Systemic Diseases and Periodontal Disease Flashcards
What is the Focal Infection Theory?
The idea that localized infections can cause chronic or acute diseases in distant body sites.
How is a focal infection described?
A low-grade infection that progresses slowly, producing local and systemic symptoms.
Why was the theory dismissed in 1952?
JAMA stated that removing infection foci did not consistently relieve systemic symptoms.
What is a key limitation of the Focal Infection Theory today?
Lack of interventional studies proving causation.
Why has interest in the theory resurfaced?
Modern research links periodontitis to systemic diseases through inflammation and pathogenic mechanisms.
How can periodontal therapy impact systemic health?
It lowers systemic inflammatory cytokines, reducing disease risk.
What is an example of the focal infection theory regarding P. gingivalis?
It can invade the whole body, along with simple a schematic representation of P. gingivalis-associated systemic diseases
What systemic diseases are associated with Porphyromonas gingivalis?
Alzheimer’s disease, cardiovascular diseases (CADs), rheumatoid arthritis, and pre-term birth.
What systemic diseases modify periodontal disease?
Diabetes, HIV, immune disorders.
How can local infections affect systemic disease?
Oral-derived bacteremia → infective endocarditis.
When does bacteremia occur?
After mechanical therapy + daily oral hygiene.
What do periodontal bacteria cause?
Continuous bacterial challenge → persistent inflammation.
What are the potential mechanisms by which periodontal infections could influence systemic health?
Oral-systemic immune axis
Oral microbiome and systemic disease
Unique and shared biomarkers between periodontitis and systemic diseases
What is the causal pathway of periodontal disease to systemic disease?
The periodontium acts as a reservoir of bacteria, bacterial products, and immune mediators, influencing other organs and disease development.
What is the non-causal pathway of periodontal disease to systemic disease?
Periodontal disease shares risk factors with systemic conditions, coexisting without directly causing them.
Since cardiovascular disease is the leading cuase of death, How many people died from CVD in 2019?
17.9 million, 32% of global deaths.
What is atherosclerosis?
Development of atheromatous plaques along the arterial wall.
What are atheromatous plaques made of?
Lipid-laden macrophages (foam cells) and a fibrous cap.
How are atheromatous plaques related to inflammation?
They are similar to healing inflammatory lesions.
What is cardiac stenting (PCI)?
A procedure to dilate narrowed heart arteries using a thin tube.
How does periodontal disease potentially contribute to CVD?
By promoting systemic inflammatory markers like fibrinogen and CRP.
What is molecular mimicry in periodontal disease and CVD?
Antibodies to periodontal pathogens cross-react with host cells.
How does P. gingivalis affect vascular permeability?
Degrades endothelial adhesion molecules, promotes platelet aggregation, leukocyte adhesion, and cytokine secretion.
Where is P. gingivalis found in atherosclerosis?
Most abundant microbial species in plaques.
How do periopathogens translocate through the body?
Indirectly via phagocytes and dendritic cells throughout the circulatory system.
What is the effect of periodontal therapy on CVD markers?
Various CVD markers are evaluated alongside periodontal therapy.
What does Pulse wave velocity (PWV) measure?
Arterial stiffness and wave speed.
What is pre-term birth (PTB)?
Birth before the 37th week of gestation.
What is low-birth weight (LBW)?
Born at term but weighing less than 2500 grams (<5.5 lbs).
What percentage of all births are pre-term or low-birth weight?
Approximately 6-10% of all births.
What is the direct mechanism of periodontitis affecting preterm birth and low birth weight?
Oral microbes/by-products enter circulation, colonize the feto-placental unit, and induce inflammation.
What is the indirect mechanism of periodontitis affecting preterm birth and low birth weight?
Inflammatory mediators from periodontal disease trigger inflammation in the feto-placental unit.
What is the association between periodontitis and pre-eclampsia?
Significant association (OR 3.18, 95% CI 2.26 - 4.48, p < 0.00001).
Where is the association between periodontitis and pre-eclampsia stronger?
In lower-middle-income countries (OR 6.70, 95% CI 2.61 - 17.19, p < 0.0001).
What did the Mitchell-Lewis et al., 2001 study find regarding periodontal therapy and PTB?
