugar control in diabetes patients?
age
smoking
socio-economic
temporal
longitudinal
interventional
Background Information
Diabetes is a complex metabolic disorder characterized by chronic ____
Prevalence: ____ of the US population
Blood sugar levels are regulated by a hormone called ____ that is synthesized by ____ cells of the ____
Clinical symptoms of DM
____, polydipsia, ____, pruritus, weakness, ____
Complications: microvascular diseases (____, nephropathy, neuropathy), macrovascular diseases (____, cerebrovascular conditions), impaired ____, increased susceptibility to infections
Treatment goal – reduce blood ____ levels to prevent complications
• Sixth complication of diabetes: \_\_\_\_
hyperglycemia 8.3% insulin beta pancreas
polyuria
polyphagia
fatigue
retinopathy cardiovascular wound healing glucose periodontitis
When you eat food, it will break down in blood to cause elevated ____. The pancreas secretes insulin and then the ____ will be transported into muscle and other cells to be used as energy. Insulin also help store excess glucose as ____ in muscle and liver. Insulin also help ____ breaking down glycogen to glucose in the blood.
blood glucose
glucose
glycogen
prevent
Primary Diabetes
• Type 1 (5-10%): impaired production of insulin (insulin ____)
- ____ autoimmune disease
- Destruction of insulin-producing ____ cells of pancreas (viral
infection in predisposed individuals /autoimmune response)
- 90% diagnosed before age ____
• Type 2 (90-95%): deficient utilization of insulin (insulin ____)
- Disorder of ____ immune system or results from a ____
inflammatory process
- Changes in the structure or number of the cell ____ for
insulin, or defects of the insulin-signaling ____
- More gradual and less ____
- Usually present after age ____
• Type 3 - related to \_\_\_\_
dependent
beta
21
resistance innate chronic receptors cascade severe 40
alzheimer’s
Secondary Diabetes
Hyperglycemia secondary to other diseases or conditions
- –____ diabetes associated with pregnancy
- —–2% to 10% of all pregnancies but disappears after ____
- —–Mainly in the ____ trimester
Associated with diseases that involve the pancreas and the destruction of the insulin-producing cells
——Endocrine diseases (e.g., ____, ____ syndrome), tumors, ____, and drugs or chemicals that cause altered ____ levels
gestational
delivery
third
acromegaly
cushing’s
pancreatectomy
insulin
Usually only type 2 and gestational relates to ____ . For type 1, you need insulin ____ to treat.
For type 2, you usual ____ medicine to treat. For Gestational, this is similar to type 2.
You can also use diet and lifestyle change for ____ to get a better results. Also there is a ____ for type 2 and gestational, whereas type 1 is usually ____ .
overweight
injection
oral
type 2
family history
random
Diagnosis of Diabetes
These are different blood glucose tests - A1C
○ Glucose ____ bind to Hemoglobin
○ Looks at blood sugar of past 3 months, because ____ turnover over every 120 days
○ Normal: below ____ // if over 6.5 = ____
- Random plasma glucose cell
○ If patient has more than ____ = diabetes - Fasting plasma glucose
○ Patient fast for 8 hrs and you test if more than ____, you have diabetes. -
Oral glucose tolerance test
○ [audience answer]: give a patient ____, and you test their blood glucose levels later to see how it is dealt with
○ We usually use this for ____ patients for ____ diabetes
irreversibly
RBC
5.7
diabeters
200
126
glucose dosage
pregnant
gestational
How Does DM Affect Periodontitis?
