IMPACT OF PERIODONTAL

INFECTION ON SYSTEMIC
HEALTH
Learning objectives
● Focal infection theory revisited
● Periodontal disease and mortality
● Periodontal disease and coronary heart disease
● Periodontal disease and stroke
● Periodontal disease and diabetes
● Periodontal disease and prgnancy
● Periodontal disease and COPD
● Periodontal disease and acute respiratory infections
● Periodontal disease is an inflammatory disease
initiated by bacterial pathogens.

● Environmental ,physical ,social ,and host stresses

may affect and modify disease expression through a
multitude of pathways .

● Certain systemic condition can affect the initiation

and progression of gingivitis and periodontitis .
Organ systems and conditions possibly influenced
by periodontal infection
● 1] Cardiovascular and ● 2] Kidney diseases
cerebrovascular systems ➢Renal insuffiency
➢Atherosclerosis
➢Chronic kidney diseases
➢Coronary heart disease
➢End –stage kidney
➢Angina
disease
➢Myocardial infarction
➢Cerebrovascular accident
➢Erectile dysfuction
➢anemia
 ● 6] Respiratory system
● 3] Endocrine system ➢Chronic obstructive
➢Metabolic syndrome pulmonary disease
➢Diabetes mellitus ➢Acute bacterial pneumonia

● 4] Reproductive system ● 7] Cognitive function

➢Preterm low birth weight ➢Dementia
infants ➢Alzheimer disease
➢Preeclampsia
● 8] Cancers
● 5] Autoimmune disease ➢Colorectal
➢Rheumatoid arthritis ➢Pancreatic
➢Ankylosing spondylitis ➢Hapatocellular
➢others
Focal infection theory revisited

● William Hunter ,a British physician, first developed the idea

that oral microorganisms were responsible for a wide range
of systemic conditions.

● Extraction of teeth with these gingivitis and periodontitis

helps to eliminate the source of sepsis.

● The focal infection theory fell into dispute in the 1940s and
1950s when widespread extraction, often of the entire
defination, failed to reduce or eliminate the systemic
conditions .
Periodontal disease and mortality
● Patient with poor periodontal health may also have
other risk factors that increase mortality rates.

● Host susceptibility factors that predispose the patients

to periodontitis also predispose them to systemic
conditions such as ischemic heart disease, stroke,
respiratory infections

● May cause mortality if chronic low bacteremia persists

Periodontal disease and coronary heart disease
● Coronary heart disease and related events are a major
cause of death.

● MI has been associated with acute systemic bacterial and

viral infections and is sometimes preceded by influenza
like symptoms .

● Localized infectionschronic inflammatory reaction has

been suggested mechanism underlying CHD in these
individuals .
● Study done by Matilla et al found that MI patients had
significantly worse dental health than did the controls

● This association between poor dental health and MI was

independent of the known risk factor for heart disease
such as age, hypertension, cholesterol levels ‘ diabetes.

● Periodontal infection may affect the onset or progression

of atherosclerosis and CHD through certain mechanisms
increasing viscosity of blood ,thrombus formation and
embolization.
Factors affecting the blood viscosity
Plasma fibrinogen
Plasma lipoproteins
White blood count
Von Willebrand factor

Increase blood viscosity

● Increased viscosity of blood increase risk of thrombus

formation ischemic heart disease and cerebrovascular
accident
Effect of periodontal infection
● Ischemic heart disease
● IHD is associated with a process of atherogenesis
and thrombogenesis
Systemic infections
● DAILY ACTIVITIES

● The exposure time to bacteremia from routine daily

chewing and tooth brushing is much greater than
from dental procedures .

● An estimated 8% of all cases of infective endocarditis

are associated with periodontal or dental disease
without a preceding dental procedure .
Thrombogenesis
● Platelet aggregation plays a major role in
thrombogenesis .

● Most cases of acute myocardial infarction are

precipitated by thromboembolism

● Oral organisms may be involved in coronary

thrombogenesis i.e S. sanguis and P. gingivalis
Thromboembolism mechanism
● Oral pathogens – Streptococcus sanguis and P. gingivalis

● Expression of –platelet aggregation associated protein

on some of strains

● Bacterial strains enters the circulation and aggregation

of platelets

● Forms thromboembolism
Atherosclerosis
● It is a focal thickening of the arterial intima, the
innermost layer lining the lumen of the vessel, and the
arterial media, the thick layer under the arterial intima
consisting of smooth muscle, collagen, and elastic
fibers .
● Intimal lesion is called atheroma or atheromatous or
fibro fatty plaques

● Enlarges gradually, protrude into and obstruct vascular

lumen
● Periodontitis and atherosclerosis have many potential
pathogenic mechanism in common
● Both have
❖ Complex causation
❖ Genetic and gender predisposition
❖ Share many risk factors ,most significant is smoking
status
● Periodontitis, which is a chronic a chronic
inflammation initiated by microbial plaque can
predispose to atherosclerosis
Pathogenesis of atherosclerosis
Role of periodontal disease in MI or stroke

