PERIODONTAL MEDICINE AN OVERVIEWPERIODONTAL MEDICINE AN OVERVIEW

PERIODONTAL MEDICINE
AN OVERVIEW

PERIODONTAL MEDICINE
• Periodontal Medicine is a rapidly emerging
branch of Periodontology which deals with
two way relationship between periodontal
disease and systemic disease.
William and Offenbacher-2000

FOCAL INFECTION THEORY
• W.D.Miller in 1891 propounded the theory
that local infection affecting a small area of the
body can lead to subsequent infection or
symptom in other parts of the body due to
spread of the infecting agent itself or toxins
produced by it.
“Micro-organisms of human mouth” (1891)

ORAL CAVITY AS FOCUS OF
INFECTION
• William Hunter, a British physician identified
caries teeth, gingivitis and periodontitis as
foci of infection and advocated extraction of
these teeth to eliminate the source of sepsis
(oral sepsis as cause of disease. British medical journal 1900)

REJECTION OF FOCAL
INFECTION THEORY
• William Hunter’s concept of oral cavity as
focus of infection was discarded since it was
not based on sound scientific knowledge.

The scientific basis of periodontal
medicine
• Advanced research methodology
• Systems biology
• Epigenetics

Renewed interest in
association between oral and
systemic disease

Association between dental health
and acute myocardial infarction
• Matilla et al in their case controlled study observed an association
between poor dental health and acute myocardial infarction.
• They concluded that that dental caries or periodontal disease, or
both, is more common among patients with acute myocardial
infarction than among controls matched for age and sex.
• More prospective studies in various populations are, however,
needed to confirm the association and to elucidate its nature.
Matilla et al
Br med j 1989;298:779-82

Dental disease and risk of coronary
heart disease and mortality.
DeStefano et al investigated the incidence of
mortality or admission to hospital because of
coronary heart disease and total mortality in
subjects suffering from periodontitis. They
noted that patients with periodontitis had 25%
increased risk of mortality due to coronary heart
disease.
DeStefano et al
BMJ 1993 Mar 13;306(6879):688-91.

Report of national center for health
statistics - USA
(Leading causes of death in United States in 2005)
 Heart diseases
 Cancer
 Stroke
 Chronic respiratory diseases
 Accidental injuries
 Diabetes mellitus
Five out of these were related to periodontal disease

“A person cannot have good general health
without good oral health”
-US Surgeon General

Explosion of research in
periodontal medicine

SYSTEMIC DISEASES ASSOCIATED
WITH PERIODONTAL DISEASE
• Alzheimers disease
• Aneamia
• Atheroschlerosis
• Auto-immune disease
• Cancer
• Chronic obstructive pulmonary disease
• Colon cancer
• Crohns disease
• Death
• Dementia
• Diabetes
• Dry mouth
• Endometriosis
• Erectile dysfunction
• Fatigue
• Fever
• Fibromyalgia
• Gastro-oesophageal reflux disease
• Hypertension
• Infertility
• Inflammatory bowel disease
• Intellectual function
• Leukemia
• Low birth weight
• Lung cancer
• Lupus
• Metabolic syndrome
• Miscarriage
• Mouth cancer
• Multiple sclerosis
• Obesity
• Obstructive sleep apnea
• Osteoporosis
• Pneumonia
• Polycystic ovaries
• Pre-eclampsia
• Premature birth
• Psoriasis
• Renal disease
• Rheumatoid arthritis
• Stroke
• Stomach ulcers Mark Bartold

Joint workshop of AAP – EFP
Consensus report on periodontal
medicine
Spain Dec 2012

ASSOCIATION
Association is defined as the concurrence of
two variables more often than would be
expected by chance.

CAUSALITY
Causality is defined as the relationship between
an event (cause) and a second event (effect)
where the second event is understood as a
consequence of the first.

TYPES OF CAUSAL
RELATIONSHIPS
• Sufficient Cause
• Necessary Cause
• Risk Factor

CRITERIA FOR CAUSALITY
• Epidemiological Association.
• Biological Plausibility.
• Impact of intervention.

