Periodontist and the Risk for Systemic Disease 10/29/15 Flashcards
What is the Focal infection theory?
System disease are often caused by oral infections or tooth problems. Also stated that lessening systemic diseases, should take precedence over preserving teeth (1910-1950)
What are the problems with the Focal Infection Theory?
- Extracting teeth didn’t necessarily cure disease
- People with good oral health and no infection still develop systemic diseases.
- People with no teeth still develop systemic diseases.
By what mechanism could Periodontitis influence systemic disease?
Through the Acute phase reaction cascade:
Triggering factors –> Local Reactions —> Mediators —-> Secondary systemic reactions.
What are the Triggering factors of the Acute phase rxn?
- Plaque
- Infection
- Surgery
- Nercorsis
- NEoplasia
- Radiation
What are the Local rxns of the Acute Phase run.
- Macrophages
- Fnrboblasts
- Endothelial cells
What are the mediators?
- TNF-A
- Il-1
- IL-6
- INF-y
What are the Secondary systemic rxns?
- Fever
- Complement activation
- Serum Glucocorticoids
- altered synthesis of acute phase proteins
What are the important acute phase proteins?
- Complement components: opsonization, lysis, chemotaxis.
- Protease inhibitors
- C-reactive protein
- Fibrinogen
- Plasminogen
_____% of americans 30 yrs and older have periodontitis?
47%
What are the sources of risk for systemic disease from periodontitis?
- Inflamed and infected tissues
- Periodontal pockets provide environment for gram negative biofilm.
What Defines a Risk factor?
- Consistency of association
- Strength of Associations
- Correct time sequence
- Specific Associations
- Degree of exposure (degree of exposure correlates with occurrence of disease)
- Biological plausibility (associations make sense)
- Support from experimental evidence (animals who are episode to risk factors get the disease)
Name 4 systemic disease associated with Periodontitis?
- Atherosclerotic vascular disease AVD (heart disease)
- Adverse pregnancy outcomes (low birthweight, Preterm birth)
- Diabetic complications
- Respiratory infections
What is AVD?
Common disorder in larger arteries where lumen becomes occluded by plaque and less capable of passing blood through.
What are the 2 common complications of AVD?
- Coronary Thrombosis
- Acute Myocardial infarction
Both Periodontitis and AVD are more common in what groups of People?
- Older
- Male
- Smokers
- Lower income
- hypertensive
- Under stress
- diabetics
What pathways explain the link between periodontitis and Cardiovascular disease?
- effect of Periodontal bacterial on platelets
- Invasion of endothelial cells and macrophages by periodontal bacteria
- Endocrine-like effects of pro-inflammatory mediators
______ and _____ can produce proteins that stress collagen and can cause a blood clot/Thrombo-embolic events.
S. Sanguis and P. Gingivalis
_________ Enhances foam cell formation by macrophages.
A.a LPS
____ and _____ increase the coagulation effect.
C-reactive protein and fibrinogen (Acute phase response)
What is the effect of Periodontal therapy on Cardiovascular disease Biomarkers?
Studies have NOT shown that Cardiovascular disease Biomarkers are consistently reduced by periodontal therapy. * Yet successful therapy made it 4x more likely to have a decrease in serum C-reactive proteins.
However, A recent study suggest that treatment of mild to moderate periodontitis in otherwise healthy patients may significantly decreases carotid artery intimal-medial thickness.
Cool.
Does treatment of periodontitis reduce the risk of Atherosclerotic vascular disease?
There is currently a lack of strong evidence, but it would make sense…….whatever that means.
Does periodontitis meet the requirement of Specificity? (Strength of evidence)
Not fully
What are some reasons for Plausibility of Periodontitis being associated with AVD?
- Periodontal pathogens have been isolated form human carotid atheromas.
- P. gingivalis can induce platelet aggregation
- Systemic pro-inflammatory mediators CSRP and Fibrinogen are elevated in subjects with periodontitis.
What are the Adverse Pregnancy outcomes associated with periodontitis?
- low birth weight (less than 2.5 kg)
- Preterm birth (less than 37 wks)
- Intrauterine growth constriction
- These can result in longterm disability
How does Periodontitis influence Pregnancy outcomes?
- Through translocation of bacteria and endotoxin into the systemic circulation.
- Inflamed tissues produce significant quantities of inflammatory mediators (IL-1B, IL-6, TNF-a and PGE-2), These cytokines may have systemic effects.
Mothers with Periodontitis are ____ to ____ times more likely to deliver a preterm infant than healthy mothers.
4 to 7 times more likely
Does Periodontal treatment decrease the likelihood of PLBW or PTB?
Not statistically significant, but yes it appears to…….man this lecture is ridiculous…
Does Periodontitis predispose to poor diabetic control?
Yes (type 2)