Possible mechanism influenced by ____
Alteration of bacterial pathogens
To date, there is insufficient evidence to support the role of a specific altered ____ that is responsible for periodontal disease destruction in patients with diabetes
Polymorphonuclear Leukocyte dysfunction
In patients with poorly controlled diabetes, the function of PMNs, monocytes, and macrophages is ____
-Altered Collagen Metabolism
Excessive ____ and its receptor ____ formation
The interaction leads to immune cell ____ and increased ____ cytokines
• Advanced glycation end product** + RAGE > immune cell dysfunction and increase pro-inflam cytokine
hyperglycemia microflora impaired AGEs (advanced glycation end-products) RAGEs dysfunction proinflammatory
AGEs (Advanced Glycation End-Products) & RAGEs
Monocytes, macrophages, endothelial cells have increased receptors for ____
Binding of AGE to its receptor (RAGE) results in the upregulated production of ____ mediators such as IL-1β, TNF-α and IL-6
AGEs also enhance the ____ (rapid release of ROS) in PMNs, which has the potential to significantly increase local ____ damage in periodontitis
AGEs accumulation affects the ____ and ____ activity of mononuclear and polymorphonuclear phagocytic cells due to vascular occlusion resulting from the ____ endothelial basement membrane
AGEs have detrimental effects on ____ metabolism, leading to impaired repair and bone formation and decreased extracellular matrix production
AGEs (RAGEs)
inflammatory
respiratory burst
tissue
migration
phagocytic
thickened
bone
- AGE used to crosslink ____, but too much > the collagen cannot turnover to ____ - more susceptible to infection and impaired wound healing
- Causes ____
- Influences ____ via turnover rate
collagen
repair
vascular occlusion
wound healing
Network of Potential Mechanisms Involved in the Pathogenesis of Periodontitis in Diabetes
• AGE/RAGE axis, influences \_\_\_\_ dysfunction and \_\_\_\_, eventually traumatizing \_\_\_\_
dysfunction
inflammation
periodontitis
How Does Periodontitis Affect DM?
- Periodontitis contributes to ____
- – Elevated serum ____ (IL6, TNFalpha and C-reactive protein (CRP))
- Increase insulin ____
- – TNF-alpha, IL6, CRP have been shown to impair intracellular ____ signaling, potentially contributing to insulin resistance
- Periodontitis increases ____
- – Systemic dissemination of these periodontal organisms or their products may induce a ____ or ____, inducing an elevated ____ state and stimulating increased levels of ____ inflammatory markers
- Periodontitis increasing bacteremia = ____
- (Inflammation is ____)
inflammation
proinflam cytokines
resistance
insulin
bacteremia bacteremia endotoxemia inflammatory serum
Periodontal Disease -> Diabetes Mellitus
Periodontal pathogens will cause insulin ____ which leads to ____. The pathogen will also release ____ (LPS), which triggers ____ cytokines that is usually localized first and then spreads out to cause systemic ____.
resistance
hyperglycemia
endotoxin
diabetes
Two Way Relationship
It is a ____ relationship between diabetes and periodontitis.
The heart of this relationship is ____. There are many different diseases but conclusion is all the same: inflammation. This is related to ____ of inflammation.
Hyperglycemia cause ____, alter PMN function (cannot fight bacteria –> more severe periodontitis), alter ____ for matrix formation cells (prevents repair)
____ - another main focus of this lecture that cause periodontitis.
bi-directional
inflammation
dysregulation
AGE/RAGE
apoptosis
smoking
Is Having Diabetes a Risk Factor for Periodontal Disease?
The majority of well-controlled studies show a higher ____ and severity of periodontal disease in individuals with diabetes as compared with nondiabetic persons with similar local factors
It was found that the average pocket depth as well as the clinical attachment loss was ____ in patients with diabetes mellitus (____ of the type of diabetes mellitus)
Adult who are 45 years old or older with poorly controlled diabetes (i.e., with a glycated hemoglobin level of > ____) were ____ times more likely to have severe periodontitis than those without diabetes. The likelihood was even greater (____ times) among ____ with poorly controlled diabetes
prevalence
increased
independent
9%
2.9
3.6
smokers
The Effect of Periodontal Disease on Diabetes Control, Complications and Incidence?