ROLE OF PERIODONTAL
DISEASE IN THE
PATHOGENESIS OF
SYSTEMIC DISEASES

PERIODONTAL DISEASE
Periodontal disease is an immuno
inflammatory disease initiated by micro-
organisms and characterized by the
destruction of the supporting tissues of the
tooth.

PATHOGENESIS OF
PERIODONTAL DISEASE

PATHWAYS OF SPREAD OF
PERIODONTAL DISEASE
• METASTASIS
• INFLAMMATION
• IMMUNOLOGICAL INJURY

SYSTEMIC DISEASES
ASSOCIATED WITH
PERIODONTAL DISEASE
• CARDIO-VASCULAR DISEASES
• ADVERSE PREGNANCY OUTCOMES
• DIABETES MELLITUS
• RHEUMATOID ARTHRITIS
• CHRONIC KIDNEY DISEASES
• COPD & PNEUMONIA
• CANCER

PERIODONTAL DISEASE
AND CARDIOVASCULAR
DISEASE

CARDIO VASCULAR
DISEASES
Cardiovascular diseases are
the class of diseases that
involve the heart and blood
vessels.

CARDIO VASCULAR
DISEASES ASSOCIATED WITH
PERIODONTAL DISEASE
• Coronary heart disease
• Cerebro Vascular Accidents

EVIDENCE FOR
ASSOCIATION OF CVD AND
PERIODONTITIS

Meta-Analysis
Systematic Reviews
HIERACHY OF EVIDENCE

Periodontal Disease and Coronary
Heart Disease Incidence:
A Systematic Review and Meta-
analysis- prospective cohort studies
Linda L. Humphrey, Rongwei Fu, David I. Buckley, Michele Freeman, Mark Helfand
J Gen Intern Med. 2008 ; 23(12): 2079–2086.

Objective
To aid the united states preventive services task
force (USPSTF) in evaluating whether
periodontal disease is an independent novel risk
factor for incident coronary heart disease

Conclusion
Periodontal disease is a risk factor or marker for
coronary heart disease that is independent of
traditional CHD risk factors including
socioeconomic status. Further research in this
important area of public health is warranted.

PATHOPHYSIOLOGY OF
CVD
Adhesion of platelets and
leukocytes
Formation of foam cells
Smooth muscle cells
proliferation
Thromboembolic event
Atheroma formation
Infiltration of monocytes
Endothelial dysfunction

Proposed link between periodontal disease and coronary heart disease

Role for Periodontitis in the Progression of Lipid Deposition in an
Animal Model
• An animal study conducted on New Zealand White rabbits
reported that Animals with experimentally induced periodontitis
had more extensive accumulations of lipids in the aorta than did
non-periodontitis animals (P < 0.05), and there was a positive
correlation between the severity of periodontal disease and the
extent of lipid deposition (r2
= 0.9501).
• The results provide direct evidence that periodontitis may be a
risk factor and may contribute to the pathogenesis of
atherosclerosis. The data support the concept that infections at
remote locations can modulate atherosclerotic events distantly.
Ashish Jain et al 2003

A systematic review and meta-analyses on
C-reactive protein in relation to periodontitis
(A meta analysis of randomized controlled
trial)
Paraskevas S, Huizinga JD, Loos BG
J Clin Periodontol 2008; 35: 277–290

Elevated plasma C-reactive protein (CRP) is
regarded as a risk predictor for cardiovascular
diseases. This systematic review explored the
effect of periodontal therapy on CRP levels in
periodontitis patients.
Objective

Conclusion
• Long-term treatment studies evaluating the effect
of periodontal treatment on CRP values in relation
to healthy controls are scarce. All treatment
studies show an effect on CRP levels in favour of
periodontal treatment. The available studies
included in the meta-analysis again showed a
benefit of periodontal treatment for patients
compared with untreated subjects.

• In conclusion, this systematic review provides
evidence that periodontitis elicits a mild acute-
phase response with elevation of CRP levels
compared with healthy controls. Periodontal
treatment results in lowered CRP levels;
however, the treatment studies available are
scarce.

Periodontal disease and
cerebrovascular accident

• A stroke, or cerebrovascular accident (CVA), is the rapid
loss of brain function due to disturbance in the blood supply to
the brain. This can be due to ischemia (lack of blood flow)
caused by blockage (thrombosis, arterial embolism), or
a haemorrhage
• Etio-pathogenesis of this is similar to CHD.

