oral systemic disease connection

oral systemic connection refers to

the relationship between oral health and overall health

research indicates a potential correlation between periodontal disease and:

• coronary heart disease

• pregnancy

• diabetes

• bacterial pneumonia

• alzheimers disease

PD is no longer thought of as a prevalent condition for which all people are at equal risk because…

everyone had different genetics and environmental factors

• host susceptibility is an important factor

association between susceptibility and severity to periodontitis with there presents of

interleukin 1

having interleukin 1…

makes you 7 times more likely to develop periodontal disease

hereditary gingival fibromatosis

gingival overgrowth is due to excessive production of collagen

cyclic neutropenia

abnormally low count of neutrophils

• associated with increased severity of gingivitis, periodontitis, and necrotic ulcerations

Down syndrome

genetic disorder, displays periodontal destruction

papillon-lefevre syndrome

dry scaly patches on hands and palms, degeneration of periodontium

chediak hitachi disease

genetic disorder, compromised neutrophils

hypophosphatasia

abnormal development of bones and teeth due to defective mineralization

inrease of PD increases with…

• age

  • 70% of Americans 65 or older have PD

• men

  • 56% compared to women (%38)

• race

  • genetics and environmental exposures

patients taking hypertensive medications may…

bleed more

• xerostomia

• gingival overgrowth

• same bacteria found in PD attaches to plaques in clogged heart arteries

stress

• long term increases susceptibility to periodontal disease

• depresses immune response to periodontal pathogens

• increased production of glucocorticosteroids and cortisol = immunosuppression

atherosclerosis

hardening of the arteries when fat deposits stick to the sides of arteries

• if plaque blocks blood flow completely = heart attack/stoke possible

• bacteria from mouth can enter blood stream

CVA

cerebral vascular accident

bacteremia

bacteria enters blood stream and triggers platelets to clump, infect and obstruct blood vessels in heart and brain

40% of bacteria in heart disease and the brain have been traced back to…

the oral cavity (Step. sanguine, P. gingivitis)

Cardiovascular disease and periodontal disease are both

associated with elevated levels of

C-reactive protein

angina pectoris

chest pain/discomfort due to coronary artery disease

• occurs when hear muscle doesn’t get as much blood/oxygen as it needs (ischemia)

• results from one or more narrowed/blocked arteries in heart

spirits of ammonia is also called…

smelling salts

• fainting (syncope)

myocardial infarction (heart attack)

• when flow of blood to heart becomes blocked

• causes tissue damage = life threatening

valvular heart disease

• damage/ defect in one of the 4 heart valves

mitral valve prolapse

can make heart susceptible to life threatening infections from oral bacteria

rheumatic fever

inflammatory reaction to strep throat or scarlet fever

• body produced antibodies (to fight), but antibodies attack own body tissues

  • begin in joints and move to heart/surrounding tissues

tissue heart valves (prosthetic)

from porcine (pig), bovine (cow), and homografts or allografts (human)

mechanical heart valves (prosthetic)

from manufactured materials

• designed to mimic and function like heart valves

cardiac arthythmia is

any type of disturbance in the normal rhythm of heartbeat (too fast/too slow)

occasional palpitation/ fluttering

usually not serious, persistent arrythmia may be life threatening:

• controlled w/ medications, pacemaker

• cardizem increases xerostomia and plaque retention

congestive heart failure

hearts function as a pump is inadequate to deliver oxygen rich blood to body

• caused by disease (weaken or stiffen heart muscle)

• anticoagulants: heparin, coumadin, aspirin

arthritis

inflammation of joints

artificial joints

bacteria associated with periodontal disease may relocate to artificial joins and cause prosthesis failure

diabetes mellitus (endocrine distrubtion)

increased susceptibility to infections due to abnormal neutrophil functions

• delayed host response and wound healing

pregnancy and gingivitis (endocrine disruption)

most severe during 2nd and 3rd trimesters

• elevated hormone level make gingiva more susceptible to plaque induced inflammation

• increased levels of hormones promote the growth of Prevotella Intermedia

• release of inflammatory mediators (prostaglandins)…..

pyogenic granuloma

pregnancy mouth cyst

osteoporosis

• result of estrogen depletion

• bone becomes more porous

• decreased thickness of the cortical plate

• hormone replacement therapy

• can effect jaw (osteonecrosis, ONJ)

bisphosphonates

• prescribed to patients with osteoporosis, breast or prostate cancer

• patients do not produce osteoclasts to resorb the necrotic bone (new bone is laid over diseased bone)

• if necrotic bone cannot be resorbed by osteoclasts = inhibit blood supply to area and cause ONJ

leukemia

• first sign, spontaneous bleeding

• purple colored gingival enlargement, ulcerations, inflammation, and spontaneous bleeding

hep A:

transmitted through fecal oral route or consumption of contaminated food or water

• common place is ball pits, food/water in restaurant for children

hep B:

contracted through contact with the blood or body fluids

hep C:

contracted by the blood

• safe if on interferon injections

as DH, most concerned with HEP:

*B* & C (through the blood)

HIV

impairment of the host response to combat infection

• HIV paitients are vulnerable to PD including NUG & NUP

• linear gingival erythema common

At risk for respiratory diseases…

pneumonia, bronchitis, and emphysema, COPD

• bacteria from mouth taken into lungs

tobacco

• smoking is a risk factor

• 2-6 times more likely to have perio destruction

• surpasses host-defense system that may promote disease progression

• decreased bleeding and fibrotic gingiva

• cessation restores inflammatory response

  • 10-12 weeks after may have gingival inflammation/ bleeding

  • 1 year after gingiva is less fibrotic and normal consistency

non smokers classified as…

no smoking in the past year

smokeless tobacco

• contribute to PD

• gingival recession common at site

• may lead to oral cancer

e-cigarettes

• “tobacco products”

• may lead to PD, tooth loss and cancer

• cells lose power to divide and grow, speed up cell death

alcohol

increased risk for:

• PD

• cancers

• tooth loss

• hyposalivation

• malnutrition

adverse affects:

• host defense (PMN’S)

• clotting

• healing

nutrition - vitamin C

needed for normal function of fibroblasts, osteoclasts, and odontoblasts

• deficiency results in delayed wound healing

Alzheimers disease

early exposure to PD may increase risk for developing

• oral bacteria spreads gram - pathogens to brain and genetics from production of inflammatory mediators in response to perio. bacteria