There is consistent and robust evidence that severe periodontitis, adversely affects the ____ in individuals with and without diabetes
Moderate-to-severe periodontitis is associated with an increased risk for the development of ____
Evidence supports a ____-dependent role for periodontitis severity and diabetes complications
Compared to periodontally healthy individuals, people with poor periodontal health:
Type 2 diabetes or no diabetes: have greater risk of developing poorer ____ control
Type 1 or type 2 diabetes: have greater risk for ____-related complications
No diabetes: have greater risk of developing manifest ____
HbA1C
diabetes
dose
glycemic
diabetes
diabetes
Does the Treatment of Periodontal Diseases Provide Better Glycemic Control Among Diabetic Patients?
Randomized controlled trials (RCTs) consistently demonstrate that ____ associates with approximately a ____ reduction in HbA1C at ____ months, a clinical impact equivalent to adding a second ____ to a pharmacological regime for diabetes
There is no current evidence to support adjunctive use of ____ for periodontal management of diabetes patients
mechanical periodontal therapy
0.4%
3
drug
antimicrobials
Key Point
People with poorly controlled diabetes (both type 1 and type 2 diabetes mellitus) must be considered at risk for ____
Early ____ and ____ of DM are of fundamental importance to avoid the largely irreversible tissue loss that occurs in periodontitis, and early referral of adults and children with poorly controlled diabetes to dental clinicians is indicated for periodontal screening
Periodontal therapy in patients with diabetes is associated with improvements in glycemic control (____ reductions of approximately 0.4%) that may be clinically relevant in the management of diabetes
Oral health should be promoted in people with diabetes as an integral component of their overall diabetes management
•\_\_\_\_ is the key point
periodontitis
diagnosis
prevention
HbA1c
inflammation
Background Information
- 2010 in the US 19.3%
- Smoking is the major ____ for periodontitis
- ____% of periodontitis cases (6.4 million cases) in the US adult population were attributable to current smoking and that approximately ____% (1.7 million cases) were attributable to former smoking
Tobacco smoke contains thousands of noxious chemicals
____ phase
Solid (particulate) phase: ____
Cumulative exposure to cigarette smoke
____ = Number of packs smoked per day x Number of years of smoking
• Major risk factor of periodontitis - smoking • Nicotine is in the solid phase • P-Y = # of packs per day x number of years smoking ○ \_\_\_\_ cigarettes per pack
risk factor
42
11
gaseous
nicotine
pack-year
20
Effects of Smoking on the Prevalence and Severity of Periodontal diseases
A. Gingivitis
Smokers present with less ____ (gingivitis) than nonsmokers
B. Periodontitis
Cross sectional & longitudinal studies
NHANE III Current Smoker \_\_\_\_x Non- smoker Former smoker \_\_\_\_x Non- smoker
gingival inflammation
4
1.7
- NHANE III
- – Periodontitis and number of cigarettes (____-response relationship)
- ⩽ 9 cigarettes per day —> ____x
- > 31 cigarettes per day -> ____x
Former smokers have less risk for periodontitis than current smokers but more risk than nonsmokers
In former smokers, the odds of having periodontitis ____ with the number of years since quitting
____ programs must be an integral component of periodontal education and therapy
Less information is available about the effects of cigar and pipe smoking, but it appears that effects similar to those of ____ smoking are observed with these forms of tobacco use
dose
2.8
6
declined
smoking cessation
cigarette
Effects of Smoking on the Etiology and Pathogenesis of Periodontal Disease
⬆____ and ____ of periodontal destruction
It suggests that the host–bacterial interactions are altered, thereby resulting in more extensive periodontal breakdown
Smoking
> ____
> ____ response
> ____
prevalence
severity
microbiology
immune-inflammatory
physiology
Microbiology
No effect on rate of ____ accumulation
Smoking decreased ____ tension → overgrowth of ____ bacteria
Smokers do not respond to ____ therapy as well as nonsmokers do → this is associated with increased levels of ____, A. actinomycetemcomitans, and ____ remaining in the pockets after therapy in the smoking group as compared with nonsmokers
plaque O2 anaerobic mechanical T. forsythia P. gingivalis
Checkerboard DNA-DNA hybridization
Never (n=124), past (n=98), current smokers (n=50)
Members of the ____ and ____ complexes were significantly more prevalent in current smokers than in former or non-smoker
The major difference was in the ____ of species in shallow pocket (PD < 4mm) rather than counts or proportions
* Prevalence of species is higher in \_\_\_\_ pockets * Smoking changes the preference of the red/orange complex * In disease, red complex is most related to periodontitis
orange
red
prevalence
shallow
Immune-inflammatory response
⬆ ____ in crevicular fluid
⬆ Release of ____ in GCF: neutrophil elastase, ____ (PGE2), and matrix metalloproteinase-8 (MMP-8)
⬆ ____ generation from PMNs Immunosuppressive
⬇ PMN ____, phagocytosis
⬇ Serum ____ levels
Inhibit human gingival ____ proliferation and attachment (____, acrolein, acetaldehyde)
TNF-alpha collagenases prostaglandin E2 ROS chemotaxis IgG2 fibroblasts nicotine
Physiology
The response of the ____ to plaque accumulation appears to be altered in smokers as compared with nonsmokers
⬇ Gingival ____ with developing inflammation
⬇ Gingival ____ flow and bleeding on probing with developing inflammation
-So you have less bleeding on probing on smokers, but that does not mean that the disease is less in them. It is just ____, as we addressed in a previous slide. The disease is actually more prone in smokers, of course.
