1. PERIODONTAL MEDICINE
BY
M.BHARATH REDDY

2. OBJECTIVES
 Introduction
 Era
of focal infection
 Periodontal and coronory heart
disease/Atherosclerosis
 Periodontal disease & Diabetes mellitus
 Role of periodontitis in pregnancy out come
 Periodontal disease & COPD
 Periodontal disease & Acute Respiratory
Infection
 Periodontal Medicine In Clinical Practice

3. INTRODUCTION




Advances in the science & technology over the
last centuary have greatly expanded our
knowledge of pathogenesis of periodontal disease.
Certain systemic conditions may affect the
initiation & progression of gingivitis &
periodontitis.
The effect of oral health on the rest of the human
body was proposed by assyrians in the 7th
centuary.
In the 18th centuary a pennsylvanian physician
named Benjamin Rush quoted that arthritis could
be treated in some people after they get extracted
the infected teeth.

4. ERA OF FOCAL INFECTION
 WD
MILLER & WILLIAM HUNTER
given a concept that oral bacteria &
infection were likely to cause most of the
person’s systemic illness.
 This
 This
concept became very popular.
era,which came to be known as “THE
ERA OF FOCAL INFECTION”

5. However by 1940 medicine & dentistry were
realising that there was much more to explain a
patients general condition than bacteria in his/her
mouth.
o They realised that1.extarcting a person teeth donot make their
disease go away.
2.people with very healthy mouths also
develop systemic disease.
3.people with no teeth & thus no apparent oral
infection still develop systemic disease.
FOCAL INFECTION as a primary cause of
systemic infection finally came to an end.
o

6. Periodontal and coronory
heart disease/Atherosclerosis

7. Periodontal and coronory
heart disease
CHD and CHD RELATED diseases aare the
major cause of death.
1989  Mattila and colleagues found an
increase in caries, periodontal disease,
pericoronitits and perapical lesions in patients
with recent MI, when compared to controls.
 Many risk factors for MI were the same for
Periodontitis, mainly:



Smoking
Older Male Patients
Lower SES

8. Effect of periodontal infection
 ISCHEMIC
HEART DISEASE:
 IHD is associated with atherogensis and
thrombogenesis
 Increased blood viscosity may promote IHD
 Increase in FIBRINOGEN ,WBC
COUNT,VON WILLEBRAND FACTOR
increases the risk of IHD

10. ATHEROSCLEROSIS

11. STROKE
 OVERALL
25% OF ALL STROKE
PATEINTS HAD SIGNIFICANT DENTAL
INFECTIONS.
 Gingivitis and Radiographic bone loss
independently associated with risk of a
cerebral ischemic event
 How?
– Active periodontitis increases the prothromotic state
 recurrent bacteremia, platelet activation, increased
clotting factors

12. Periodontitis and Diabetes

13. Diabetes
– American Diabetes Association recognizes that
periodontal disease is common in diabetic
patients
– Studies have shown:
Diabetes is a risk factor for periodontal disease
 Diabetic control improves the prognosis of
periodontitis
 Treatment of periodontitis improves
metabolic/diabetic control


14. Periodontal infection associated with
glycemic control in diabetes
 Acute
bacterial and viral infections have
been shown to increase insulin resistance
and aggravate glycemic control.
 Systemic infections increase tissue
resistance to insulin,preventing glucose
from entering target cells ,causing elevated
blood glucose levels
 Pancreatic insulin production increases to
maintain normalglycemia

16. Role of periodontitis in pregnancy
outcome
 Periodontitis
is a gram-ve infection that
play role in low birth weight individuals.
 Bacteria and products causes inflammatory
response with stimulation of cytokine
production in amnion.
 P.gingivalis implanted in subcutaneous
chambers during gestation caused
significant increase in TNF-ALFA and
PGE2 levels

17.  This
subcutaneous infection leads to increase in
fetal death and a decrease in fetal birth weight.

18. Periodontal disease and
COPD

19.  COPD
is characterised by airflow
obstruction resulting from chronic
bronchitis or emphysema.
 About 14 million americans have COPD
,tobacco smoking is the primary risk factor.
 COPD shares similar pathogenic
mechanisms with periodontal disease.
 In both diseases ,host inflammatory
response is mounted in response to chronic
challenge by
bacteria in periodontal disease
cigarette smoking in COPD

20.  Broncial
mucosa glands enlarge ,and
inflammatory process occurs in which
neutrophils and mononuclear inflammatory
cells accumulate with in lung tissue.
 The resulting neutrophil influx leads to
release of oxidative and hydrolytic enzymes
that cause tissue distruction .
 In current smokers ,however the presence of
severe periodontits was associated with
increased risk of COPD.
 This results suggest that smoking may act
as a major “effect modifier” in relationship
btw COPD and periodontal disease.

21. Periodontal disease and acute
respiratory infection
 Pneumonia
is classified as Community
Acquired or Nosocomial.
 The
most common organisms found are S.
pneumoniae and H. influenzae
 How do the bacteria go from the mouth to the
lungs?
– Hematogenous Spread
– Aspiration:
 45% of healthy people aspirate upper airway
substances during sleep
 70% of those with impaired consciousness
aspirate substances from upper airway

22.  Hospital
acquired bacterial pneumonia is usually
caused by aspiration of oropharyngeal contents.
 Oropharyngeal colonization with potential
respiratory pathogens(PRP) increases during
hospitalizations.
 PRP may also orginate in the oral cavity ,with
dental plaque serving as a reservoir of these
organisms .
 PRPS are commonly isolated from
supragingival plaque and buccal mucosa of the
patients .

23. Periodontal medicine in
clinical practice
 Periodontal
infection may act as
independent risk factor for systemic
disease in suseptible individual.
 Dentists need to know more about systemic
diseases and physicians need to increase
their knowledge of oral diseases.
 Patient education in this regrad is also very
important.

24. Thank you