PERIODONTAL MEDICINE (Janani.J).pptx

PERIODONTAL
MEDICINE
JANANI.J
FINAL YEAR

INTRODUCTION
The term PERIODONTAL MEDICINE –first
Suggested by Steven offenbacher.
“Rapidly emerging branch of periodontology
focusing on a strong
Relationship between periodontal health
Or disease.”
--Steven offenbacher.(1996)

Impact of periodontal disease on systemic health
•Periodontal disease is an infectious disease but
certain systemic condition may affect the
initiation & progression of the condition.
•Evidence had shed light on converse side
Of the relation.
Systemic
condition
Periodontal
disease

FOCAL INFECTION THEORY
• Williams Hunter (1900) first developed --idea that the
focal oral infection -- responsible for wide range of
systemic conditions.
• Williams Hunter – indicated dentistry as a cause of
what he called “Oral sepsis”- that
caused rheumatic & other chronic disease.

SUB GINGIVAL ENVIRONMENT AS
RESERVOIR OF BACTERIA
Sub gingival microbiota in patient with periodontitis – Gram –ve
bacterial challenge.
Gram –ve
organism & their Sulcular epithelium Periodontal
Products mainly tissues &
LPS circulation
Bacteremia

Systemic c0nditions & periodontal
diseases
CARDIO VASCULAR SYSTEM :
 Atherosclerosis
Coronary heart disease
Myocardial infarction
ENDOCRINE SYSTEM
Diabetes mellitus
REPRODUCTIVE SYSTEM
Pre term low birth weight infants
Pre eclampsia

AUTO IMMUNE SYSTEM
Rheumatoid arthritis
Ankylosing spondylitis
RESPIRATORY SYSTEM
COPD
Acute bacterial pneumonia
Renal system
Renal insufficiency
Chronic kidney disease
End stage kidney disease

ETIOLOGY OF PERIODONTAL DISEASE
• Porphyromonas gingivalis
• Actinobacillus actinomycetemcomitans
• Prevotella intermedia
• Bacteroides forsythus
• Campylobacter rectus
• Fusobacterium nucleatum &
• Spirochetes
P.Gingivalis –link between periodontal & heart disease

EFFECTS OF MEDICATIONS & PERIODONTAL
DISEASE
Phenytoin
Cyclosporine
Dihydropyridines : Nifedipine & Nitrendipine
Heavy metals

Periodontal disease & CHD
Matilla et al found that MI patient had significantly
worse dental.
Recently,evidence has accumulated that certain Oral
Infections—significant role in ATHEROSCLEROSIS.

STAGES IN FORMATION OF
ATHEROSCLEROTIC PLAQUE

Periodontal disease & LEUKEMIA
Malignant neoplasm of WBC Precursors
Characterised by
Diffuse replacement of bone marrow with
Proliferating cell.
Abnormal numbers & forms of immature WBC in
circulating blood.
Widespread infiltrates in liver,spleen,lymphnode
& other body sites.

Periodontium in leukemic patient
Leukemic infiltration
Bleeding or hemorrhage
Oral ulceration
infection

Stress & periodontium
• Stress affects periodontium directly or indirectly.
• Direct: alteration of resistance of periodontium
• to infection.
• Psychological aspect of a person with imparing
Behavior like : poor oral hygiene , alcohol consumption ,
poor nutrition & bruxism.

Female hormones & periodontium
Gingival alterations during puberty , pregnancy &
menopause.
In puberty & pregnancy –non specific inflammatory
changes – HEMORRHAGIC COMPONENT

RESPIRATORY SYSTEM & PERIODONTIUM
COPD
Chronic obstruction to airflow with excess
Production of sputum.
ETIOLOGY:
Smoking , pollution , infections – rhinovirus.
CLINICAL FEATURE :
 Breathlessness
 wheezing
 fever –muco purulent relapses.

Oral cavity –reservoir of bacterial pathogens –
LUNG DISEASE.
OROPHARNYNGEAL colonization more common in
patient—teeth & denture.
Diminished salivary secretion & Ph
Poor oral hygiene
ETIOLOGY
• P.gingivalis
• Bacteroides gracilus
• Clostridium
• Fusobacterium necrophorum
• Actinomycetes.

pathogenesis
• Bacteria colonize SUPRA or SUB GINGIVAL PLAQUE.
into saliva
saliva
Lower
Respiratory
system
Cytokines from PDL
tissuessaliva from GCF.
Local inflammatory
Process-initiation &
Progression.

Mechanism of action
• Aspiration of oral pathogens
• Enzymes in saliva  adhesion & colonization.
• PDL associated enzymes destroy salivary pellicle.
• Cytokines promote infection.

DIABETES MELLITUS
Metabolic disorder
Diminished or impaired insulin action , results – inability of
glucose transport from blood stream.
Periodontal disease <---------> Diabetes mellitus.

PERIODONTAL MEDICINE (Janani.J).pptx

PERIODONTAL MEDICINE (Janani.J).pptx

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