السلام عليكم.. في هذه المحاضرة تتم مناقشة العلاقة مابين امراض اللثة و تأثيرها على كل من مرض السكري و الحمل و امراض القلب in this lecture , we discuss the relationship between the periodontal diseases and (DM, pregnancy and heart disease)

1. Periodontal diseases
and
their systemic effects
By :
‫السالم‬ ‫عبد‬ ‫سمية‬‫رمضان‬‫الفيتوري‬
Misurata /Libya

2. What is periodontitis ?
Periodontal disease is a chronic bacterial
infection that affects both the gingiva and the
bone that supports the teeth and is caused by
anaerobic Gram- negative microorganisms
that are present in the bacterial plaque that
adheres to the teeth

3. Risk factors for periodontitis
*Non Genetic :
• Smoking is a major risk factor
• Diabetes
• Conditions associated with compromised immune
responses (e.g. HIV)
• Nutritional defects
• Osteoporosis
• Medications that cause drug induced gingival overgrowth
(e.g. some calcium channel blockers, phenytoin,
cyclosporine)
• local factors (e.g. anatomical deficiencies in the alveolar
bone)
Genetic factors (as yet poorly defined)

4. IS PERIODONTITIS A RISK FACTOR
FOR………….??
• Cardiovascular disease
• Diabetes mellitus
• Adverse pregnancy outcomes
• Respiratory infections
• Rheumatoid arthritis
• Renal dysfunction
• Alzheimer’s disease

5. Mechanism

6. Periodontitis
disturbs systemic homeostasis
Chronic damage of epithelial tissues due
to periodontitis
may induce the periodontal pocket to
ulcerate
that allows access to the bloodstream
Bacteria and their toxins,
cytokines,mediators of inflammation
disrupt homeostasis when toxins gain entry
to the systemic circulation
The proinflammatory cytokines TNF-α, IL-1β,
and gamma interferon as well as PGE2 reach
high tissue concentrations in periodontitis

7. So the periodontitis is sub-acute
infection cause :
Bacteremia:
Disseminated
inflammation
Low grade
infection , mainly
gram –ve which
produce LPS

11. The six "classic" major complications
of diabetes include :
•microangiopathy
• nephropathy
• neuropathy
•macro vascular disease
•delayed wound healing
•Periodontitis

13. effect of DM on periodontitis

14. Role of TNF-alpha Antagonist to IRS-1. Inhibits
phosphorylation and translocation of insulin receptor.
Inhibits intracellular glucose transport.
DM2
Insulin resistance: improper glycemic control

15. Diabetic patients have a stronger predisposition for
periodontal disease and a greater difficulty in
controlling their metabolic glucose levels if not
treated. Alterations to glucose control
Periodontal therapy Proper diabetic treament
Proper glycemic level in blood

23. so it’s not related to the mouth !
But !
Solution starting from mouth