periodontal disease and systemic relationship

Question 1

periodontal disease associated disease

Answer 1

1) uncontrolled diabetes
2) Heart disease

Question 2

periodontal disease is a chronic inflammatory disease

Answer 2

1) increase inflammatory mediators in circulation
2) periodontal pathogens can enter blood stream
- transient ischemia
- local inflammation

Question 3

microbial challenge

Answer 3

gram - organisms
- anaerobes
- produce virulence factors
- gingipans (proteases)

Question 4

host inflammatory response

Answer 4

1) IL2, IL6, IL8, TNF alpha
neutrophils, macrophages, lymphocytes
- CT and bone destructions
- MMP destroy collagen, gelatin, elastin
2) leads to periodontitis

Question 5

pathogenesis of periodontal diseases

Answer 5

1) depends on genetic risk and environmental risk factors

Question 6

systemic effects of periodontitis

Answer 6

1) CVD
2) pre term birth
3) diabetes
4) respiratory disease
5) alzheimer

Question 7

atherosclerosis

Answer 7

1) a progressive disease loss of elasticity in medium and large arteries
2) infections and inflammation are associated with fatty plaques and thromboembolism
3) BP, smoking, and high cholesterol influence

Question 8

c reactive protein

Answer 8

1) acute phase response CRP, fibrinogen
2) forms fatty plaques (promotes atherogenesis)

Question 9

bacteremia

Answer 9

1) bacteria directly infect blood vessels

Question 10

how is the mechanism being tested

Answer 10

1) antibody titers
2) systemic inflammation
3) oral microbiology
4) etc.

Question 11

antibody titer

Answer 11

1) titers to certain perio pathogens linked to increased prevalence of CVD atherosclerosis in carotid
2) increased risk for cardiac events in 10 year follow up

Question 12

systemic infections

Answer 12

1) CRP levels increased means there is a strong relationship with CV events

Question 13

oral microbiology

Answer 13

1) periodontal pathogens are present in atherosclerotic plaques where they may play a role in the development and progression of atherosclerosis

Question 14

intervention studies

Answer 14

1) intreating patients with severe perio, following acute systemic inflammation, there was an improvement of endothelial function
2) periodontal treatment decreases systemic inflammation

Question 15

management of periodontal disease in high risk atherosclerosis patients

Answer 15

1) complete perio exam
2) prevention and treatment of perio
3) education
4) modify risk factors for atherosclerosis

Question 16

pregnancy gingivitis

Answer 16

1) 30-75% of pregnant women
2) erythema
3) edema
4) hyperplasia
4) bleeding

Question 17

pregnancy tumors

Answer 17

1) grow and bleed rapidly
2) hyperplasia

Question 18

etiology

Answer 18

1) subgingival plaque and calculus
2) maternal hyperimmunoresponsiveness
3) hormones

Question 19

preterm low birth weight

Answer 19

1) preterm
- before 9 mo of gestation
2_ low birth weight
- <5 lbs

Question 20

biological plausibility

Answer 20

1) periodontal disease
2) inflammatory response
3) mediators
- PGE2 and TNFalpha
4) uterine contraction cervical dilation

Question 21

periodontal disease and preterm birth

Answer 21

1) association has odds ratio of 7.9
2) strong association
3) treatment of periodontitis doesnt have much effect on preterm birth
- fail to show reducitons in pregnancy complications

Question 22

management of pregnant patients

Answer 22

1) preventative oral services
2) if exam needs perio therapy, 2nd trimester
3) acute infection, abscess or other sources of sepsis my warrant prompt innervation

Question 23

diabetes and periodontal disease

Answer 23

1) negative effect of glycemic metabolism
2) AGE produced *protein + fate +sugar)
2) accumulation of AGE influence perio destruction
3) alters collagen metabolism leading to unhealthy collagen breakdown and poor healing
4) AGE + RAGE increases proinflammatory cytokines

Question 24

how does PD influence diabetes

Answer 24

1) chronic inflammation increases dysregulated inflamed environment, increases insulin resistance
2) anything greater than 7 is uncontrolled diabetes

Question 25

interventional studies

Answer 25

1) antibiotics to improve glycemic control 2) effect is pronounced in poorly controlled diabetes with severe periodontitis 3) HBA1C can be reduced 0.45

Question 26

periodontal dieases and respiratory diease

Answer 26

1) commonly COPD 2) poor OH and periodontitis seems to influence pulmonary infections 3 interventional - oral care vs no oral care - increased incidence of pneumonia and related mortality

Question 27

alzheimers and periodontal dieases

Answer 27

1) proinflammatory molecules compromise BBB an enter the cerebral regions leading to activation of microglial cells and leading neuronal damage 2) virulence factors : gingipans are toxic proteases

Question 28

alzheimers conclusion

Answer 28

1) randomized controlled studies and interventional studies are needed to validate