Perio and systemic disease

Question 1

What did they use to say about local infections

Answer 1

It leads to chronic diseases

Question 2

Why does the focal infection theory not make sense?

Answer 2

Extracting teeth doesn’t help
People with oral health can have systemic disease
Edentulous people still get systemic diseases

Question 3

How can periodontitis potentially influence systemic disease?

Answer 3

The acute phase reaction cascade

Question 4

What is the acute phase reaction cascade

Answer 4

Triggering factors > local reaction> mediatos> secondary systemic reaction

Question 5

What are some triggering factors

Answer 5

Infection necrosis surgery neoplasia radiation

Question 6

What cells are involved in local reactions

Answer 6

Macrophages fibroblasts and endothelial cells

Question 7

What are mediators?

Answer 7

Inflammatory cytokines ex.

TNF-@, IL-1, IL-6, INFy

Question 8

What are common secondary systemic reaction

Answer 8

Fever and leukocytosis
Complement activation
Serum glucocorticoid increased
Altered synthesis of acute phase proteins

Question 9

What are the acute phase proteins

Answer 9

Complement components
Protease inhibitors (@2 macro globulin)
C reactive proteins
Fibrinogen
Plasminogen

Question 10

What do complement fragments do

Answer 10

Opsonization lysis and Ctx

Question 11

What do c reactive proteins do

Answer 11

Opsonization

Question 12

What does fibrinogen do

Answer 12

Coagulation ctx

Question 13

What does plasminogen do

Answer 13

Degrades blood clots

Question 14

What percentage of Americans over thirty have periodontitis

Answer 14

47%

Question 15

What kind of bacteria live in perio pockets

Answer 15

Gram negative

Question 16

Do infected and inflamed tissues pose a risk for perio?

Answer 16

Yes

Question 17

Perio leads to a systemic exposure to:

Answer 17

Bacteria, their products and inflammatory cytokines

Question 18

What defines a risk factor?

Answer 18

Consistency of association
Strength of association
Correct time sequence
Specificity of associations
Degree of exposure
Biological plausibility
Support from experimental evidence

Question 19

What does specificity mean?

Answer 19

If the factor is only associated with one disease, it is likely to be unconnected

Question 20

What does degree of exposure have to do with a risk factor

Answer 20

More exposure should equal more risk

Question 21

What is biological plausibility

Answer 21

The risk factor should make sense

Question 22

What counts as experimental evidence

Answer 22

Animal testing

Question 23

What are four diseases associated with perio

Answer 23

Avd
Adverse pregnancy outcomes
Diabetes
Respiratory infection

Question 24

What is atherosclerosis

Answer 24

Progessive disease where med-large muscular and large elastic bvs get occluded w atheromas

Question 25

What are atheromas

Answer 25

Fibro lipid lesions

Question 26

What are common complications of AVD

Answer 26

Coronary thrombosis and acute mi

Question 27

What is the progression of AVD

Answer 27

Macrophages and cholesterol and LDL forms foam cells that die and recruit more macs forming an atheroma that rupture and form a thrombosis that occlude arteries

Question 28

Besides perio what is a factor for avd?

Answer 28

High risk lipid profile, diet

Question 29

What factors are common to avd and periodontitis

Answer 29

Smoking, age, diabetes, educational and socioeconomic status

Question 30

What study showed a significant association bw oral health and mi

Answer 30

Mattila

Question 31

What did the NHANES I study demonstrate

Answer 31

Periodontitis assoc with a small risk of coronary heart disease in men

Question 32

Can tooth loss predict Chd?

