Risk Factor For Systemic Diseases Research Articles

Denture Stomatitis: Causes, Cures and Prevention.

Removable dentures are worn by 20% of the UK population and two thirds of these individuals have denture stomatitis. Poor oral hygiene is commonplace among this group, as is smoking and xerostomia, which also contribute to the development of denture stomatitis. A complex polymicrobial biofilm is able to proliferate on the surface of denture materials and matures to form visible denture plaque. This denture plaque biofilm stimulates a local inflammatory process that is detectable clinically as erythema, and hyperplasia. Systemically, denture plaque represents a potential risk factor for systemic disease, in particular aspiration pneumonia. Respiratory pathogens have been detected in the denture plaque and overnight denture wear has been linked to an increased risk of aspiration pneumonia. There is a general lack of evidence on the adequate management of denture stomatitis and we present a protocol for use in the primary care setting.

Involvement of Porphyromonas gingivalis in the progression of non-alcoholic fatty liver disease.

The risk factors in the progression of nonalcoholic fatty liver disease (NAFLD) have not been fully clarified. Porphyromonas gingivalis (P.g) has been considered to be a confounding risk factor for systemic diseases. We aimed to evaluate the effect of P.g infection on risk of progression to NASH. (1) Serum IgG antibody titers against P.g fimbriae (fimA) in 200 biopsy-proven NAFLD patients were measured by ELISA and compared with histological findings. (2) C57BL/6J mice were fed a control diet (CD) or high-fat diet (HFD) with or without P.g-odontogenic infection and analyzed histologically. Mouse livers were analyzed using CE-TOFMS and LC-TOFMS. (1) A significant correlation between fibrosis progression and antibody titers against P.g possessing fimA type 4 was identified (P=0.0081). Multivariate analysis identified older age and type 4 P.g-positivity as risk factors for advanced fibrosis. (2) Fibrosis and steatosis were more severe in HFD P.g(+) mice compared with HFD P.g(-) mice. In metabolome analysis, fatty acid metabolism was significantly disrupted with HFD in P.g-infected mouse livers. Monounsaturated/saturated fatty acid ratios were significantly higher in the HFD P.g(+) group than in the HFD P.g(-) group (P<0.05). Moreover, expression levels of SCD1 and ELOVL6 were significantly reduced. These results suggest that P.g infection is an important risk factor for pathological progression in NAFLD. Increase in the monounsaturated/saturated fatty acid ratio may be an important change that facilitates progression of NAFLD.

Three-dimensional measurement of periodontal surface area for quantifying inflammatory burden.

PurposeMeasurement of the root surface area (RSA) is important in periodontal treatment and for the evaluation of periodontal disease as a risk factor for systemic disease. The aim of this study was to measure the RSA at 6 mm below the cementoenamel junction (CEJ) using the Mimics software (Materialise, Leuven, Belgium).MethodsWe obtained cone-beam computed tomography (CBCT) data from 33 patients who had visited the Department of Oral and Maxillofacial Radiology of Dankook University Dental Hospital. The patients comprised 17 men and 16 women aged from 20 to 35 years, with a mean age of 24.4 years. Only morphologically intact teeth were included in our data. Because the third molars of the maxilla and mandible have a high deformation rate and were absent in some participants, they were not included in our research material.ResultsThe CBCT data were reconstructed into 3-dimensional (3D) teeth models using the Mimics software, and the RSA at 6 mm below the CEJ was separated and measured using 3-Matic (Materialise). In total, 924 3D teeth models were created, and the area at 6 mm below the CEJ could be isolated in all the models. The area at 6 mm below the CEJ was measured in all teeth from the 33 patients and compared based on sex and position (maxilla vs. mandible).ConclusionsIn this study, we demonstrated that it was feasible to generate 3D data and to evaluate RSA values using CBCT and the Mimics software. These results provide deeper insights into the relationship between periodontal inflammatory burden and systemic diseases.

Periodontitis as a risk factor for systemic disease: Are microparticles the missing link?

Periodontitis is an oral inflammatory disease affecting the teeth supportive tissue. Its bacterial infectious etiology is well established. Periodontitis has been associated with increased prevalence of systemic diseases such as cardiovascular diseases, diabetes, rheumatoid arthritis, preeclampsia, preterm birth and inflammatory bowel disease. The rational of considering periodontitis as risk factor for systemic disease is the passage of inflammatory cytokines and/or bacteria in the bloodstream, thus affecting distant organs.Membrane microparticles are released by multiple cells in inflammatory environment. Recent data suggested the role of these microparticles in the pathogenic process of many systemic diseases, that can be also associated to periodontitis. We hypothesized that periodontitis could be a chronic reservoir of microparticles, hence elucidating partially the interaction with systemic diseases initiation or progression.

