Periodontal Medicine Flashcards
what is periodontal medicine
systemic conditions that increase susceptibility to periodontal disease
periodontal infections that are risk factors for systemic conditions
what is the ‘focal infection theory’
states that infectious agents from a central focal infection - such as teeth, roots, inflamed gum tissues or perhaps tonsile, metastasize to the heart, the eyes, the kidneys, lungs or other organ/tissues, establishing the same infection in new, distant sites
4 major common infections in the oral cavity
- caries
- periapical lesions- nonvital teeth
- fungal and viral infections
- periodontitis
what we look at for the potential link of perio and overall health
RISK FACTORS
the challenge to the potential link
NOT CAUSE AND EFFECT MECHANISM
- someone may have both perio disease and systemic disease but how do yo know if one caused the other
describe two faced neutrophil
- harmful
- excessive release of noxious copounds that cause tissue damage
- PMN mediated destruction - protective
- phagocyte function/ clearance of microbes
- increase intracellular killing of microbes via controlled release of ROS
why is there so much variability
there are different kinds of plaque
- patients respond differently
- genetics may play a factor; susceptibility to perio diseases and variance in response to treatment
potential risk factors
- systemic conditions
- like DM - local anatomy
- medications
- genetics
- smoking
- stress/ SES
- all are yet to be indentified and understood
perio disease needs to be viewed as what (either __ or ___)
- consequence of underlying hyperinflammatory trait
OR - as a facotr contributing to systeic inflammation
implication of interleukin 1 (IL-1) gentotye being + or -
individuals who are genotype positive roduce two to four times more IL-1beta than individual who are genotype negative
- if positive produce more IL-1 as a response to plaque – more heightened response – more bone loss potential?
5 major complications of DM
- blindness
- kidney disease
- nerve disease
- heart disease and stroke
- PERIODONTAL DISEASE
Oral manifestations of DM in the oral cavity
- burning mouth syndrome
- candidiasis
- dental caries
- glossodynia
- lichen planus
- neurosensory dysesthesias
- periodonttitis
- salivary dysfunctino
- taste dysfunction
- Xerostomia
major connection between DM and perio
Diabetic patients who have perio are more susceptible to devloping recurrent and multiple periodontal abscesses
studies show an increase in what with diabetic patients and perio disease
GREATER
- prevalence
- incidence
- severity
- extent
- progression
dose response - so as diabetic situation worsens - perio worsens and likley because these patients cannot fight infections as well
study with pima indians was which type
epidemiological study
epidemiological study with pima indians showed?
diabetics had more severe perio than non
destructive perio occured earlier in life than non
diabetics were 15 x more likely to lose teeth
epidemiological study with pima indians major finding? supported by?
finding
- when perio was treaed the management of their diabetes improved
supported by JOurnal of Perio in 1997 with the 113 Pima indians with both perio and diabetes
what is the mechanism of adjunctive diabetic therapy with periodontal patietns?
as a consequence of perio disease - the pateitn has reduced glycolyated hemoglobin and thus require less insulin
if this is verified, physicians may consider perio therapy a needed adjunctive therapy in the treatment of certain diabetic patients whom are struggling with glycemic control
what can we say and not say about relationship between DM and perio?
CANNOT SAY perio tx will improve glycemic control in all patients
CAN SAY
- with good certaintiy that DM is a contributing factor to the severity of perio disease and evidence is showing that perio is a contributing factor to impaired glycemic control
MAY NOT BE TRUE FOR ALL INDIVIDUALS
potential link between CVD and perio
- perio organisms have been found in atheromas
- both diseases have nearly identical risk factors
- age, male gender, smoking, and diabetes - both involve the inflammaotry processes- perio disease could be stimulating immune mediators that affect the heart
- involve same inflammatory mediators and mechanisms
what are increased in CD and Perio?
- fibrinogen
- WBC
- contributed by genetics, cytokines, LPS, Smoking
INCREASES PLATALET aggregation and fibrinogen levels initiate thrombus formation
describe c-reactive protein
- produced by the liver
- produced in the normal immune response
- also elevated during injury, inflammation and infection
* 4. elevated CRP levels are associated with negative CV outcomes
CRP levels in periodonotitis
- Perio disease increases CRP levels
- stastically significant increases in CRP levels were observed in subjects with perio disease when compared to healthy controls - perio treatment can decrease CRP levels
- clinical perio control accompanied by significant reductions in CRP
CRP relationship with atherosclerosis
CRP participates in development of clots and plaques
- CRP involved in blot clots - causing MI stroke and other vascular diseases
- CRP is mediator in the inflammation of arteries, resulting in formation of clots and plaques that lead to CVD
major findings from studies that look at Cardio disease and Perio?
support AN ASSOCIATION
- DO NOT SUPPORT A CAUSATIVE EFFECT
ASSOCIATION IS REAL- AND INDEPENDENT OF SHARED RISK FACTORS
no known evidence that perio therapy can prevent ASVD or modify outcomes
pregnancy and risk for Perio? there is increased?
Pre-term, low birth weight infants
- less than 37 weeks and weight less than 5lbs 8 oz
- vascular permeability
- GCF flow
- GI scores
- PMN’s in the sulcus
- PGE2
- Bacteriocides species
conclusion with pregnancy and risk for perio
PREGNANCY MAY ACCELERATE ATTACHMENT LOSS
- those with moderate to severe perio were more likely to have perio progress versus those that were initially healthy
major biological mechanism associated with pregnancy and perio
PGE2 levels increased in mothers with LBW infants that in controls
- the lower the birth weight the higher the PGE2 - which is a prostagladin
- may interfer with fetal growth and trigger preterm labor
