1 / 27

CARDIAC IMPLICATIONS OF PERIODONTAL DISEASE

CARDIAC IMPLICATIONS OF PERIODONTAL DISEASE. dr shabeel pn. WHERE IT ALL STARTED. MATTILA & OTHERS (1989) First to link dental health and the heart Myocardial infarction patients Caries, Periodontal Disease, or both? Classic risk factors? MATTILA (1993) Pathogenic mechanism.

clara
Télécharger la présentation

CARDIAC IMPLICATIONS OF PERIODONTAL DISEASE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CARDIAC IMPLICATIONSOFPERIODONTAL DISEASE dr shabeel pn

  2. WHERE IT ALL STARTED • MATTILA & OTHERS (1989) • First to link dental health and the heart • Myocardial infarction patients • Caries, Periodontal Disease, or both? • Classic risk factors? • MATTILA (1993) • Pathogenic mechanism

  3. THANK YOU DR CHOW! • JADA EDITORIAL (1998) • “Research has identified periodontal disease as a major risk factor for cardiovascular disease and stroke.” • “Practitioners, get ready!” • DR CHOW • “I really want to know more.”

  4. 1995 NHANES Study PD 1.7 X CHD PD 2.6 X Dead Hypothesis 1998 Review of literature U.S. Veterans Statistically significant “association” Risk indicators S. sanguis LOESCHE

  5. PATHOGENISIS REVIEW • Pathogenesis is still hypothetical • Bacteria produce destructive toxins • gram negative = lipopolysaccharide • gram positive = mucopeptide complex • Toxins attract White Blood Cells • Accumulation is inflammation • Inflammation is destructive as well

  6. PERIODONTIUM • The soft tissue is in intimate contact with the tooth and plaque. • The junctional epithelium is non-keratinized with exposed intercellular spaces. • The tissue is highly vascularized and plaque products have access to it.

  7. PERIODONTIUM • The plaque products provoke increased permeability and exudation. • Inflammatory components and mediators are present in the gingival crevicular fluid. • Periodontal disease appears to involve preferential diffusion through the junctional epithelium.

  8. BECK • Periodontal disease represents a previously unrecognized risk factor for atherosclerosis and thromboembolic events. • Common risk factors • Common etiologic pathway • Common mechanism

  9. BLOOD MONOCYTE PHENOTYPE • MØ+ phenotype • Common inflammatory response trait • Abnormally high inflammatory reaction • Early-onset and Refractory Periodontitis • Insulin-dependent Diabetes Mellitus • Cascade of action

  10. BECK’S CASCADE Perio Pathogen MØ+ LPS Endotoxin PGE & IL Vasodilation Vasopermeability Connective Tissue Degradation Vasculature Endothelial Deposition Smooth Muscle Deposition Platelets

  11. INFLAMMATORY MEDIATORS • PGE, IL, & TNF • Gingival crevicular fluid • MØ+ secrete 3-10X more • NSAIAs?

  12. THE PLAYERS • Streptococci • Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Treponema denticola. • Platelet aggregation associated protein (PAAP) • Induce platelet aggregation

  13. FRIEND OR FOE? • Commensal vs. Opportunistic • Bacteremia • Periodontal Disease • Toothbrushing 40% • Extractions 60% • Periodontal surgery 88% • P. gingivalis & S. sanguis

  14. Family History? Age? Social Class? Smoking? Cholesterol? Diabetes? Hypertension? Periodontal Disease? RISK FACTORS

  15. AAP • 1998 Position Paper • Risky patients for PD • IDDM, Neutropenia, osteopenia, & stress • Risky patients for CHD • HTN, Hypercholesterol, smokers, etc. • Perio patients risky for CHD? • New rationale for periodontal therapy?

  16. AAP • 1996 Informational Paper • Periodontal Management of Patients with Cardiovascular Disease • Recommendations: • Medical History • Physical Examination • Vital Signs • Medical Consultation

  17. FACTORS Age Sex Heredity FACTOIDS Smoking Cholesterol Blood Pressure Physical Inactivity Obesity Diabetes Mellitus Stress Socioeconomic Status AHA

  18. WOW! • Oral Risk Management Protocol • Caries and Periodontal Protocol • AHA • SBE Prophylaxis! • Periodontal Pharmacotherapeutics • What to use and when?

  19. EUROPEAN WORKSHOP • Adjunctive Antibiotics • Adjunctive Antiseptics • Adjunctive Antimicrobials • Others?

  20. PERIODONTICS WORKSHOP • Sustained Release Therapies • tetracycline, doxycycline, minocycline • metronidazole, chlorhexidine • stannous fluoride, methylene blue, ofloxacin • Systemic Antibiotics • EOP (PPP, JP, & RPP) & RP • Others...

  21. MEDICAL APPROACH • Mechanical • Chemical • C & S, DNA, & GCF • Environmental • Risk factors & factoids • Maintenance

  22. FDA APPROVED PERIOSTAT ATRIDOX PERIOCHIP

  23. PERIOSTAT (doxycycline hyclate) • Suppresses collagenase • Inhibits host response • 20 mg capsule • bid for months

  24. ATRIDOX (10% doxycycline hyclate) • Sustained release gel • suppresses collagenase • 1 application X 7 days

  25. PERIOCHIP (chlorhexidine digluconate) • Biodegradable chip • > 5 mm pockets • Maintenance supplement

  26. WHAT WE KNOW • If you have MØ+, you have potential • Plaque in the gums, plaque in the arteries • Bacterial endotoxins & Host cytokines • CHD yes, CVA maybe • ASA/NSAIA benefits • PD linked to many systemic diseases

  27. DOCTOR DENTIST • Paradigm shift • Medical instead of mechanical • Diagnosis • The tools are changing • Rationales • Now have systemic implications • The Next Ten Years?

More Related