Answer 32

Small assoc bw tooth loss and coronary hart disase

Question 33

What is the relation bw perio and atheromas

Answer 33

Perio can influence atheroma formation

Question 34

What is the assoc bw perio disease and Chd

Answer 34

No convincing evidence for assoc bw perio disease and chd risk

Question 35

What is the relationship bw tooth loss and mi risk

Answer 35

Men and women with tooth loss have higher risk of mi

Question 36

Does the loss of alveolar bone correlate with atherosclerosis

Answer 36

Yes, significant dose response curve

Question 37

Can perio pathogens cause Atherosclerosis

Answer 37

Yes

Question 38

Will perio tx fix atherosclerosis

Answer 38

Pathogens and probe depths decrease will decrease rate of carotid artery changes

Question 39

By how much Does perio increase the risk of avd

Answer 39

Twice the rate

Question 40

What is the rationale for he avd perio link

Answer 40

Perio bacteria affect platelets Perio bacteria invade endo cells and macrophages Endocrine like effects of pro inflammatory mediators

Question 41

What pathogens induce thromboembolic events

Answer 41

S sanguis and p gingivalis

Question 42

What mediates the bacterial thromboembolic events

Answer 42

Collagen like platelet aggregation proteins made by bacteria

Question 43

What DNA is found in avd lesions

Answer 43

Perio pathogens

Question 44

P gingivalis and LDL do what

Answer 44

Turn macrophages into foam cells

Question 45

What is elevated in perio patients?

Answer 45

Crp, fibrinogen are twice as high

Question 46

What do bacteria release into systemic circulation?

Answer 46

Endotoxin

Question 47

Bacteria, endotoxins and cytokines in systemic circulation up regulate what?

Answer 47

Endothelial adhesion molecules and monocytes activation and il1 tnf@ and il6

Question 48

What do endothelial adhesion molecules, monocytes and cytokines do

Answer 48

Monocyte and tcell production, atheroma development

Question 49

What does the liver make in response to TNF a, il6 and il8

Answer 49

Acute phase proteins which increase coagulation

Question 50

What does scaling and root planing do

Answer 50

Maybe reduces crp. Just maybe

Question 51

Does perio therapy improve endothelial function

Answer 51

Probably

Question 52

Does treatment of perio reduce the risk of avd?

Answer 52

No strong evidence suggests this but the link between the two is probably legit

Question 53

Is the perio avd link specific

Answer 53

No

Question 54

Does the degree of exposure make sense?

Answer 54

Yes worse perio is assoc w worse Chd

Question 55

Is it biologically plausible?

Answer 55

Yes

Question 56

Is there enough evidence

Answer 56

Not really

Question 57

What does aha say

Answer 57

Perio and avd is plausibly linked, but they share risk factor No causal relationship supported Not enough evidence

Question 58

How should dentists approach the avd perio link

Answer 58

Tx risk factors Collab w physicians to prevent both ex send to a periodontist if they have both risk factors

Question 59

Ptbw is what

Answer 59

Less than 2.5kg

Question 60

Ptbw is How many of births and how many of those that die

Answer 60

10% overall, 66% of deaths

Question 61

How could perio cause ptb

Answer 61

Macrophage and cytokines make placental tissues release pge2 causing myometrial contraction, also increased mmps weaken membranes

Question 62

Is perio tx safe for preggos

Answer 62

Yes

Question 63

Does perio cause ptbw

Answer 63

Assoc is modest

Question 64

Does perio therapy reduce ptb

Answer 64

No

Question 65

How could diabetes correl w perio

Answer 65

Chronic hyperglycemia leads to glycemic end products, which thicken endo walls, decreasing PMNs recruitment which decreases host response and also fibroblast recruitment delays healing. Also cytokines increase tissue breakdown, as well as elastase, collagenase and b glucoronidase

Question 66

Does perio tc reduce HBAIC

Answer 66

Yes, similar to adding 2nd drug, but follow ups needed so provide guidelines for dentists who tx diabetics.

Question 67

Does perio tx fix COPD?

Answer 67

No

Question 68

Does plaque cause pneumonia

Answer 68

More likely

Question 69

Is perio health linked to systemic

Answer 69

Yes, but need more studies