systemic factors perry ch. 16/ nield-gehrig ch. 7
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Systemic FactorsSystemic FactorsSystemic FactorsSystemic Factors
Perry Ch. 16/ Nield-Gehrig Ch. 7Perry Ch. 16/ Nield-Gehrig Ch. 7
Important Concepts• Periodontal disease is bacterial
infection of the periodontium• Host responds to the bacterial invaders
by mobilizing its defensive cells and releasing chemicals
• Host response is responsible for most of the tissue destruction in periodontitis
Important Concepts• Everyone who is infected with periodontal
pathogens does not experience periodontitis; some only experience gingivitis
• Additional factors, such as systemic disease, genetic variations, and smoking, play a significant role in determining the onset and progression of periodontitis
Risk factors for Periodontitis
• Presence of pathogenic bacteria– A. actinomycetemcomitans– P. gingivalis– B. forsythus
• Heredity• Smoking• Diabetes• Systemic disease• Psychosocial stress• Faulty restorations
Cardiovascular diseases
• More than 40 million people in US• Hypertension• Coronary artery disease• Valvular heart disease• Cardiac arrhythmias• Congestive heart failure
Hypertension• High BP is major risk factor for
cardiovascular disease, stroke, and kidney failure.
• “Silent killer” frequently asymptomatic and more than half of patients do not realize they have it.
Hypertension• See table 16-1 pg. 365• Systolic 180-209• Diastolic 110-119
– Not to be treated….sent immediately to physician
Hypertension medications
• Diuretics (thiazides)• Sympatholytics (beta-adrenergic
blockers such as propanolol• Vasodiators ( hydralazine HCI)• Angiotensin-converting enzyme
inhibitors (enalapril)
Coronary Artery Disease
• Cholesterol-containing material is deposited in the walls of arteries
• Two most common clinical manifestations:– Angina pectoris– Myocardial infarction
Cardiovascular Disease
Angina pectoris• Severe recurring chest pain that radiates into
the left shoulder and arm.• May involve neck lower jaw and face• Oxygen demands of heart are not being met• Stable angina is achieved by taking one or
more of the following medications:– Nitrates– Beta-adrenergic blockers– Calcium channel blockers-nifedipine (Procardia)
Angina pectoris• Nifedipine (Procardia) common
side effect is…..
• Gingival Enlargement
Valvar Heart Disease• Dental or periodontal procedures
that introduce bacteria into the bloodstream with valvar heart disease can increase their risk of a potentially fatal heart infection called infective endocarditis.
To prevent infective endocarditis
• Pre-med with antibiotics• Heart valves allow unidirectional
forward flow of blood through the heart
• disease can be acquired or congenital
Valvar heart disease• Acquired are more common than
congenital• Half of all acquired occur as isolated
stenosis (narrowing) of orifice of either the aortic or the mitral valve.
• Valvar insufficiency is the failure of a hear valve to close completely leading to regurgitation
Aquired heart murmurs• Often found with history of:• rheumatic fever• Ischemic heart disease• Systemic lupus erythematosus• connective tissue disorders• Other systemic diseases
Acquired heart murmurs
• Rheumatic fever is an acute systemic inflammatory disease that sometimes follows a streptococcal antigens associated with the infection.
• This may cause scarring of the heart valves.
• No periodontal probing or exploring
Mitral valve prolapse• 7% of the US population between
the ages of 20 and 40 years have this cardiac abnormality.
• Pre-med is needed if there is regurgitation or backward flow
• See table 16-1 for cardiac conditions associated with endocarditis
Cardiac Arrhythmias• Irregular heartbeat
– Can be associated with a variety of systemic conditions
HIGH FEVERISCHEMIC HEART DISEASECONGESTIVE HEART DISEASEMITRAL VALVE PROLAPSERHEUMATIC HEART DIEASEMYOCARDIAL INFARCTIONHYPERTENSIONACERTAIN ALLERGIC
REACTIONS(ANAAPHYLAXIS) HYPERTHYROIDISM
Cardiac Arrhythmia Medications
• disopyramide (Norpace)• mexiletine (Mexitil)• verapmil (Calan)• diltiazem (Cardizem)• May lead to xerostomia • Phenytoin (Dilantin),verapamil and
diltiazem may cause ging.enlargement
Pacemaker• Some cases of cardiac arrhythmia
under the skin of the upper chest wall. Wire leas connect to an electrode that is placed in contact with heart tissue.
