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.
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]
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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