Impact Of Periodontal Inflammation On Systemic Health PDF

Impact of Periodontal Inflammation on Systemic Health HYGN 1360 | Kaleigh Warden RDH, BA(IS), MAIS  Chapter 15 Session Objectives: Following participation in this s...

Impact of Periodontal Inflammation on Systemic Health HYGN 1360 | Kaleigh Warden RDH, BA(IS), MAIS  Chapter 15 Session Objectives: Following participation in this session, students will be able to: 1. Compare and contrast the terms “association” & “causation” 2. Discuss the relationship between oral health & Diabetes 3. Discuss the relationship between oral health & Cardiovascular disease 4. Discuss the relationship between oral health & respiratory conditions 5. Discuss the relationship between oral health & adverse pregnancy outcomes 6. Discuss potential associations between oral health & other systemic conditions Lecture content adapted from Gehrig, JS, Shin. DE. Willmanm, DE. Foundations of Periodontics for the Dental Hygienist, 5th Edition. Philadelphia: Wolters Kluwer. 2023 unless otherwise indicated All images obtained from Gehrig, JS, Shin. DE. Willmanm, DE. Foundations of Periodontics for the Dental Hygienist, 5th Edition. Philadelphia: Wolters Kluwer. 2023 unless otherwise indicated  Association vs Causality Current research suggests a bi-directional relationship between oral health & systemic health. Systemic disease may increase the likelihood of periodontal disease, or chronic oral infection may have an adverse effect on systemic health. This Photo by Unknown Author is licensed under CC BY-SA Association vs Causality Association – indicates that there is a relationship or a connection between two or more variables. An association cannot explain why or how the variables are related & does not necessarily mean that one variable causes the other variable. More research is necessary before that conclusion can be reached. E.g. smoking is associated with alcoholism, but smoking does not cause alcoholism Causation – the action of causing something (i.e. X is certain to cause or lead to Y) Determining causation of a disease or condition is difficult. Diseases may be caused by a multitude of factors. E.g. SARS-CoV-2 virus causes coronavirus Based on available research, it is not possible to prove causation between periodontitis & systemic disease It is possible that the association is the result of common risk factors & not causality Periodontitis & Systemic Disease A large body of evidence documents the association of periodontitis with several systemic conditions, including: 1. Diabetes Mellitus 2. Cardiovascular Disease 3. Bacterial Pneumonia 4. Adverse pregnancy outcomes Periodontitis as a Risk Factor for Diabetes Complications Diabetes Mellitus Diabetes is the pathological consequence of a number of physiological changes & the resulting impairment of metabolic regulation, hyperglycemia, & chronic inflammation that potentially impacts tissue integrity & repair. Diabetes & Periodontal Disease— A Two-Way Relationship There is a direct relationship between periodontitis severity & diabetes complications in patients with diabetes. Severe periodontitis adversely effects diabetes control. A direct relationship exists between periodontitis severity & diabetic complications in patients with diabetes, & emerging evidence suggests that severe periodontitis may predispose individuals to the development of diabetes. Glycemic Control in Diabetes Periodontitis may impact glycemic control Glycemic control: refers to the typical levels of blood glucose in a person with diabetes mellitus Optimal management of diabetes involves patients monitoring & recording their own blood glucose levels. If left unchecked & untreated, prolonged & elevated levels of glucose in the blood may result in serious health complications, or even death. Measuring Blood Glucose Level Measured with a glucose meter, with the result in either milligrams per deciliter (United States) or millimoles per liter (Canada & Europe) **new technologies (e.g. continuous glucose monitoring) are rapidly changing the way Diabetes is managed HbA1C HbA1C level is the average blood glucose level over the past 2 to 3 months (the average lifespan of a red blood cell) A normal HbA1C level for nondiabetics is below 5.6% A reasonable HbA1C goal for many adults with diabetes is below 7% Prolonged elevated glucose in the blood may result in serious diabetic complications & sometimes even death Proposed Biological Pathway Periodontal diseases may serve as initiators