❑ Possible mechanism are ;

● Effects of infectious agents in atheroma formation
● Host mediated effects
● Common genetic predisposition for periodontal
disease and atherosclerosis
● Common risk factors such as lifestyle
● Periodontal disease and stroke :
● Presence of systemic infection

● Production of acute phase reactant proteins (CRP &

fibrinogen )

● Hypercoagualable state decreased micro –cerebral

perfusion ,increased risk of thromboembolism

● Greater ischemia & more severe post ischemic

neurologic defect
Periodontitis and diabetes
● DIABETES MELLITUS
● Chronic hyperglycemic state due to relative and
absolute deficiency of insulin

● Hyposecrection of insulin or peripheral resistance of

insulin impaired glucose uptake by the cells
impaired glucose utilization chronic hyperglycemia

● Result into lipid and protein metabolism

● Two types
● Type 1 diabetes mellitus (insulin dependent )
● Type 2 diabetes mellitus (non –insulin dependent )
● Gestational diabetes
Mechanism of action of insulin
● Ingestion of food

● Secretion of insulin -ve Type I DM

● Glucose uptake through glucose transpoters through

insulin dependent process
● -ve Type II DM
● Utilization of blood glucose

● Decreased blood glucose

● COMPLICATIONS OF DIABETES MELLITUS
● Retinopathy
● Nephropathy
● Neuropathy
● Macrovascular disease
● Altered wound healing
● Periodontal disease
● Periodontitis and diabetes mellitus

● It is clear from epidemiological data that DM increase

risk and severity of periodontitis .

● T h e i n c re a s e d p re v a l e n c e a n d s e v e r i t y o f
periodontitis typically seen in patients with diabetes ,
especially those with poor metabolic control led to
the designation of periodontal disease as sixth
complication of diabetes
● Effect of periodontal infection on glycemia

● Acute viral and bacterial infection have shown to

increase insulin resistance and aggravates glycemic
control.

● Systemic infection increases tissue resistance to

insulin, preventing glucose from entering into the cell
causing elevated blood glucose level required
increased amount of insulin to maintain
normoglycemia.
Periodontal disease & pregnancy
● LOW BIRTH WEIGHT
● They are 40 times more likely to die in neonatal
period than normal birth weight infants and account
for two third of neonatal death.

● Infants who survive increased risk of

congenital
anomalies, respiratory disorders and neuro
developmental disabilities .
● CAUSES OF LBW
● Preterm labor or premature rupture of membranes
● Smoking, alcohol or drugs use during pregnancy
● Inadequate prenatal care
● Race, low socioeconomic status
● Hypertension ,diabetes
● High or low maternal age
● Genitourinary tract infection
● Maternal stress and genetic background
● Periodontal disease
Periodontitis and COPD
● CHRONIC OBSTRUCTIVE PULMONARY DISEASE

● Characterized by airflow obstruction resulting from

chronic bronchitis or emphysema

● Emphysema is a chronic enlargement of airways

distal to bronchioles due to bronchiolar smooth
muscles and elastic fiber destruction .
● Chronic bronchitis is narrowing of airways proximal
to distal bronchi due reactive hyperplasia of
bronchial mucos glands and hypertrophy of muscles
● RISK FACTORS OF COPD
● Cigarette smoking
● Industrial smoke tars
● Genetic conditions
Presence of defective alpha 1 antitrypsin
Defective alpha 1 antichymotrypsin
Alpha 2 macroglobulin
Vitamin d binding protein
Effect of periodontitis
● Neutrophil influx

● Release of oxidative & hydrolytic enzymes

● Tissue destruction

● Release of proinflammatory cytokines

● Recruitment of monocyte & macrophages

Acute respiratory infection
● The upper respiratory tract are often contaminated
with organisms derived from oral, nasal ,and
pharyngeal region.

● Pneumonia is an infection of lungs parenchyma by

bacteria, virus, fungi and or mycoplasma.
● It is classified as

● 1 ) community acquired pneumonia

● 2) hospital acquired pneumonia

Community acquired pneumonia
● Caused by Streptococcus pneumonia and H. influenzae
in individuals hospitalized 90 days or before for 2 days
or more .

● Caused by :
● Inhalation of infectious aerosol
● Aspiration of oropharyngeal organism

● Till now no association between periodontal disease and

community acquired pneumonia has been found .
Hospital acquired pneumonia
● Gram –ve aerobic organism

● It is usually caused by the aspiration of

oropharyngeal contents during esophageal reflux
containing potential respiratory pathogens

● Potential respiratory pathogens may also originate in

oral cavity, dental plaque serve as a reservoir
● Subgingival plaque harbor potential respiratory
pathogens and periodontal pathogens, associated
with nosocomial pneumonia.
Thank you