EVIDENCE FOR ASSOCIATION
BETWEEN PERIODONTAL DISEASE
AND CEREBROVASCULAR
ACCIDENTS

Association between periodontal
disease and
stroke- a meta-analysis
Sfyroeras GS, Roussas N, Saleptsis VG, Argyriou C, Giannoukas AD.
Journal of Vascular Surgery
Volume 55, Issue 4, Pages 1178–1184

Data provided by each prospective study and its
contribution in pooled estimate

Conclusion
• There is evidence that periodontitis is associated with
increased risk of stroke. However, the results of this meta
analysis should be interpreted with caution because of the
heterogeneity of the studies as well as the differences in
periodontitis definition.

AAP- EFP CONSENSUS
REPORT ON ASSOCIATION
BETWEEN PERIODONTAL
DISEASES AND
CARDIOVASCULAR DISEASE
2013
• Working group concluded that there is a consistent and strong
epidemiological evidence that periodontitis imparts increase risk for
future cardio vascular disease.

• Clinical studies do not support the interaction
and biological mechanism, intervention trials
to date are not adequate to draw further
conclusions.

• Well designed intervention trials on impact of
periodontal treatment and prevention of
cardiovascular disease with hard clinical
outcomes are needed.

EFFECT OF PERIODONTAL
DISEASE ON ADVERSE
PREGNANCY OUTCOMES

For centuries dental profession was aware of effect of pregnancy
on periodontal health but in recent years due to the work of
Offenbacher and associates it is realized that pregnancy and
periodontal disease have a bidirectional relationship and
periodontitis can be a risk factor for adverse pregnancy outcome
Periodontal
disease
Adverse
pregnancy
outcome
PERIODONTAL DISEASE AND PREGNANCY

Types Of Adverse Pregnancy
Outcomes
• STILL BIRTH
• FETAL DEATH
• PREMATURE RUPTURE OF MEMBRANES
• PRETERM BIRTH
• LOW BIRTH WEIGHT
• PRE-ECLAMPSIA

PRETERM BIRTH AND LOW
BIRTH WEIGHT
• PRE-TERM refers to gestation less than 37 weeks
• LOW BIRTH refers to infants less than 2500 grams
• PRE-ECLAMPSIA: disease of unknown origin
characterized by hypertension and protein-urea

SYSTEMATIC REVIEW OF
COHORT STUDIES

Evidence grade associating
periodontitis to preterm birth and/or
low birth weight: I. A systematic
review of prospective cohort studies
Chambrone L, Guglielmetti MR, Pannuti CM, Chambrone LA.
J Clin Periodontol 2011; 38: 795–808.

OBJECTIVE
The aims of this systematic review (SR) were to evaluate the
association between maternal periodontitis and preterm birth (PB)
and/or low birth weight (LBW), and the methodological quality of
prospective cohort studies conducted for such a purpose.

CONCLUSION
The results of this Systematic Review of prospective cohort
studies provide evidence to support the hypothesis that
periodontitis is associated with the risk of PB and/or LBW

Mechanism of parturition
• Birth takes place at the end of third trimester, 38
weeks from the conception.
• The exact mechanism of the onset of labour,
sequence of events that leads to birth is not well
understood.

• Increase in hormonal levels initiate the process
of parturition by inducing placental cells to
secrete prostaglandins, that cause smooth
muscle of the uterine wall to contract.
• As the pregnancy advances the level of PGE2
in amniotic fluid rises steadily till the critical
threshold level is reached to induce labour.

Effect of periodontitis on
pregnancy
• The Periodontal disease is also associated with
low grade inflammation.
• PGE 2 is a major arachidonic acid metabolite with
pro - inflammatory effects released locally by
periodontal tissues during infection.
• Hence it is hypothesized that patients with
periodontal disease have an increased risk for
PLBW.

ANIMAL STUDY
• Offenbacher and associates using a
bacteraemia model and a chamber model to
mimic a focal infection on pregnant hamsters
demonstrated that periodontal bacteria and
the inflammatory mediators have the ability
to disseminate systematically to the foetal-
placenta unit, via the blood circulation and
induce pregnancy complications

• They proposed that oral infections such as
periodontitis may act as a distant unfectious
reservoiur and affect pregnancy outcomes.
Collins, Offenbacher et al 1994.

