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Perio > Perio and systemic disease > Flashcards

Perio and systemic disease Flashcards

1
Q

What did they use to say about local infections

A

It leads to chronic diseases

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2
Q

Why does the focal infection theory not make sense?

A

Extracting teeth doesn’t help
People with oral health can have systemic disease
Edentulous people still get systemic diseases

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3
Q

How can periodontitis potentially influence systemic disease?

A

The acute phase reaction cascade

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4
Q

What is the acute phase reaction cascade

A

Triggering factors > local reaction> mediatos> secondary systemic reaction

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5
Q

What are some triggering factors

A

Infection necrosis surgery neoplasia radiation

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6
Q

What cells are involved in local reactions

A

Macrophages fibroblasts and endothelial cells

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7
Q

What are mediators?

A

Inflammatory cytokines ex.

TNF-@, IL-1, IL-6, INFy

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8
Q

What are common secondary systemic reaction

A

Fever and leukocytosis
Complement activation
Serum glucocorticoid increased
Altered synthesis of acute phase proteins

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9
Q

What are the acute phase proteins

A 
Complement components
Protease inhibitors (@2 macro globulin)
C reactive proteins
Fibrinogen
Plasminogen
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10
Q

What do complement fragments do

A

Opsonization lysis and Ctx

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11
Q

What do c reactive proteins do

A

Opsonization

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12
Q

What does fibrinogen do

A

Coagulation ctx

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13
Q

What does plasminogen do

A

Degrades blood clots

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14
Q

What percentage of Americans over thirty have periodontitis

A

47%

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15
Q

What kind of bacteria live in perio pockets

A

Gram negative

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16
Q

Do infected and inflamed tissues pose a risk for perio?

A

Yes

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17
Q

Perio leads to a systemic exposure to:

A

Bacteria, their products and inflammatory cytokines

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18
Q

What defines a risk factor?

A 
Consistency of association
Strength of association
Correct time sequence
Specificity of associations
Degree of exposure
Biological plausibility
Support from experimental evidence
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19
Q

What does specificity mean?

A

If the factor is only associated with one disease, it is likely to be unconnected

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20
Q

What does degree of exposure have to do with a risk factor

A

More exposure should equal more risk

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21
Q

What is biological plausibility

A

The risk factor should make sense

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22
Q

What counts as experimental evidence

A

Animal testing

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23
Q

What are four diseases associated with perio

A

Avd
Adverse pregnancy outcomes
Diabetes
Respiratory infection

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24
Q

What is atherosclerosis

A

Progessive disease where med-large muscular and large elastic bvs get occluded w atheromas

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25
Q

What are atheromas

A

Fibro lipid lesions

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26
Q

What are common complications of AVD

A

Coronary thrombosis and acute mi

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27
Q

What is the progression of AVD

A

Macrophages and cholesterol and LDL forms foam cells that die and recruit more macs forming an atheroma that rupture and form a thrombosis that occlude arteries

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28
Q

Besides perio what is a factor for avd?

A

High risk lipid profile, diet

29
Q

What factors are common to avd and periodontitis

A

Smoking, age, diabetes, educational and socioeconomic status

30
Q

What study showed a significant association bw oral health and mi

A

Mattila

31
Q

What did the NHANES I study demonstrate

A

Periodontitis assoc with a small risk of coronary heart disease in men

32
Q

Can tooth loss predict Chd?

A

Small assoc bw tooth loss and coronary hart disase

33
Q

What is the relation bw perio and atheromas

A

Perio can influence atheroma formation

34
Q

What is the assoc bw perio disease and Chd

A

No convincing evidence for assoc bw perio disease and chd risk

35
Q

What is the relationship bw tooth loss and mi risk

A

Men and women with tooth loss have higher risk of mi

36
Q

Does the loss of alveolar bone correlate with atherosclerosis

A

Yes, significant dose response curve

37
Q

Can perio pathogens cause Atherosclerosis

A

Yes

38
Q

Will perio tx fix atherosclerosis

A

Pathogens and probe depths decrease will decrease rate of carotid artery changes

39
Q

By how much Does perio increase the risk of avd

A

Twice the rate

40
Q

What is the rationale for he avd perio link

A

Perio bacteria affect platelets
Perio bacteria invade endo cells and macrophages
Endocrine like effects of pro inflammatory mediators

41
Q

What pathogens induce thromboembolic events

A

S sanguis and p gingivalis

42
Q

What mediates the bacterial thromboembolic events

A

Collagen like platelet aggregation proteins made by bacteria

43
Q

What DNA is found in avd lesions

A

Perio pathogens

44
Q

P gingivalis and LDL do what

A

Turn macrophages into foam cells

45
Q

What is elevated in perio patients?

A

Crp, fibrinogen are twice as high

46
Q

What do bacteria release into systemic circulation?

A

Endotoxin

47
Q

Bacteria, endotoxins and cytokines in systemic circulation up regulate what?

A

Endothelial adhesion molecules and monocytes activation and il1 tnf@ and il6

48
Q

What do endothelial adhesion molecules, monocytes and cytokines do

A

Monocyte and tcell production, atheroma development

49
Q

What does the liver make in response to TNF a, il6 and il8

A

Acute phase proteins which increase coagulation

50
Q

What does scaling and root planing do

A

Maybe reduces crp. Just maybe

51
Q

Does perio therapy improve endothelial function

A

Probably

52
Q

Does treatment of perio reduce the risk of avd?

A

No strong evidence suggests this but the link between the two is probably legit

53
Q

Is the perio avd link specific

A

No

54
Q

Does the degree of exposure make sense?

A

Yes worse perio is assoc w worse Chd

55
Q

Is it biologically plausible?

A

Yes

56
Q

Is there enough evidence

A

Not really

57
Q

What does aha say

A

Perio and avd is plausibly linked, but they share risk factor
No causal relationship supported
Not enough evidence

58
Q

How should dentists approach the avd perio link

A

Tx risk factors
Collab w physicians to prevent both
ex send to a periodontist if they have both risk factors

59
Q

Ptbw is what

A

Less than 2.5kg

60
Q

Ptbw is How many of births and how many of those that die

A

10% overall, 66% of deaths

61
Q

How could perio cause ptb

A

Macrophage and cytokines make placental tissues release pge2 causing myometrial contraction, also increased mmps weaken membranes

62
Q

Is perio tx safe for preggos

A

Yes

63
Q

Does perio cause ptbw

A

Assoc is modest

64
Q

Does perio therapy reduce ptb

A

No

65
Q

How could diabetes correl w perio

A

Chronic hyperglycemia leads to glycemic end products, which thicken endo walls, decreasing PMNs recruitment which decreases host response and also fibroblast recruitment delays healing. Also cytokines increase tissue breakdown, as well as elastase, collagenase and b glucoronidase

66
Q

Does perio tc reduce HBAIC

A

Yes, similar to adding 2nd drug, but follow ups needed so provide guidelines for dentists who tx diabetics.

67
Q

Does perio tx fix COPD?

A

No

68
Q

Does plaque cause pneumonia

A

More likely

69
Q

Is perio health linked to systemic

A

Yes, but need more studies

Perio (2 decks)

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