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