Periodontal pathogens and systemic disease Flashcards
List the diseases that periodontal disease is associated with (8)
- Diabetes mellitus
- Cardiovascular disease
- Rheumatoid arthritis
- Pneumonia
- Cancers
- Adverse pregnancy outcomes eg. preterm birth, low birth-weight and preterm low birth-weight ?
- Alzheimer’s disease?
- Renal disease?
Briefly explain the focal infection theory
Aninfectionin which bacteria are localized in some region, as the tonsils or the tissue around a tooth, from which they may spread to some other organ or structure of the body.
List the systemic diseases in which periodontal disease TREATMENT has a positive effect (4)
Perio therapy reduces medical costs and hospitalizations for patients individuals with:
- Type 2 diabetes (40.2%);
- Coronary artery disease (10.7%)
- Cerebral vascular disease (40.9%)
- Pregnancy (73.7%) complications
Does periodontal disease treatment have an effect on rheumatoid arthritis?
Nil reduction for rheumatoid arthritis (RA)
What is the mechanism of the oral- systemic health connection? (3)
- Direct effect of infectious agent
- Indirect or host-mediated responses eg. elevated systemic proinflammatory mediators
- Common genetic predisposition
Describe:
- The link between periodontitis and diabetes (3)
- AGE receptors and periodontitis (2)
- The changes to the oral microbiome
Link between periodontitis and diabetes:
• Diabetes tends to increase susceptibility to infection, including oral infections
• Periodontitis increases the risk of poor glycaemic control in people with diabetes
• Diabetes interferes with the capacity to form new bone
AGE receptors
• AGE: excess sugars in body bind to proteins/ cells, glycated them. This changes the behaviour of these proteins and they stimulate the immune response
• Advanced glycation end (AGE) products and its receptor are proinflammatory, exacerbating the inflammatory response to periodontal pathogens
The changes to the oral microbiome:
• No conclusive evidence that oral microbiome is different in diabetic patients.
Describe the histological link between diabetes, obesity and periodontitis by mentioning the following:
- Adipokines
- AGE/ RAGE interactions
- Cytokine production
- Pro- inflammatory cytokines and MMPs
- Subgingival biofilm
- Obesity is caused by a build up of adipose tissue
- Diabetes can lead to obesity, and obesity can lead to diabetes
- These adipose tissue leads to adipokines, AGE/RAGE interactions
- In turn, this leads to increased cytokine production, altered PMN function and altered apoptosis
- Overall, this causes a dysregulated inflammatory response, with increases in proinflammatory cytokines, MMPs and this can cause periodontitis
- The presence of the subgingival biofilm can itself lead to increases in proinflammatory cytokines, MMPs and this can cause periodontitis
Describe the link between periodontitis and cardiovascular disease (7)
- Similar risk factors to periodontal disease eg. smoking, age, lower socioeconomic group, stress
- Increase in the risk for CVD in patients with periodontal disease
- Oral bacteria or viruses may directly infect atherosclerotic lesions contributing to the inflammatory process
- Aortic atheromas contain antigens from periodontal pathogens including P. gingivalis, T. forsythia, and P. intermedia
- P. Gingivalis can induce platelet aggregation = thrombus formation
- Oral infections may increase systemic inflammation through the release of toxins or the leakage of chemical mediators (eg. CRP) into the circulation
- Animal model studies show that P. Gingivalis increases atheroma size and elevate CRP levels.
Describe the pathophysiology of how p. gingivalis leads to CVD
- Initially there is P gingivalis floating in the blood that is able to bind to endothelial cells on lumen of arteries
- These endothelial cells begin to recruit monocytes to try and clear the infection
- The white blood cells release reactive oxygen species (ROS) to kill the bacteria, however these ROS also oxidise the LDL, making it into oxidised LDL
- Oxidised LDL accumulate in the blood vessel wall, and macrophages try to metabolise it
- However, the LDL particles begin to accumulate in the phagocytes (as they struggle to metabolise them) and this leads to foam cells
- With time these foam cells begin to accumulate, and when they die, these LDL particles begin to deposit in the blood vessels tissue, causing an atheroma
Describe the link between periodontitis and rheumatoid arthritis (3)
- Studies show positive correlation between PD & RA (if you periodontal disease, you are 1.5 times likely to develop RA, and if you have RA you are 4.1 times more likely to get PD)
- Active perio in RA patients have been reported to respond poorly to some RA medications
- Case reports of RA resolution after perio treatment/teeth extraction
Provide three reasons for why rheumatoid arthritis causes periodontal disease
- May share a common genetic risk factor
- Manual dexterity difficulties in oral hygiene
- Immunosuppressive drugs in RA impact periodontal defence
Explain the pathophysiology of how periodontitis causes rheumatoid arthritis
- Citrullinationis the conversion of arginine in a protein into the amino acidcitrulline
- Peptidyl-arginine deiminase (PAD) is what converts arginine into citrulline
- Patients with rheumatoid arthritis (RA) have antibodies against citrullinated proteins (which have been generated by the activation of peptidylarginine deiminases PADs)
- Human PAD plays an important role in homeostatic processes such as the development of hair, skin, the myelin sheath, embryogenesis, formation of neutrophil extracellular traps (NETs), citrullinated chemokines and regulate gene transcription
- P .Gingivalis has a unique Porphyromonas PAD (PPAD) enzyme that mimics human PAD
- Thus, P. Gingivalis can use its PPAD to circulated human and bacterial proteins
- In periodontal infection an immune response is mounted against the bacteria, and some of these bacteria contain citrullinated protein residue
- Thus, the body produces antibodies against the bacteria’s citrullinated protein residue. However, these citrullinated residues can be similar to human citrullinated residues
- Therefore, these antibodies will also attack human citrullinated residues (in joints), causing inflammation/ damage and increasing the risk of rheumatoid arthritis
- With RA, people struggle to maintain OH, thus allowing p gingivalis to continue the cycle
Describe the link between periodontitis and cancer, and the types of cancers associated with periodontitis (6)
- Some studies show that periodontal diseases, or poor OH increases the risk of Squamous Cell Carcinoma (independent of alcohol & smoking habits)
- Other studies showed no correlation
Types of cancers associated with periodontitis: • GI cancer • Oesophageal • Lung cancer • Pancreatic cance • Uterine • Colorectal, prostate
Describe the specific oral bacteria involved in the carcinogenesis of cancer:
Fusobacterium, Porphyromonas, Peptostreptococcus, and Mogibacteriumwere:
F. nucleatum:
Fusobacteria
Fusobacterium, Porphyromonas, Peptostreptococcus, and Mogibacterium:
• Enriched in the mucosa-adherent microbiota in colorectal cancer
F. nucleatum:
• Mediates adherence and invades different types of host cells, including human epithelial and endothelial cells
Fusobacteria:
• Generates a proinflammatory microenvironment that is conductive for colorectal neoplasia progression
Describe the link between periodontitis and adverse pregnancy outcomes by explaining the effect of periodontitis on pregnancy outcomes (8)
- Preterm labor
- Preterm premature rupture of membranes
- Pre-eclampsia
- Miscarriage
- Intra-uterine growth retardation
- Low birthweight
- Stillbirth
- Neonatal sepsis
