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The Relation of Periodontal Infections to Systemic Diseases.

 

Periodontal infections have strong correlations with multiple systemic diseases. This issue will examine several of these relationships

What You'll Find in this WebPage:
Periodontal disease and cardiovascular disease.
Periodontal disease and diabetes.
Periodontal disease and causative risk factors.
Periodontal disease and pre term low birth weight babies.
Periodontal disease and systemic medications.

Periodontal disease and cardiovascular disease.

Chronic, gram negative anaerobic infections may represent a previously unrecognized risk factor for atherosclerosis and thromboembolic events. An underlying inflammatory response trait may place an individual at high risk for both periodontal disease and athersclerosis. A biologic burden of bacterial endotoxins and inflammatory cytokines result from an established periodontal infection. These may initiate and exacerbate atherosclerosis and thromboembolic events. A VA Hospital study, done on 1147 men with severe periodontal disease from 1968 to 1971, showed that 26.7% or 306 had demonstrated coronary heart disease or had died from an atherosclerotic or thromboembolic event. J. Perio 67:1123, 1996. Additionally, periodontal disease has been shown to induce episodes of significant bacteremias. Streptococcus sanguis has been demonstrated to cause platelets to aggregate upon contact with bacteria. Therefore the platelet aggregation, that has long been suspected of causing ischemic cardiac events may be responsible for acute MI's. Also, these aggregates have been shown to trigger an accumulation of fibrin into the heart valve vegetations of endocarditis. Both of these mechanisms were confirmend by inducing bacteremias into hyperlipidemic rabbits. J Perio 67:1138, 1996. [top]

Periodontal disease and Diabetes-

Diabetes mellitus and periodontal disease are two very common chronic diseases in this country. The two may be linked because diabetics generally have increased susceptibilities to many types of infections, particularly gram negative anaerobic bacteria. Many studies have shown a positive relationship between poor glycemic control and increased incidences of periodontitis. Additionally, impaired neutrophil function has been demonstrated in diabetic patients. One recent study reported that severe periodontitis was a risk factor for poor glycemic control and that physicians treating diabetes should be alert to signs of periodontitis in managing diabetes. J Perio 67:1085, 1996 Results of non-surgical periodontal therapy were enhanced when an irrigant of water or chlorhexidine was used during ultrasonic debridement and when doxycycline 100mg QD for two weeks was prescribed. Three months following root planing, hyperglycemia was modestly reduced. J. Perio 67:1094, 1996. [top]

Current View of Risk Factors and Periodontal Diseases-

Periodontal disease are infections and many forms of the disease are associated with specific pathogenic bacteria which colonize the subgingival area. At least two of these microorganisms. Porhyromonas gingivalis and Actinobacillus actinomycetumcomitans, also invade the periodontal tissue and are virulent organisms. Initiation and progression of periodontal infections are clearly modified by local and systemic conditions called risk factors. The local factors include pre-existing disease as evidenced by deep probing depths and plaque retention areas associated with defective restorations. Systemic risk factors recently have been identified by large epidemiologic studies using multifactorial statistical analyses to correct for confounding or associated co-risk factors. Risk factors which we know today as important include diabetes mellitus, especially in individuals in whom metabolic control is poor and cigarette smoking. These two risk factors markedly affect the initiation and progression of periodontitis and attempts to manage these factors are now an important component of prevention and treatment of adult periodontitis. Systemic conditions associated with reduced neutrophil numbers or function are also important risk factors in children. juveniles and young adults. Diseases in which neutrophil dysfunction occurs include the lazy leukocyte syndrome associated with localized juvenile periodontitis. cyclic neutropenia. and congenital neutropenia. Recent studies also point to several potentially important periodontal risk indicators. These include stress and coping behaviors. and osteopenla assoclated with estrogen deficiency. There are also background determinants associated with periodontal disease including gender (with males having more disease). age (with more disease seen in the elderly), and hereditary factors. The study of risk in periodontal disease is a rapidly emerging field and much is yet to be learned. However. there are at least two significant risk factors-smoking and diabetes-which demand attention in current management of periodontal disease." Robert Genco J Periodontol 67:1041,1996. [top]

Periodontal Infection as a Possible Risk Factor for Pre Term Low Birth Weight (PLBW)-

Gram negative anaerobic bacterial infections that occur with periodontal disease are commonly observed in women of child bearing age. In a case controlled study of 124 pregnant or post-partum mothers. 93 mothers who had PLBW babies had signficantly worse periodontal disease that their respective normal brith weight controls.The data indicate that periodontal diseases, with the predominantly gram negative anaerobic flora are a significant risk factor for PLBW. J. Perio 67:1103, 1996

Medications as Risk Factors for Periodontitis-

Significant gingival enlargement (hyperplasia) has been noted with the following medications: Phenytoin, calcuim channel blockers (particularly nifedipine, verapamil, diltiazem, and oxodipine), and cyclosporin. Xerosomia as a side effect from medications taken by the patient play a particularly important role in the progression of periodontitis. These include, the antihypertensives, antihistamines, narcotic anagesics, quinalones, some tranquilizers and tricyclic antidepressants. Frequent updating of medication histories is a must. J. Perio 67: 1055, 1996. [top]

 

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