Systemic Diseases and Periodontal Disease

Question 1

What is the Focal Infection Theory?

Answer 1

The idea that localized infections can cause chronic or acute diseases in distant body sites.

Question 2

How is a focal infection described?

Answer 2

A low-grade infection that progresses slowly, producing local and systemic symptoms.

Question 3

Why was the theory dismissed in 1952?

Answer 3

JAMA stated that removing infection foci did not consistently relieve systemic symptoms.

Question 4

What is a key limitation of the Focal Infection Theory today?

Answer 4

Lack of interventional studies proving causation.

Question 5

Why has interest in the theory resurfaced?

Answer 5

Modern research links periodontitis to systemic diseases through inflammation and pathogenic mechanisms.

Question 6

How can periodontal therapy impact systemic health?

Answer 6

It lowers systemic inflammatory cytokines, reducing disease risk.

Question 7

What is an example of the focal infection theory regarding P. gingivalis?

Answer 7

It can invade the whole body, along with simple a schematic representation of P. gingivalis-associated systemic diseases

Question 8

What systemic diseases are associated with Porphyromonas gingivalis?

Answer 8

Alzheimer’s disease, cardiovascular diseases (CADs), rheumatoid arthritis, and pre-term birth.

Question 9

What systemic diseases modify periodontal disease?

Answer 9

Diabetes, HIV, immune disorders.

Question 10

How can local infections affect systemic disease?

Answer 10

Oral-derived bacteremia → infective endocarditis.

Question 11

When does bacteremia occur?

Answer 11

After mechanical therapy + daily oral hygiene.

Question 12

What do periodontal bacteria cause?

Answer 12

Continuous bacterial challenge → persistent inflammation.

Question 13

What are the potential mechanisms by which periodontal infections could influence systemic health?

Answer 13

Oral-systemic immune axis
Oral microbiome and systemic disease
Unique and shared biomarkers between periodontitis and systemic diseases

Question 14

What is the causal pathway of periodontal disease to systemic disease?

Answer 14

The periodontium acts as a reservoir of bacteria, bacterial products, and immune mediators, influencing other organs and disease development.

Question 15

What is the non-causal pathway of periodontal disease to systemic disease?

Answer 15

Periodontal disease shares risk factors with systemic conditions, coexisting without directly causing them.

Question 16

Since cardiovascular disease is the leading cuase of death, How many people died from CVD in 2019?

Answer 16

17.9 million, 32% of global deaths.

Question 17

What is atherosclerosis?

Answer 17

Development of atheromatous plaques along the arterial wall.

Question 18

What are atheromatous plaques made of?

Answer 18

Lipid-laden macrophages (foam cells) and a fibrous cap.

Question 19

How are atheromatous plaques related to inflammation?

Answer 19

They are similar to healing inflammatory lesions.

Question 20

What is cardiac stenting (PCI)?

Answer 20

A procedure to dilate narrowed heart arteries using a thin tube.

Question 21

How does periodontal disease potentially contribute to CVD?

Answer 21

By promoting systemic inflammatory markers like fibrinogen and CRP.

Question 22

What is molecular mimicry in periodontal disease and CVD?

Answer 22

Antibodies to periodontal pathogens cross-react with host cells.

Question 23

How does P. gingivalis affect vascular permeability?

Answer 23

Degrades endothelial adhesion molecules, promotes platelet aggregation, leukocyte adhesion, and cytokine secretion.

Question 24

Where is P. gingivalis found in atherosclerosis?

Answer 24

Most abundant microbial species in plaques.

Question 25

How do periopathogens translocate through the body?

Answer 25

Indirectly via phagocytes and dendritic cells throughout the circulatory system.

Question 26

What is the effect of periodontal therapy on CVD markers?

Answer 26

Various CVD markers are evaluated alongside periodontal therapy.

Question 27

What does Pulse wave velocity (PWV) measure?

Answer 27

Arterial stiffness and wave speed.

Question 28

What is pre-term birth (PTB)?

Answer 28

Birth before the 37th week of gestation.

Question 29

What is low-birth weight (LBW)?

Answer 29

Born at term but weighing less than 2500 grams (<5.5 lbs).

Question 30

What percentage of all births are pre-term or low-birth weight?

Answer 30

Approximately 6-10% of all births.

Question 31

What is the direct mechanism of periodontitis affecting preterm birth and low birth weight?

Answer 31

Oral microbes/by-products enter circulation, colonize the feto-placental unit, and induce inflammation.

Question 32

What is the indirect mechanism of periodontitis affecting preterm birth and low birth weight?

Answer 32

Inflammatory mediators from periodontal disease trigger inflammation in the feto-placental unit.

Question 33

What is the association between periodontitis and pre-eclampsia?

Answer 33

Significant association (OR 3.18, 95% CI 2.26 - 4.48, p < 0.00001).

Question 34

Where is the association between periodontitis and pre-eclampsia stronger?

Answer 34

In lower-middle-income countries (OR 6.70, 95% CI 2.61 - 17.19, p < 0.0001).

Question 35

What did the Mitchell-Lewis et al., 2001 study find regarding periodontal therapy and PTB?