Evidence grade associating
periodontitis with preterm birth and/or
low birth weight: II. A systematic
review of randomized trials evaluating
the effects of periodontal treatment
Chambrone L, Guglielmetti MR, Pannuti CM, Chambrone LA.
J Clin Periodontol 2011; 38: 795–808.

The aim of this systematic review was to evaluate
whether maternal periodontal disease treatment
(MPDT) can reduce the incidence of preterm
birth (PB) and/or low birth weight (LBW).
OBJECTIVE

CONCLUSION
• In spite of the positive results achieved by more than half of the
included studies, the pooled estimates of the present Systematic
review failed to sustain the argument that maternal periodontal
disease treatment (MPDT) can decrease the risk of PB and/or LBW.
• Despite the lack of an association between MPDT and the incidence
of and/or LBW, pregnant women with PD should be instructed about
the importance of periodontal health and undergo proper treatment.
Moreover, obstetricians could be advised to refer their patients for a
periodontal examination.

PERIODONTAL DISEASE AND
PRE-ECLAMPSIA

Pre- eclampsia
Pre- eclampsia is a maternal multiorgan
disease that clinically manifests in the
second half of pregnancy by the appearance
of hyper-tension and protein urea.

BETWEEN PERIODONTAL DISEASE
AND PRE-ECLAMPSIA

PRE-ECLAMPSIA : A
SYSTEMATIC REVIEW
Aim: The aim of this systematic review was to
evaluate the published scientific evidence for
this possible relationship between periodontal
disease and pre-eclampsia.
Kunen A et al
J Clin Periodontal 2010

• 8 observational studies reported positive while 4
studies found no association.
• None of the randomized controls reported
reduction in pre-eclamptic rate after periodontal
therapy during pregnancy.
• Therefore it is questionable whether periodontal
disease plays a causal role in pre-eclampsia.
Conclusion

AAP – EFP WORKSHOP CONSENSUS REPORT
ON PREGNANCY AND ADVERSE PREGNANCY
OUTCOMES.
• Working committee opnide that observational studies provide
evidence for impact of periodontal disease on adverse
pregnancy outcome.
• Two major pathways that is direct and indirect have been
identified for oral infection to reach feto – placental unit.
• Although periodontal therapy has been shown to be safe and
lead to improve periodontal conditions in pregnant women. It
doesn’t reduce overall rate of pre term birth and low birth
weight.

• Every female patient in a child bearing age
pregnant or intending to become pregnant
should be provided with periodontal care.

EFFECT OF PERIODONTAL
DISEASE ON DIABETES
MELLITUS

DIABETES MELLITUS
• Diabetes mellitus is a heterogeneous group of
disorders characterized by hyperglycaemia,
absolute or relative insulin deficiency or
resistance to action of insulin.
• There is a two way relationship between
diabetes and periodontitis.

BETWEEN PERIODONTAL
DISEASE
AND DIABETES MELLITUS

SYSTEMATIC REVIEW FOR
CASE-CONTROL STUDIES

Effect of periodontal disease on
diabetes: systematic review of
epidemiologic observational
evidence
Borgnakke WS, Ylöstalo PV, Taylor GW, Genco RJ.
Journal of Periodontology 2013, Vol. 84, Pages S135-S152 ,

Objective - To systematically review
epidemiologic evidence for effects of
periodontal disease on diabetes control,
complications and incidence.

Methodology - Longitudinal and cross-sectional
epidemiologic studies that permit determination of
directionality of observed effects were included

• Conclusion
Results suggested that periodontal disease
adversely affects diabetes outcomes,.

Infection
Acute systemic
Endotoxemia
TNF-α +IL-β FFA, LDL,TRG
hyperlipidemia
Increased serum
pro-inflammatory cytokines
Diabetes
Altered lipid metabolismInsulin
resistance
Monocyte
hyper response
Chronic localized Bacteremia
Effect of infection on glycemic control

Periodontal disease and diabetes mellitus

• Periodontal treatment decreases local inflammation and as a
consequence, decreases chemical mediators involved in
inflammation i.e TNF-α, IL-1, IL-6 and CRP.
• Reduction in level of inflammatory mediator results in
suppressing insulin resistance thereby contributing towards
improved glycemic control.