⬇ Subgingival ____
⬆ ____ needed to recover from the vasoconstriction caused by local anesthesia
microcirculation blood vessels crevicular blood masked temperature time
“This is a summary of how smoking influences periodontal disease.
So, in local part (she means locally I guess?), they will cause peripheral ____, local ischemia. So ____ bacteria will grow more, which as we know is related to the disease.
In the systemic part, there will be decreased ____ and ____ immune response. So ____ and ____ will decrease in serum, and also ____ PMN chemotaxis and phagocytosis function.
ROS - so they also increase the oxygen stress and activate ____ - this is the inflammatory pathway. Causes more active inflammatory cascade, release more TNF-a, IL-1B, IL-6.
So all this will cause more severe periodontitis.
All this actually sounds very complicated but its all very similar. Similar to diabetes as well.”
vessel constraction
anaerobic
adaptive innate IgG IgA decrease
NFK-beta
Effects of Smoking on Response to Periodontal Therapy
Smoking
“You must explain to the patient that this is very important (effects of smoking). Because if they dental work doesn’t work, you can blame the smoking.
Smoking has really bad effect on treatment. Even surgical, non-surgical, implants and also maintenance.
Non-surgical treatment you have less ____ reduction, less attachment gain, but the thing is that if the patient has extremely good oral hygiene, you negative effect of smoking ____, but they must have extremely good oral hygiene for this to be the case. But most of the time, if they smoke, they cannot have good oral hygiene.
If you have surgery, like GTR (we dont know what this is yet - it’s when you have some bone loss and you want to repair, you use grafting to fix. Smoking will have bad effect on this kind of treatment. Also bad effect on implants. ____ the failure rate in smokers.)
____ treatment - if you smoke, you have higher chance to have periodontitis.”
pocket depth
decreases
double
maintenance
Conclusion From the Studies
Smokers may present with periodontal disease at an ____ age
They may be difficult to treat effectively with conventional therapeutic strategies
They may continue to have progressive or recurrent periodontitis
That they may be at an increased risk of ____ loss or ____ bone loss, even when an adequate maintenance control is established
early
tooth
peri-implant
Effects of Smoking Cessation on Periodontal Treatment Outcomes
Smoking has a negative impact on the gingival vasculature and that these changes are ____ with smoking cessation
Smoking cessation seems to promote additional beneficial effects in reducing ____ and improving ____ following non-surgical periodontal treatment
Benefit of smoking cessation on the periodontium
A shift toward a less ____microbiota
The recovery of the gingival ____
Improvements in certain aspects of the immune–____ responses
reversible
probing depths (PD)
attachment level
pathogenic
microcirculation
inflammatory
5 A’s for Smoking Cessation
____ them about their smoking status
____ them the associations between oral disease and smoking ____ their interest in and readiness to attempt smoking cessation
____ them with their quit attempt
____ for follow-up visit or a referral to professional smoking cessation services
ask advise assess assist arrange
Smoking Cessation
Read if you want!
