The mysterious link
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Transcript of The mysterious link
The mysterious linkA tragic Drama
The association between Periodontal disease and
systemic diseases
Starring…
Periodontal Disease
Co-Starring…
Inflammation
With help from…
Inflammatory mediators
C-reactive protein
Serum amyloid A
Fibrinogen
Special Guest Stars…
Diabetes
Rheumatoid Arthritis
Respiratory Disease
Adverse Pregnancy Outcome
Alzheimers
And a likely appearance by…
CardiovascularDisease
Periodontal Infection
Immune ResponseBacteremia
Inflammatory Mediators (IL-1, IL-
6, TNF a)
Liver C-reactive protein Serum amyloid A
Fibrinogen
Cardiovascular disease
Periodontal Pathogens
Platelet aggregation,Endothelial invasion
Antibodies to bacteria,Cross-reactive antigens, T-cell sensitisation
Inflammatory mediators
Cytokines:Interleukin-1: Responsible for the production of inflammation,
as well as the promotion of fever and sepsis. Produced mainly by macrophages and neutrophils. Involved in regulation of the immune response..
Inflammatory mediators
Interleukin-6: Released in response to infection.Acts as both a pro-inflammatory and anti-
inflammatory cytokine. Secreted by T-cells and macrophages to
stimulate immune response.
Inflammatory mediators
TNF-a: (Tumor necrosis factor) involved in systemic
inflammation and is a member of a group of cytokines that stimulate the acute phase reaction.
Regulates immune cells, induces fever, apoptotic cell death, sepsis, inflammation and inhibit tumorigenesis and viral replication.
Periodontal Infection
Immune ResponseBacteremia
Inflammatory Mediators (IL-1, IL-
6, TNF a)
Liver C-reactive protein Serum amyloid A
Fibrinogen
Cardiovascular disease
Periodontal Pathogens
Platelet aggregation,Endothelial invasion
Antibodies to bacteria,Cross-reactive antigens, T-cell sensitisation
C-reactive protein
Synthesized by liverFound in the bloodIncreased in response to inflammation
Patients with a high CRP are more likely to develop diabetes, hypertension and cardiovascular disease.
Serum amyloid A
Released in response to inflammatory stimuli.
Implicated in several chronic inflammatory diseases, such as amyloidosis, atherosclerosis, and rheumatoid arthritis.
Fibrinogen
Synthesized in the liver.
Converted by thrombin into fibrin, which plays a role in the inflammatory response AND the development of rheumatoid arthritis.
Patient educationWhat might your patients know?
Discussion:
• What studies, if any, show a link between PD and systemic diseases?
• Does the article come to a definite conclusion of any kind?
• Anything of interest in your article.
Why is it a mystery?
“The difficulty in drawing a cause and effect relationship between
periodontitis and cardiovascular disease stems from the fact that the two groups of diseases share many
risk factors” J Periodontol, 2012 May 25
In Conclusion…
“As the ongoing studies report and confirm the strength of the association between periodontal disease and cardiovascular disease, in the next two decades, the oral healthcare professionals and the medical professionals have to prepare for better planning of prevention programs. It seems from the scientific evidence gathered so far that interventional periodontal care remains invaluable not only for oral health but for general health as well.” J Indian Soc Periodontol, 2010 Jul-Sep; 14(3): 148-154