of insulin resistance, thereby aggravating glycemic control. Dental Hygiene Implications RDHs should educate patients with diabetes about the possible impact of periodontal infection on glycemic control & encourage oral disease prevention & ongoing professional dental hygiene therapy. It is important that RDHs routinely ask patients with Diabetes for their most recent HbA1C so they are better able to estimate their blood glucose status & potential periodontal risks. Dental Hygiene Implications Periodontal therapy may result in improved insulin sensitivity, & eventually lead to improved glycemic control & overall outcomes of diabetes mellitus Diabetic patients should be informed of other associated oral conditions, such as xerostomia, burning mouth syndrome, fungal infections, & slower wound healing. Dental Hygiene Implications Many patients with diabetes remain undiagnosed, & oral findings may offer an opportunity for the identification of affected individuals unaware of their condition. Dental health care professionals have the opportunity to identify unrecognized diabetes or prediabetes in dental patients and refer them to a physician for further evaluation and care. Periodontitis as a Risk Factor for Atherosclerotic Cardiovascular Disease (ACVD) Risk for Atherosclerotic Cardiovascular Disease (ACVD) ACVD is a group of heart or vascular diseases − Includes: angina, myocardial infarction, stroke, transient ischemic attack (TIA), & peripheral artery disease Atherosclerosis (thickening of artery walls) is a major component of CVD Atheroma (i.e. arterial plaque) is a fatty deposit in the inner lining of an artery Risk for Cardiovascular Disease (ACVD) Four possible biologic pathways proposed to explain link between inflammation due to periodontitis & ACVD: 1. Periodontal lesions may heighten systemic inflammation 2. Periodontitis may initiate host immune response; antibody cross-reactivity 3. Periodontitis elevates levels of fibrinogen; increased vascular inflammation 4. Periodontitis may result in dyslipidemia Dyslipidemia Dyslipidemia refers to abnormal amounts of lipids (fats) in the blood Periodontal infection may elevate serum cholesterol & low-density lipoproteins (LDLs) Triglycerides & very low-density lipoproteins (vLDLs) may also be elevated These inflammatory lipids may more easily enter the blood vessel wall & therefore are more likely to be incorporated into the atherosclerotic lesion (thickening of the vessel wall) ACVD Research summary: Research findings associate severe periodontal disease & CVD Evidence suggests that periodontal therapy reduces systemic inflammation, but there is limited evidence on its effects on cardiovascular health in the long term Ongoing research needed Dental Hygiene Implications RDHs should be aware of the emerging evidence that periodontitis is a risk factor for developing ACVD. Periodontitis patients who have other known risk factors for ACVD (such as smoking, hypertension, & obesity) and who have not been seen by a physician within the last year should be referred for a physical. Comprehensive periodontal therapy should include patient education & advice on modifiable lifestyle risk factors such as smoking, diet, & exercise. Periodontitis as a Risk Factor for Pneumonia Pneumonia Pneumonia is a serious inflammation of one or both lungs Caused by the inhalation of microorganisms & can range in severity from mild to life threatening Types of Pneumonia: 1. Community-acquired pneumonia (contracted outside the hospital setting) 2. Hospital-acquired pneumonia (contracted during a stay in a hospital or long-term care facility) Community-acquired bacterial pneumonia Most cases of community-acquired bacterial pneumonia are caused by aspiration of oropharyngeal organisms such as Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae into the lung. Community-acquired bacterial pneumonia generally responds well to appropriate medical treatment. There is no evidence that periodontal disease or oral hygiene alters the risk for community-acquired pneumonia. Hospital-acquired pneumonia Usually results from organisms called potential respiratory pathogens that are generally found in the gastrointestinal tract but may colonize the mouth & oropharynx. Bacterial plaque biofilms can serve as reservoirs of potential respiratory pathogens, particularly during prolonged hospitalization. Oral colonization with potential respiratory pathogens increases during hospitalization, and the longer a patient is hospitalized, the greater their prevalence. How is Periodontitis Related to Pneumonia? 