YAY
Female Sex Hormones
Hormonal changes during pregnancy and puberty leads to ____ and ____ alteration
The aggravation of gingivitis during pregnancy has been attributed principally to the increased levels of ____
____
aggravate the gingival response to local factors in a manner similar to that seen during pregnancy
gingival
periodontal
progesterone
hormonal contraceptives
Stress & Psychosomatic Disorders
Psychosocial stress, have been implicated as ____ for periodontal disease
Stress and psychosomatic disorders impact periodontal health via changes in the individual’s ____ and through complex interactions among the ____, ____, and ____ systems
Production of ____ → suppress the immune response
Systematic review showed a ____ relationship between psychosocial stress and chronic periodontal disease
The most commonly studied periodontal disease in relation to stress is ____
Individuals with high levels of ____ stress and poor ____ skills had twice as much periodontal disease
risk indicators behavior nervous endocrine immune cortisol
positive
acute necrotizing ulcerative gingivitis (ANUG)
financial
coping
Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome
Human immunodeficiency virus (HIV) attacks most cells in the human immune system, especially those that carry the ____ cell surface receptor molecule (____, monocytes, ____, dendritic cells, neuronal and ____ cells)
HIV infection to AIDS (acquired immune deficiency syndrome): plasma CD4-T lymphocytes less than ____/mm3 or CD4-T lymphocyte percentage less than ____ of total lymphocytes
Highly active antiretroviral therapy (HAART): combine the use of ____ and ____ inhibitor drugs
CD4
helper T lymphocytes
macrophages
glial
200
14%
antiretroviral
protease
Oral Manifestations of HIV Infection
- ____
- Erythematous candidasis
- ____ lymphoma
- Oral hairy leukplakia
- ____ sarcoma
- Linear gingival erythema
- ____
- Immune suppressent, opportunistic infection
- Oral hairy leukoplakia - ____
- Kaposi sarcoma - ____
- Necrotizing ulcerative gingivitis - no ____
pseudomembranou candidiasis
non-hodgkin’s
kaposi
necrotizing ulcerative gingivitis
EBV
HPV
attachment loss
HIV Infection & Chronic Periodontitis
The limited data available appear to affirm that periodontal destruction is more prevalent and somewhat more severe in ____-positive individuals, and that this susceptibility may worsen as CD4-T cell counts ____ and as viral bioload ____
The incidence of chronic periodontitis may be decreasing with the advent of ____
HIV
decrease
increases
HAART
“This is a review to discuss the direct and indirect pathways.
Periodontal infection will cause ____ and will cause some local ____. This is indirect. They all go into circulation and cause acute phase protein increase (____ is key factor).
We take a look at inflammation status of systemic condition.
And also some other IL-6, TNF-a, and IL-1 all increase the circulation. Eventually they will cause aggravation of some other disease. ____ outcome, diabetes, atherosclerotic CVS disease.
We will talk about atherosclerosis and pre term low birth weight later.”
