relation between periodontal diseases and cardiovascular system, pregnancy, respiratory diseases

1. PERIODONTAL
MEDICINE

2. CONTENTS
O Introduction
O Focal infection
O Subgingival environment as reservoir of
bacteria
O Periodontal disease and coronory heart
disease/Atherosclerosis
O Role of periodontitis in pregnancy outcome
O Periodontal disease & COPD
O Periodontal disease & Acute Respiratory
Infection
O Periodontal disease & COVID-19

3. PERIODONTAL MEDICINE
O Periodontal Medicine is branch of
Periodontology which establishes a strong
relationship between periodontal health or
disease and systemic health or disease.
William and Offenbacher-2000

4. FOCAL INFECTION THEORY
O William Hunter in 1900
O Oral microorganisms are responsible for many
systemic conditions
O Gingivitis & periodontitis- foci of infection
O The degree of systemic effect produced by oral
sepsis depends on the virulence of the oral
infection and the individual's degree of
resistance

5. O The oral organisms had specific actions on
different tissues and that these organisms acted
by producing toxins, resulting in low-grade
"subinfection,“
O Connection between oral sepsis & resulting
systemic condition could be shown by removal
of causative sepsis through extraction &
observation of improvement in systemic health

6. SUBGINGIVAL ENVIRONMENT AS RESERVOIR
OF BACTERIA
O The subgingival microbiota in patients with
periodontitis provides persistent gram-
negative bacterial challenge to the host
O These organisms and their products, such
as lipopolysachrides (LPS), enters into the
circulation through the sulcular epithelium

7. O Cardiovascular system:
Atherosclerosis
Coronary heart disease (CHD)
Angina
Myocardial infarction (MI)
O Cerebrovascular system
Cerebrovascular accident (stroke)
O Endocrine system
Diabetes mellitus

8. O Reproductive system
Preterm low birth weight infants
Preeclampsia
O Respiratory system
Chronic obstructive pulmonary
disease Acute bacterial pneumonia
Covid 19

9. Periodontal diseases and
Cardiovascular system

11. Increased viscosity of blood
Increase risk of thrombus formation
Ischemic heart disease & cerebrovascular accident
Factors affecting blood viscosity
O Plasma fibrinogen
O Plasma lipoproteins
O White blood cell count
O Von Willebrand factor

12. ↑ Fibrinogen, ↑ White blood cell count
↑ von Willebrand factor
Ischemic heart disease
SYSTEMIC OR PERIODONTAL INFECTION
↑ Blood viscosity

13. THROMBOGENESIS:
Platelet binds – Streptococcus sanguis and P.
gingivalis
↓
Induction of Plalelet Aggregation Associated
Protein (PAAP)
↓
Increases Platelet aggregation
↓
Forms thromboemboli
↓
Cardiac changes

14. Atherosclerosis
O It is a focal thickening of the arterial intima , the
innermost layer lining the lumen of the vessel ,
and the arterial media, the thick layer under the
arterial intima consisting of smooth muscle,
collagen, and elastic fibres

16. 1. Direct effects of infectious agents in atheroma
formation
2. Indirect or host mediated effects triggered by
infection
3. Common genetic predisposition for
periodontal disease & atherosclerosis

17. Periodontal infection
Gram- negative bacteremia/ LPS
Endothelial damage, Platelet adhesion/
aggregation
Monocyte infiltration/ proliferation
Cytokine/ growth factor production
Thrombus formation
Atheroma formation and Vessel wall thickening
Thromboembolic events

18. DIRECT EFFECT
LPS,PGE2, Pro inflammatory cytokines from periodontal pathogens
Increases the adhesion of Monocytes Monocytes transform to macrophages
Macrophages to the vascular endothelium
Monocyte Ingest circulating LDL & forms foam cell Smooth muscle & collagen
proliferation
Atheromatous plaque Arterial wall thickening
Narrows lumen and ↓blood
flow
Atherosclerosis

19. INDIRECT EFFECT

20. Hypercoagulability

21. Periodontal disease and Stroke
O A stroke, or cerebrovascular accident (CVA), is
the rapid loss of brain function due to disturbance in
the blood supply to the brain. This can be due to
ischemia (lack of blood flow) caused by blockage
(thrombosis, arterial embolism), or a haemorrhage
O Due to thromboembolism or atherosclerosis of
cerebral vessels

22. PLBW
O PRE-TERM refers to gestation less than 37 weeks
O LOW BIRTH refers to infants less than 2500 grams
Bacteria causes inflammatory response with
stimulation of cytokine production in
amnion increase in TNF-ALFA and PGE2
levels

26. PRE-ECLAMPSIA:
The disease of unknown origin characterized by
hypertension and protein-urea
The presence of periodontitis during pregnancy, or a
worsening of periodontal disease during pregnancy may
increase the risk for preeclampsia 2- to 2.5-fold."‘
Increased CRP acute phase proteins

27. O Neutrophil influx → release of oxidative &
hydrolytic enzymes → tissue destruction
directly
O Recruitment of monocytes & macrophages leads
to further release of proinflammatory cytokines.

28. O Community acquired
O Hospital acquired
Pneumonia

29. Community acquired
Caused by
O Inhalation of infectious aerosol
O Aspiration of oropharyngeal organism
Streptococcus pneumoniae & H.influenzae
O No association between periodontal disease &
community acquired pneumonia has been found

30. Hospital acquired
O Nosocomial pneumonia
O Gram- negative aerobic organism, anaerobic bacteria
in the subgingival environment
O It is usually caused by the aspiration of
oropharyngeal contents, potential respiratory
pathogens (PRPs)
O Subgingival plaque harbor PRPs & periodontal
pathogens, associated with nosocomial
pneumonia.

31. Periodontal disease and
COVID-19