Perio And Systemic Disease Flashcards
How does periodontitis affect risk of diabetes?
Increases risk of diabetes
As perio is associated with increased Hb1Ac (glycated haemoglobin)
What is the diabetic threshold for glucose in blood plasma?
7.0 mmol/L
What is the difference between blood glucose levels and Hb1Ac levels?
Hb1Ac indicates level of blood glucose over the last three months as this is the life span of erythrocytes
How does diabetes worsen periodontitis?
Unregulated immune response arising from each condition, adversely affects the other.
In diabetes, there is increased deposition of advanced glycation end products (AGE’s) in periodontal tissues leading to activation of the immune system and increased inflammation through release of cytokines and disruption of RANKL/OPG balance leading to bone resoprtion
How does perio worsen diabetes?
Periodontal bacteria and the inflammatory cytokines produced in response are produced and enter circulation.
This contributes to unregulated systemic immune response, thus worsening the effect of a patients diabetes due to impaired insulin signalling and insulin response.
What are the potential ways periodontal disease may influence cardiovascular disease?
Periodontal disease leads to activation of the immune system.
The systemic immune upregulation can lead to inflammation in blood vessel walls due to cytokines, TNF-a and CRP etc.
This can result in an incresed risk of atherosclerosis, also it can lead to vasoconstriction and thus hypertension, further increasing risk of cardiovascular disease.
A single session of intensive dental tx to manage periodontal inflammation resulted in a systemic inflammatory spike that was accompanied by deterioration in vascular endothelial function.
How can periodontal tx help reduce cardiovascular risk?
General reduction in systemic inflammation and presence of CRP and TNF-a
Decrease in pro-inflammatory cytokines
Systematic reviews have shown this and also a reduction in blood pressure levels after periodontal treatment.
How is it believed periodontitis affects pregnancy?
Periodontitis is linked to adverse pregnancy outcomes
These can be things such as:
- small gestational size
- hypertension
- preeclampsia
- preterm birth
How is it thought that periodontal disease may influence pregnancy pathologically?
Direct migration of oral microorganisms into the fetal-placenta unit
Inflammatory mediators produced in the oral cavity affecting the fetal-placenta unit
How does pregnancy increase gingivitis in women?
During pregnancy, women have a rise in the hormones oestrogen and progestorone.
These can affect the gums and increase risk of gingivitis as they will
- increase blood flow to gingiva
- alter the host immune response, increasing susceptibility
How can PD worsen RA?
microorganisms in plaque biofilm induce an immune response releasing inflammatory cytokines and tissue destructive proteinases such as MMPS.
These enter the systemic circulation, thus increasing the inflammation already caused by rheumatoid arthritis’ auto-antibody attack
P.gingivalis also induces citrullination of the amino acid Arginine to citrulline by expressing the PPAD enzyme.
- produces anti-citrullinated protein antibodies ACPA which increase autoantibody complexes and favours the progression of RA
How can RA worsen PD?
Systemic disease RA results in systemic inflammatory mediators being present in the serology of pt.
These include destructive cytokines such as TNF-a, CRP and also MMPs.
These inflammatory cells reach the periodontium and aggregate the existing inflammation present.
This is a bidirectional relationship.
How might Alzheimer’s play a role in perio disease?
Cognitively impaired individuals less likely to adhere to oral hygiene routine and professional care.
How might perio play a role in Alzheimer’s progression?
Higher serum levels of p.gingivalis were linked to higher serum levels of beta amyloid and also tau protein in the CSF - those responsible for plaque build up in the brain in Alzheimer’s.
P.gingivalis contributes to the breakdown of the blood-brain barrier inducing responses in the brain such as inflamamtion and beta amyloid and tau protein production and also reduce clearance of beta amyloid in the brain.
P.gingivalis also linked to hypertension, a cofactor in Alzheimer’s progression.