bacteremia
inflammation
CRP
averse pregnancy
Periodontal Disease & Mortality
- The ultimate medical outcome measure is ____
- A number of studies suggest that an increased ____ rate is associated with inflammatory periodontal diseases
- These results only establishes an ____, not a causation• An association but not a causation of mortality
○ Too many ____ factors
mortality
mortality
association
compounding
Periodontitis & Atherosclerotic Cardiovascular Disease (ACVD)
Atherosclerosis: the artery wall thickens as a result of the accumulation of ____ and fatty materials that form ____ (atheroma) and cause the arteries to harden and stiffen
Complications of atherosclerosis include ____, myocardial infarction, ____, or aneurysm
* Plaque = atheroma * PG - triggers \_\_\_\_ muscle - proliferation
calcium plaques angina stroke smooth
____, central to the initiation and progression of periodontitis, may provide a ____ or ____ mechanistic link to the development of ____ disease
bacteria
direct
indirect
atherosclerotic
Consensus Report of the Joint EFP/ AAP Workshop
There is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future ____
The impact of periodontitis on ACVD is biologically plausible: translocated circulating oral microbiota may ____ or ____induce systemic inflammation that impacts the pathogenesis of ____
While in vitro, ____ and ____ studies do ____ the interaction and biological mechanism, intervention trials to date are not ____ to draw further conclusions
ACVD
directly
indirectly
atherothrombogenesis
animal
clinical
support
adequate
Periodontitis & Adverse Pregnancy Outcome
The main adverse pregnancy outcomes that have been associated with periodontal disease include low ____ (<2500 g), ____ birth (<37 weeks) and ____
Maternal periodontitis represents a potential source of microorganisms that may enter the circulation
Biological mechanisms: Two major pathways
Direct: oral microorganisms and/or their components reach the ____ unit
Indirect: Inflammatory mediators circulate and impact the ____ unit
birth weight pre-term pre-eclampsia foetal-placental foetal-placental
“Bacteria inflammation, although the cytokines might be different, you see that the ____ is always here (points to bubble that says PMNs), points to ____, ____ bubbles too and says same thing, that they are always here at these points in the cycle.
Sometimes you will see IL-1 or IL-6 though at the spot where TNF-a is.
In pregnancy, you will see it will eventually cause some ____ (points to bubble that reads “prostanoids”), which will cause premature rupture of ____ membrane and cause contraction of the ____ smooth muscle, which causes ____ labor.
SO THIS IS THE MECHANISM HOW PERIODONTAL DISEASE CAUSES THE ADVERSE PREGNANCY OUTCOME”
PMN
macrophages
TNF-alpha
PGE2
placenta
uterine
premature
A case report of term stillbirth caused by oral ____ provides the first human evidence that the bacteria originating from the mother’s ____ plaque could translocate to the ____ and fetus, leading to ____ inflammation and fetal demise
F. nucleatum
subgingival
placenta
acute
Periodontitis & Respiratory Disease
Periodontitis has been linked with both ____ and ____
COPD: progressive airflow obstruction and inflammation in the airways with the main cause attributed to cigarette ____
Pneumonia : ____ within the airways
Many potential opportunistic pathogenic bacteria are found within the oral cavity Improved oral hygiene has been shown in randomized controlled trials to have an important role in the prevention of ____ in a variety of at risk-populations
chronic obstructive pulmonary disease (COPD)
pneumonia
smoking
infection
pneumonia
The Potential Role of Oral Bacteria in the Pathogenesis of Respiratory Infection
Aspiration of oral pathogens (such as ____, Actinobacillus actinomycetemcomitans, etc.) into the lung to cause infection
Periodontal disease-associated enzymes in saliva may modify ____ surfaces to promote ____ and colonization by respiratory pathogens, which are then aspirated into the lung
Periodontal disease-associated enzymes in saliva may destroy salivary ____ on pathogenic bacteria to hinder their ____ from the mucosal surface
____ originating from periodontal tissues may alter ____ epithelium to promote infection by respiratory pathogens
p. gingivalis
mucosal
adhesion
pellicles
clearance
cytokines
respiratory
Periodontal disease -> Respiratory Disease
It could be from the pathogen ____ into the lung. This is the direct pathway to cause lung infection.
Also it will cause ____ response, and will cause lung inflammation. This will mainly contribute to ____ since it is an inflammatory disease.
Infection is more related to ____.”
aspirated
inflammatory
COPD
pneumonia
Links Between Periodontitis and Other Systemic Diseases
- Chronic Kidney Disease (CKD)
- – Kidney damage with decreased function for ____ months or more
- – Periodontitis is associated to CKD, but mechanism is not clear
- Rheumatoid arthritis (RA)
- – Persistent synovial ____ and associated damage to ____ cartilage and underlying bone
- – Currently little published evidence the periodontitis represents a risk factor for developing RA
- Cancer
- – Periodontitis has been identified as a possible risk factor for ____ and ____ cancer
3
inflammation
articular
oro-digestive
pancreatic