Answer 35

No significant reduction in preterm birth associated with periodontal therapy.

Question 36

What did the Jeffcoat et al., 2003 study find?

Answer 36

SRP treatment may reduce preterm birth.

Question 37

What does the study conclude about SRP during pregnancy?

Answer 37

SRP reduces PTB, but adjunctive metronidazole did not improve outcomes.

Question 38

What is the summary of the research on periodontal disease and pregnancy outcomes?

Answer 38

Association between periodontal disease and adverse pregnancy outcomes. Mixed results on treatment's impact. Periodontal treatment during pregnancy is safe and improves periodontal health.

Question 39

How is rheumatoid arthritis (RA) linked to periodontal disease?

Answer 39

RA is associated with tooth loss and deeper pocket depths.

Question 40

What is the similarity between periodontal disease (PD) and rheumatoid arthritis (RA)?

Answer 40

Both are immunoinflammatory conditions.

Question 41

What enzyme does P. gingivalis express that affects RA?

Answer 41

PAD, which converts arginine to citrulline (citrullination).

Question 42

What are anticyclic citrullinated peptide antibodies used to diagnose?

Answer 42

They are diagnostic antibodies for rheumatoid arthritis.

Question 43

How does pneumonia develop?

Answer 43

Pathogens are aspirated from the oropharyngeal cavity into the lower airway.

Question 44

How do bacterial biofilms contribute to pneumonia?

Answer 44

Biofilms on teeth or dentures are susceptible to colonization by respiratory pathogens.

Question 45

How does poor oral hygiene affect pneumonia risk?

Answer 45

It may predispose high-risk patients to oral colonization by respiratory pathogens.

Question 46

How can pathogenic bacteria from biofilms promote pneumonia?

Answer 46

Inflammatory products and bacteria shed into secretions can be aspirated into the lower airway.

Question 47

Name some bacteria associated with pneumonia.

Answer 47

P. gingivalis, Bacteroides gracilus, Bacteroides oralis, Eikenella corrodens, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans.

Question 48

Which patient populations are at higher risk for respiratory infections?

Answer 48

Patients in nursing homes and intensive care units.

Question 49

How does improving oral hygiene reduce pneumonia risk?

Answer 49

Mechanical cleaning, chlorhexidine, and metronidazole can reduce hospital-acquired pneumonia.

Question 50

What is the strongest association found between periodontal disease and cancer?

Answer 50

Oral cancer.

Question 51

What other cancer risk is associated with periodontal disease?

Answer 51

Increased susceptibility to overall cancer development.

Question 52

How might periodontal disease contribute to carcinogenesis?

Answer 52

Via alteration of oral flora, immune/inflammatory mediators, bacterial products, and virus-induced changes.

Question 53

T or F: Periodontitis and carcinogenesis connection may be due to shared risk factors

Answer 53

True

Question 54

How can bacteria from periodontal disease spread?

Answer 54

They can go into the lungs or colon and increase the risk of carcinogenesis if they cause an inflammatory response.

Question 55

What did von Wowern et al. (1994) find in osteoporotic patients?

Answer 55

Less bone mineral content and greater attachment loss in the osteoporotic group.

Question 56

What did Tazel et al. (2000) find regarding skeletal bone density and alveolar bone loss?

Answer 56

Decreased skeletal bone density is related to interproximal alveolar bone loss.

Question 57

What did Dodd et al. (2013) find in their review of studies?

Answer 57

An association between osteoporosis and periodontal disease was demonstrated in 80% of the 25 cross-sectional studies reviewed.

Question 58

What did Penoni et al. (2017) find regarding cytokines in osteoporosis and periodontal disease?

Answer 58

Increased production of pro-inflammatory cytokines (IL-1, IL-6, TNF, and RANKL) is involved in the pathogenesis of both diseases.

Question 59

What is the standard deviation for the T score in bone density

Answer 59

2.5

Question 60

What does postmenopausal osteoporosis cause?

Answer 60

Affects trabecular bone more than cortical bone Leads to increased tooth loss Increased attachment loss

Question 61

What role does estrogen deficiency play in osteoporosis?

Answer 61

Estrogen deficiency is considered a key factor in the development of osteoporosis.

Question 62

How does estrogen influence periodontal ligament cells?

Answer 62

Estrogen increases osteoprotegerin (OPG) expression and decreases RANKL.

Question 63

What severe forms of periodontitis can HIV/AIDS patients develop?

Answer 63

necrotizing ulcerative periodontitis, and necrotizing mucositis.

Question 64

What does the presence of necrotizing ulcerative periodontitis indicate?

Answer 64

A CD4+ cell count less than 200 cells per μL.

Question 65

How has the advent of Highly Active Antiretroviral Therapies (HAART) affected oral symptoms in HIV/AIDS patients?

Answer 65

The severity of oral symptoms has generally reduced in populations with access to HAART.

Question 66

Why is clinical proof of causality difficult?

Answer 66

Early phases of disease are usually asymptomatic.

Question 67

Where else could infection and inflammation originate?

Answer 67

Sites other than the oral cavity.