• Sends periodic impulses to the heart• One type of arrhythmia has irregular
twitching referred to as fibrillation. • No premed is usually necessary
Congestive Heart Failure
• The heart is unable to supply the body with sufficient oxygenated blood.
• Chair should be kept partially erect
• Supplemental oxygen should be kept nearby
Pts on anticoagulants• reduce the risk of the
development of blood clots• blood thinners• Heparin or warfarin (Coumadin)
derivatives• Increased bleeding
Joint diseases and disorders
Artificial Joints- infection occurs in approximately 1%
Different orthopedic surgeons recommend different periods of premedication and different antibiotics and doses.
Diabetes Mellitus• More than 16 million people in the
US have diabetis mellitus but only half of them have been diagnosed.
• Control of gingival inflammation may help control diabetis
Diabetes Mellitus• Group of disorders that share the
common feature of an elevated glucose level in the blood
• Insufficient supply or impaired availability of insulin– Pancreatic hormone that is necessary
for the regulation of carbohydrate metabolism.
Diabetes Mellitus• Type 1 and type 2 both have genetic
predisposition to development.• 10 – 20% are type 1 – severe deficiency
of insulin as a result of the destruction of pancreatic beta cells due to autoimmune reactions in reponse injury from viruses.– Destruction can also result from tumors,
surgery and toxic reactions to drugs or chemicals
Diabetes Mellitus• Type 1 requires self-injection of
insulin• Onset is usually rapid and occurs
around the time of puberty
Diabetes Mellitus• Type 2 – 80 – 90% • Two metabolic defects associated with type 2
DM• 1) impaired secretion of insulin • 2)insulin resistance – defective cell receptors• Onset is slow• Usually over 30 years and overweight• Diet modifications and oral hypoglycemic
agents are used
Diabetes Mellitus• Poorly controlled DM appear to be
more susceptible to infections, including periodontal disease.
• Antibacterial functions of neutrophils appear to be abnormal.
Severity of Periodontal Disease Among Diabetic and Non-Diabetic Pima
Indians Periodontal tissue loss,
measured in millimeters along the tooth root, is a key indicator of periodontal disease severity. For the Pima Indians of Arizona, a population with the highest rate of diabetes in the world, periodontal infection and tooth loss are significantcomplications of the diabetic condition.
Diabetes Mellitus• There also seems to be some evidence of
the relationship going the other way -- that if you control periodontal disease, it may help you control your blood sugar.
• Having an infection, including periodontal disease, can impair the body’s ability to process and/or use insulin. So the theory is that if you control the infection, it might be easier to control blood sugar.
Pregnancy• Increase gingival inflammation is
frequently associated with pregnancy• Elevated progesterone and estrogen
may make the gingivae respond more to plaque.
• These hormones also promote growth of periodontal pathogens such as Prevotella intermedia.
Pregnancy
Pregnancy• Maternal periodontal disease has
been associated with an increased risk of preterm birth and low birth weight.
Psychological Stress• Immunosuppression can occur during
periods of stressful life events.• Persons with chronic periodontitis
may me more prone to exacerbation during this periods.– Remember that periodontitis is episodic.
Psychological Stress• NUG – stress is modifying factor
– 1) Recent emotional stress– 2)heavy cigarette smoking– 3) lack of sleep– 4) poor diet
HIV• Those with AIDS or about manifest
symptoms of AIDS may exhibit several oral manifestations.– Epstien-Barr virus – hairy leukoplakia– NUP– HPV
Epstien-Barr virus – hairy leukoplakia
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