Ch. 15: Impact of Perio Inflammation on Systemic Health

Question 1

Association

Answer 1

relationship between two or more variable, cannot be explained as to why

Question 2

Causation

Answer 2

variable A causes or leads to variable B, multitude of factors to determine

Question 3

Metastatic infection (3 mechanisms linking perio systemically)

Answer 3

infectious disease by microorganism originating from distant body site, perio infection not limited to periodontium, oral bacteria is present systemically

Question 4

Inflammation (3 mechanisms linking perio systemically)

Answer 4

infection of perio pocket stimulates release of proinflammatory mediates, which enter the bloodstream and initiates systemic inflammation (IL-1b, IL-6, TNF-a, PGE2)

Question 5

Proinflammatory Mediators in Perio

Answer 5

IL-1b, IL-6, TNF-a, PGE2

Question 6

Immune Response (3 mechanisms linking perio systemically)

Answer 6

bacterial antigens presented to immune system initiates release of proinflammatory mediators (higher levels associated w/ obesity, diabetes, and periodontitis)

Question 7

Atherosclerotic Cardiovascular disease

Answer 7

includes angina, MI, stroke, TIA, peripheral artery disease

Question 8

Atherosclerosis

Answer 8

thickening of arterial walls by atheroma (arterial plaque, fatty deposit)

Question 9

Systemic Inflammation (4 pathways)

Answer 9

pathogens from subgingival plaque enter bloodstream and activate inflammatory response (c-reactive protein levels in blood increase)

Question 10

Antibody Cross-Reactivity (4 pathways)

Answer 10

elevated systemic antibodies reacts with hosts own endothelial cells in blood vessel wall instead of perio pathogens, leads to vascular inflammation and atherosclerosis

Question 11

Fibrinogen/Increased Vascular Inflammation (4 pathways)

Answer 11

elevated fibrinogen a risk factor for atherosclerosis

Question 12

Dyslipidemia (4 pathways)

Answer 12

elevated levels of lipids and lipoproteins in blood

Question 13

Relationship between perio and heart disease

Answer 13

Direct casual relationship has NOT been established, but periodontitis is a risk factor for coronary heart disease!

Question 14

Adverse Pregnancy Outcomes

Answer 14

preterm delivery or low birth weight is leading cause of neonatal death and long term developmental disturbances
Preeclampsia can reduce blood flow to placenta, resulting in necessary delivery before 37 weeks
Most likely share risk factor w/ periodontitis

Question 15

Direct pathway 1

Answer 15

Perio disease/infection -> maternal exposure -> systemic spread -> fetal exposure -> proinflammatory mediators from placenta -> adverse outcome

Question 16

Indirect pathway 1

Answer 16

Perio disease/infection -> maternal exposure -> proinflammatory mediators from material perio tissues -> systemic spread of mediators -> reaches placenta -> adverse outcome

Question 17

Indirect pathway 2

Answer 17

Perio disease/infection -> maternal exposure -> systemic spread to liver -> maternal liver produces elevated levels of cytokines -> systemic spread of cytokine -> adverse outcome

Question 18

Diabetes

Answer 18

2x more likely to get periodontal disease

Question 19

normal score for non-diabetics

Answer 19

<5.6%

Question 20

reasonble score for adults w/ diabetes

Answer 20

<7%

Question 21

relationship between perio and diabetes

Answer 21

Direct relationship between perio severity and diabetic complications
Perio therapy may improve insulin sensitivity (need for longitudinal studies using larger groups)
Diabetes does not cause periodontitis, it is a risk factor

Question 22

Community-acquired pneumonia

Answer 22

Fusobacterium nucleatum, responds well to medical treatment, risk not altered by perio disease or oral hygiene

Question 23

Hospital-acquired pneumonia

Answer 23

infection from potential respiratory pathogens during hospital stay

Question 24

Mechanisms (respiratory)

Answer 24

Direct inhalation, enzyme release damages oral mucosa, reduce protective salivary pellicle, salivary cytokines alter respiratory epithelium

Question 25

Chronic Obstructive Pulmonary Disease (COPD)

Answer 25

group of lung diseases characterized by obstruction of airflow during exhalation Hypothesized that perio infection may increase risk of COPD, insufficient evident at time to associate the two

Question 26

Chronic Kidney Disease

Answer 26

several studies report association w/ periodontitis, complex pathogenesis makes role difficult to determine

Question 27

Rheumatoid Arthritis

Answer 27

autoimmune disorder causing swelling, redness, warmth and pain of joint, possible association w/ periodontitis, contradictory evidence questions relationship

Question 28

Cognitive Impairment

Answer 28

current evidence for association w/ periodontitis is weak

Question 29

Obesity

Answer 29

BMI of 30 and above, weak association w/ periodontitis but should expect higher prevalence of perio among obese patient

Question 30

Metabolic syndrome

Answer 30

increases risk of heart diseases, stroke, and diabetes; emerging evidence of association w/ periodontitis

Question 31

Cancer

Answer 31

periodontitis possible risk factor for oral and oropharyngeal cancer

Question 32

Covid-19

Answer 32

associated w/ periodontitis through local and systemic inflammatory responses, further studies should see if maintenance of perio health can reduce severity of covid-19 infections