Gram negative periodontal
infection
Gram negative periodontal
infection
Increased insulin resistanceIncreased insulin resistance
Worsened glycemic controlWorsened glycemic control Improved glycemic controlImproved glycemic control
Improved insulin sensitivityImproved insulin sensitivity
Periodontal treatmentPeriodontal treatment
Potential effects of periodontal infection and periodontal therapy on
glycemia in patients with diabetes.

Does Periodontal Treatment Improve
Glycemic Control in Diabetic Patients? A
Meta-analysis of
Intervention Studies
S.-J. Janket, A. Wightman, A.E. Baird, T.E.
Van Dyke and J.A. Jones
J DENT RES 2005 84: 1154

This meta-analysis was initiated on 10 intervention studies to
quantify the effects of periodontal treatment on HbA1c level
among diabetic patients, to explore possible causes for the
discrepant reports, and to make recommendations for future
studies.
Objective

• Periodontal therapy with antibiotics appeared to decrease
HbA1c levels by statistically non-significant 0.71% among
patients with type 2 diabetes.
• Although this percent improvement in glycemic control may
be of value to some patients, the evidence currently available
was not strong enough for us to reject the null hypothesis,
"periodontal treatment does not affect glycemic control in
patients with diabetes".
Conclusion

Effect of Periodontal Treatment on Glycemic Control of
Diabetic Patients
A systematic review and meta-analysis
Teeuw WJ, Gerdes VE, Loos BG.
Diabetes Care 2010 vol. 33 no. 2 421-427

OBJECTIVE
There is growing evidence that periodontitis may affect general health. This
study was assigned to explore the robustness of observations that periodontal
therapy leads to the improvement of glycemic control in diabetic patients.

RESULTS
A total of 371 patients were included in this analysis with
periodontitis as predictor and the actual absolute change in A1C
(ΔA1C) as the outcome. The duration of follow-up was 3–9
months. All studies described a research population of type 2
diabetic patients in whom glycemic control improved after
periodontal therapy compared with the control group
The studies in a meta-analysis demonstrated a weighted mean
difference of ΔA1C before and after therapy of −0.40% favouring
periodontal intervention in type 2 diabetic patients.

CONCLUSIONS
The present meta-analysis suggests that periodontal treatment
leads to an improvement of glycemic control in type 2 diabetic
patients for at least 3 months.

RESPIRATORY DISORDERS

Chronic obstructive pulmonary disease
• COPD is characterized by airflow obstruction resulting from
emphysema or chronic bronchitis.
• Pneumonia is defined as an inflammation of the lungs caused
by bacterial, fungal, viral or parasitic infection.
Bacterial Pneumonia

Dental plaque may serve as a reservoir for pulmonary pathogens
responsible for aspiration pneumonia in high risk patients, for
example, intensive care, dentate elderly with poor oral health,
residents of long term care facilities.
BIOLOGIC PLAUSIBILITY
Azarapazhooh et al

Periodontal Disease and Risk of Chronic
Obstructive Pulmonary Disease: A Meta-
Analysis of Observational Studies
PLUSONE october 2012
Xian-Tao Zeng,Ming-Li Tu,Dong-Yan Liu, Dong , Zheng, Jing Zhang, Wei
Dong Leng

Objective
• Many epidemiological studies have found a positive
association between periodontal disease (PD) and risk of
chronic obstructive pulmonary disease (COPD), but this
association is varied and even contradictory among studies.
• A meta-analysis was performed to ascertain the relationship
between PD and COPD.

Conclusion
• Based on current evidence, PD is a significant and
independent risk factor of COPD.
• However, whether a causal relationship exists, remains
unclear. Moreover, we suggest performing randomized
controlled trails to explore whether periodontal interventions
are beneficial in regulating COPD pathogenesis and
progression.