No significant reduction in preterm birth associated with periodontal therapy.
What did the Jeffcoat et al., 2003 study find?
SRP treatment may reduce preterm birth.
What does the study conclude about SRP during pregnancy?
SRP reduces PTB, but adjunctive metronidazole did not improve outcomes.
What is the summary of the research on periodontal disease and pregnancy outcomes?
Association between periodontal disease and adverse pregnancy outcomes.
Mixed results on treatment’s impact.
Periodontal treatment during pregnancy is safe and improves periodontal health.
How is rheumatoid arthritis (RA) linked to periodontal disease?
RA is associated with tooth loss and deeper pocket depths.
What is the similarity between periodontal disease (PD) and rheumatoid arthritis (RA)?
Both are immunoinflammatory conditions.
What enzyme does P. gingivalis express that affects RA?
PAD, which converts arginine to citrulline (citrullination).
What are anticyclic citrullinated peptide antibodies used to diagnose?
They are diagnostic antibodies for rheumatoid arthritis.
How does pneumonia develop?
Pathogens are aspirated from the oropharyngeal cavity into the lower airway.
How do bacterial biofilms contribute to pneumonia?
Biofilms on teeth or dentures are susceptible to colonization by respiratory pathogens.
How does poor oral hygiene affect pneumonia risk?
It may predispose high-risk patients to oral colonization by respiratory pathogens.
How can pathogenic bacteria from biofilms promote pneumonia?
Inflammatory products and bacteria shed into secretions can be aspirated into the lower airway.
Name some bacteria associated with pneumonia.
P. gingivalis, Bacteroides gracilus, Bacteroides oralis, Eikenella corrodens, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans.
Which patient populations are at higher risk for respiratory infections?
Patients in nursing homes and intensive care units.
How does improving oral hygiene reduce pneumonia risk?
Mechanical cleaning, chlorhexidine, and metronidazole can reduce hospital-acquired pneumonia.
What is the strongest association found between periodontal disease and cancer?
Oral cancer.
What other cancer risk is associated with periodontal disease?
Increased susceptibility to overall cancer development.
How might periodontal disease contribute to carcinogenesis?
Via alteration of oral flora, immune/inflammatory mediators, bacterial products, and virus-induced changes.
T or F: Periodontitis and carcinogenesis connection may be due to shared risk factors
True
How can bacteria from periodontal disease spread?
They can go into the lungs or colon and increase the risk of carcinogenesis if they cause an inflammatory response.
What did von Wowern et al. (1994) find in osteoporotic patients?
Less bone mineral content and greater attachment loss in the osteoporotic group.
What did Tazel et al. (2000) find regarding skeletal bone density and alveolar bone loss?
Decreased skeletal bone density is related to interproximal alveolar bone loss.
What did Dodd et al. (2013) find in their review of studies?
An association between osteoporosis and periodontal disease was demonstrated in 80% of the 25 cross-sectional studies reviewed.
What did Penoni et al. (2017) find regarding cytokines in osteoporosis and periodontal disease?
Increased production of pro-inflammatory cytokines (IL-1, IL-6, TNF, and RANKL) is involved in the pathogenesis of both diseases.
What is the standard deviation for the T score in bone density
2.5
What does postmenopausal osteoporosis cause?
Affects trabecular bone more than cortical bone
Leads to increased tooth loss
Increased attachment loss
What role does estrogen deficiency play in osteoporosis?
Estrogen deficiency is considered a key factor in the development of osteoporosis.
How does estrogen influence periodontal ligament cells?
Estrogen increases osteoprotegerin (OPG) expression and decreases RANKL.
What severe forms of periodontitis can HIV/AIDS patients develop?
necrotizing ulcerative periodontitis, and necrotizing mucositis.
What does the presence of necrotizing ulcerative periodontitis indicate?
A CD4+ cell count less than 200 cells per μL.
How has the advent of Highly Active Antiretroviral Therapies (HAART) affected oral symptoms in HIV/AIDS patients?
The severity of oral symptoms has generally reduced in populations with access to HAART.
Why is clinical proof of causality difficult?
Early phases of disease are usually asymptomatic.
Where else could infection and inflammation originate?
Sites other than the oral cavity.