1. Direct Aspiration of Oral Pathogens into the Lung 2. Modification of Oral Mucosal Surfaces by Periodontal Disease-Associated Bacteria 3. Reduction of Protective Salivary Pellicle by Oral Bacteria 4. Alteration of Respiratory Epithelium by Salivary Cytokines Pneumonia Research summary: − Periodontal disease & poor oral hygiene may be associated with hospital-acquired pneumonia. − Studies show that improved oral hygiene measures can reduce the incidence of hospital-acquired pneumonia. Dental Hygiene Implications Poor oral self-care is common in hospitals & long-term care facilities, especially in patients who are quite ill. RDHs should advocate for programs that enhance access of institutionalized adults to dental care services. RDHs should advocate for training of medical healthcare providers in providing daily oral hygiene care. Periodontitis as a Risk Factor for Adverse Pregnancy Outcomes Adverse Pregnancy Outcomes: 1. Low birth weight 2. Preterm birth 3. Preeclampsia How is Periodontitis Related to Adverse Pregnancy Outcomes? Pregnant women with severe periodontitis may develop bacteremia more frequently, exposing the fetus to aggressive pathogens. Pro-inflammatory mediators produced may enter the bloodstream & trigger systemic inflammation, leading to adverse pregnancy outcomes. Adverse Pregnancy Outcomes Research summary: An association may exist between periodontal disease & adverse pregnancy outcomes. The strength of this association is modest. Further research is needed to establish pathogens related to preeclampsia development. Adverse pregnancy outcomes most likely involve additional shared risk factors with periodontitis, such as tobacco use, alcohol use, obesity, & diabetes. Dental Hygiene Implications RDHs should educate female patients early about the association between potential adverse pregnancy outcomes & periodontal infection & provide early oral hygiene services for pregnant women & those considering pregnancy. It is important to note, however, that nonsurgical treatment of pregnant women does not appear to significantly reduce the risk of preterm birth or low birthweight. Dental Hygiene Implications “Women who are pregnant or planning pregnancy should undergo periodontal examinations. Appropriate preventive or therapeutic services, if indicated, should be provided. Preventive oral care services should be provided as early in pregnancy as possible. However, women should be encouraged to achieve a high level of oral hygiene prior to becoming pregnant and throughout their pregnancies.” -The American Academy of Periodontology (2004) Dental Hygiene Implications The pregnant patient should be informed of the possible physiologic changes that take place in the periodontium during pregnancy, such as increased tissue response to biofilm, increased vascularity, & increased bleeding or gingival enlargement. Potential Associations with Other Systemic Conditions Potential Associations with Other Systemic Conditions 1. Chronic Obstructive Pulmonary Disease 2. Chronic Kidney Disease 3. Rheumatoid Arthritis 4. Cognitive Impairment 5. Obesity 6. Metabolic Syndrome 7. Cancer  Recap—Periodontitis as a Risk Factor for Systemic Disease Chronic oral infections may be a modifiable risk factor for certain systemic diseases such as CVD, diabetes, & certain respiratory conditions. Periodontal disease may also adversely affect pregnancy outcomes. Oral health education & periodontal therapy may reduce the incidence & severity of these systemic diseases.  Chapter 15 Session Objectives: Following participation in this session, students will be able to: 1. Compare and contrast the terms “association” & “causation” 2. Discuss the relationship between oral health & Diabetes 3. Discuss the relationship between oral health & Cardiovascular disease 4. Discuss the relationship between oral health & respiratory conditions 5. Discuss the relationship between oral health & adverse pregnancy outcomes 6. Discuss potential associations between oral health & other systemic conditions Lecture content adapted from Gehrig, JS, Shin. DE. Willmanm, DE. Foundations of Periodontics for the Dental Hygienist, 5th Edition. Philadelphia: Wolters Kluwer. 2023 unless otherwise indicated All images obtained from Gehrig, JS, Shin. DE. Willmanm, DE. Foundations of Periodontics for the Dental Hygienist, 5th Edition. Philadelphia: Wolters Kluwer. 2023 unless otherwise indicated