A Systematic Review of the Preventive Effect of Oral
Hygiene on Pneumonia and Respiratory Tract
Infection in Elderly People in Hospitals and Nursing
Homes: Effect Estimates and Methodological Quality
of Randomized Controlled Trials
Sjögren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J.
Journal of the American Geriatrics Society
Volume 56, Issue 11 pages 2124–2130, November 2008

Objective
To investigate the preventive effect of oral hygiene on
pneumonia and respiratory tract infection, focusing on elderly
people in hospitals and nursing homes, by systematically
reviewing effect estimates and methodological quality of
randomized controlled trials (RCTs) and to provide an overview
of additional clinical studies in this area.

• Within the limitations of this study, it can be concluded that
available results from RCTs provide strong evidence that
mechanical oral hygiene decreases mortality risk from
pneumonia and seems to have a clinically relevant preventive
effect on nonfatal pneumonia in dependent elderly individuals.
• These data show that providing mechanical oral hygiene may
prevent approximately 1 in 10 cases of death from pneumonia
in dependent elderly people and indicate a largely similar
effect for prevention of pneumonia.
Conclusion

RHEUMATOID ARTHRITIS

Rheumatoid arthritis is a chronic destructive inflammatory
disease characterized by the accumulation and persistence of an
inflammatory infiltrate in the synovial membrane that leads to
synovitis and the destruction of the joint architecture resulting in
impaired function.
RHEUMATOID ARTHRITIS

RHEUMATOID ARTHRITIS AND PERIODONTAL
DISEASE
• The relationship between rheumatoid arthritis (RA) and the
progression of inflammatory conditions elsewhere in the body,
such as periodontitis, is controversial.
• While a number of studies have presented conflicting results
regarding a relationship between periodontitis and RA, there
have been recent reports suggesting a significant association
between these two common chronic inflammatory conditions.

• Periodontitis has very similar cytokine profiles to RA, consisting
of persistent high levels of pro-inflammatory cytokines,
including IL-1β and TNF-α, and low levels of cytokines which
suppress the immuno-inflammatory response such as IL-10 and
TGF-β.
• These cytokines, together with low levels of tissue inhibitors of
metallo-proteinases(TIMPs) and high levels of MMPs and
PGE2, are associated with the active stages of both RA and
periodontitis.
• Hence, the possibility exists that both conditions result from a
common underlying dysregulation of the host inflammatory
response.
BIOLOGICAL PLAUSIBILITY

Periodontal disease, tooth loss and incident
rheumatoid arthritis: results from the First
National Health and Nutrition Examination
Survey and its epidemiological follow-up
study.
Ryan T. Demmer, Jerry A. Molitor, David R. Jacobs Jr., Bryan S. Michalowicz.
J Clin Periodontol 2011; 38: 998–1006

Aims: Infection may be a rheumatoid arthritis (RA) risk factor.We
examined whether signs of periodontal infection were associated
with RA development in the First National Health and Nutrition
Examination Survey and its epidemiological follow up study.
Conclusions: Although participants with periodontal disease or ≥5
missing teeth experienced higher odds of prevalent/incident RA,
most ORs were non-statistically significant and lacked dose-
responsiveness. Differential RA ascertainment bias complicated
the interpretation of these data.

ASSOCIATION BETWEEN
CHRONIC RENAL DISEASES

• Chronic renal disease also called as chronic kidney disease is a
progressive loss in renal function over a period of months or
years.
Chronic renal disease

Chronic renal disease and periodontal disease
• There are good number of observational studies regarding
association between periodontitis and chronic renal diseases
• 80% of these studies have reported some degree of association
between periodontitis and chronic renal disease
• The estimate of pooled data has provided an odds ratio of 1.6.
• Limited number of available interventional studies have found
positive outcome related to treatment

Periodontitis and chronic kidney disease:
a systematic review of the association of
diseases and the effect of periodontal
treatment on estimated glomerular
filtration rate
Leandro Chambrone, Adriana Moura Foz et al
Journal of clinical periodontology 2013

OBJECTIVE
The aim of this systematic review (SR) was to evaluate the
association between periodontitis and chronic kidney disease
(CKD) and the effect of periodontal treatment (PT) on the
estimated glomerular filtration rate (eGFR).

Conclusion
• Despite of the number of studies included and the nature of the
study designs, there is quite secure evidence to support the
positive association between periodontitis and CKD.
• Periodontal treatment did not significantly improve the e-GFR
levels.

CANCER

Cancer
• Cancer known medically as a malignant neoplasm is a broad
group of various diseases, all involving unregulated cell growth,
• Cancer is characterized by anaplasia, invasiveness and
metastasis
• Cancer progressively become worse and may potentially result
in death.

Periodontal Disease and Tooth Loss as Risks
for Cancer:
A Systematic Review of the Literature
Sadighi Shamami M1, Sadighi Shamami M2, Amini S 1
Iran J Cancer Prev.2011; Vol4, No4, P189-198.

Objective
This review has outlined recent epidemiologic researches
pointing to a possible role for tooth loss and periodontal disease
in carcinogenesis

Validation of studies on association of periodontal disease and
cancers

Studies support association cancer with periodontal disease

Studies did not support association cancer with periodontal disease

Conclusion
With limitation of this study, additional studies are needed to
confirm periodontal disease as a risk factor for various types of
cancer and support the possible association between periodontal
disease and cancer rates.

• EFP – AAP Consensus report of the working committee about
COPD, rheumatoid disease, chronic kidney disease and
cancer.
• The working committee unanimously opinioned that reported
association between periodontal disease and the above
mentioned diseases do not imply causality.
• Establishment of causality require new studies with precise
definition of periodontal disease
• It was concluded that because of relative immaturity the body
of evidence for each of purported relationships, the field is
wild open and the gaps in knowledge are large.

• Periodontal medicine is an emerging branch of periodontology
which explores the possible link between periodontal disease
and systemic diseases.
• Unlike focal infection theory, periodontal medicine is based
on sound scientific knowledge.
• Systems biology & epigenetics have provided insight into the
mechanism of association between periodontal disease &
systemic disease.

• Epidemiological studies have shown a strong association
between periodontitis and cardiovascular disease.
• Cohort studies have reported periodontitis as a probable
independent risk factor for CVD & CVA when other
confounders are adjusted.
• Non-surgical periodontal therapy has shown reduction in the
levels of biological markers of CVD like CRP, IL-6, IL-1β,
fibrinogen, plasma fibrinogen inhibiting factor, von willebrand
factor.
• However, there is no consensus at present about effect of
periodontal therapy to reduce the incidence of CVD.

• Periodontal disease has been linked with pre-term birth and
low birth weight.
• Observational studies have reported it to be an independent
factor.
• There are conflicting reports about utility of periodontal
therapy in reducing adverse pregnancy outcomes.
• Association of periodontal disease with pre-eclampsia needs
further exploration.

• There are conflicting reports about the effectiveness of
periodontal treatment on glycemic control.
• Observational studies have reported association between
periodontitis with pulmonary disease like COPD & pneumonia
and with rheumatoid arthritis but they are not significant.
• There are reports about the link of periodontal disease with
cancer and mortality.

• Periodontal medicine is still in its infancy and needs further
research to clarify the exact role of periodontal infections in
the pathogenesis of systemic disease and role of periodontal
treatment in primary and secondary prevention of these
diseases.

“Because of many uncertainties in establishing
causality, the causal inference could be
enough in many situations to formulate policy
rather than waiting for unequivocal proof
which may be unattainable in several disease
conditions.”
WHO
Health Research Methodology 2nd
edition 2010

Periodontitis and Systemic Diseases
Proceedings of a workshop jointly held by
the European Federation of Periodontology and
American Academy of Periodontology.
Co-edited by Maurizio Tonetti and Kenneth S. Kornman
Volume 40, Issue Supplement s14, April 2013

Periodontal Disease and Overall Health:
A Clinician's Guide
Editors: Robert J. Genco, DDS, PhD and Ray C. Williams, DMD

PERIODONTAL MEDICINE AN OVERVIEWPERIODONTAL MEDICINE AN OVERVIEW

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Ähnlich wie PERIODONTAL MEDICINE AN OVERVIEWPERIODONTAL MEDICINE AN OVERVIEW

Ähnlich wie PERIODONTAL MEDICINE AN OVERVIEWPERIODONTAL MEDICINE AN OVERVIEW (20)

Mehr von SupriyoGhosh15

Mehr von SupriyoGhosh15 (8)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

PERIODONTAL MEDICINE AN OVERVIEWPERIODONTAL MEDICINE AN OVERVIEW