Prevalence of oral soft tissue lesions and medical assessment of geriatric outpatients in North India

Introduction: Oral health reflects overall well-being for the elderly population. Compromised oral health may be a risk factor for systemic diseases commonly occurring in old age. Oral health evaluation should be an integral part of the physical examination, and dentistry is essential to qualify geriatric patient care. Aim: To determine the prevalence of oral soft tissue lesions and systemic diseases in institutionalized geriatric population in North India. Materials and Methods: Geriatric patients were clinically evaluated using a standard questionnaire and assessed for known medical illnesses and prevalence of oral soft tissue lesions. Four hundred patients (71% males and 29% females) with age ranging from 60 to 100 years were considered in the study group. Twenty-two (33.8%) patients were edentulous and seven patients (10.8%) were denture wearers. Forty-four (67.69%) patients reported with tobacco habits. Results: Most prevalent medical illness reported was diminished vision (15.5%), followed by hypertension (10%) and diabetes mellitus (6.25%). Several oral soft tissue lesions were reported among the study population. The most prevalent lesions were leukoplakia (12%), smoker's melanosis (10%), smoker's palate (9%), pigmentation on tongue (6%), frictional keratosis (5%), lichen planus (3%), denture stomatitis (2.5%), aphthous ulcers (2%), angular chelitis (1.5%), oral submucous fibrosis (1.5%), melanotic macule (1.5%), candidiasis (1.5%), irritation fibroma (1%), geographic tongue (1%), median rhomboid glossitis (1%), and traumatic ulcer (1%). Conclusion: The findings observed in this population are important and can have a determinant effect on the overall quality of life in this population. This information is a crucial prerequisite for health awareness programs involving the community health workers, oral physicians, and medical professionals.

Microbial flora in chronic periodontitis: study at a tertiary health care center from north karnataka.

Background and Objective:Periodontitis is a major public health problem in India with a prevalence of 60–80%. If untreated it acts as a risk factor for systemic diseases. Data on anaerobic periodontal microflora in the Indian population is very scarce. Hence, this study was undertaken to know the nature of oral microbiota in chronic periodontitis in this region of India and also the semiquantitative study in pre- and post-treatment group and to determine antibiotic susceptibility pattern for aerobic isolates.Materials and Methods:The present study was conducted on 60 cases. Material was collected from the subgingival pockets in patients with chronic periodontitis attending the Periodontology, Outpatient Department. Clinical samples were transported to the laboratory in fluid thioglycollate medium. Initially Gram's stain and Fontana stains were done. Aerobic, anaerobic, and microaerophilic culture were put up. Antibiotic sensitivity test was done for aerobic isolates.Results:Sixty samples yielded 121 isolates of which 78.34% were polymicrobial, 11.66% were monomicrobial and oral commensals were grown in 10% cases. Out of 121 isolates 91.74% were anaerobic, 7.43% were aerobic and 0.83% were microaerophilic. Fusobacterium species was the most common isolate among anaerobes. Using “paired t-test” “P” value was significant indicating significant reduction in colony count after phase-I periodontal therapy.Conclusion:This study has shown that anaerobic bacteria are important cause of chronic periodontitis, along with aerobes and microaerophilic organisms. Fusobacterium spp, Bacteroides fragilis, Porphyromonas spp and Prevotella intermedia are the most common anaerobic pathogens. Bacterial culture methods are still economical and gold standard.

Lesiones orales como factores de riesgo de enfermedades sistémicas

Los problemas en la salud oral influyen en la condición general del individuo. El diagnóstico clínico de la enfermedad oral puede dar idea de la causa y el pronóstico, sin embargo no refleja directamente el nivel de alteración en el individuo. En algunas personas las enfermedades orales indican un factor de riesgo pero que no son de por vida, ni tan severos que deshabiliten sus capacidades, sin embargo sus consecuencias pueden impactar en la vida diaria en diferentes grados y provocar la percepción de incapacidad alterando el desenvolvimiento psicosocial. Diversos autores mencionan signos orales como factor de riesgo de enfermedades sistémicas. Patologias del canal radicular como lugar de brote de actinomicosis sistémica. Tambien se describe a la ulceración crónica del paladar duro donde se presenta el signo de tuberculosis pulmonar no diagnosticada, asi mismo la sífilis secundaria es inicialmente diagnosticada por lesiones orales. Otros autores sost ienen que el Sarcoma de Ewing primario envuelve al hueso de la cabeza y el cuello antes de repercutir sistemicamente. Tambien se describe que el Citomegalovirus en mucosal oral es una de las primeras manifestaciones del SIDA. Asi mismo se dice que la exposición hematógena a los estreptococos orales ha sido reconocido como potencial factor iniciador de la endocarditis bacteriana. La infección ha sido reconocida como factor de riesgo para la aterogénesis y los eventos trombóticos. Se encontró asociación significativa entre el componente periodontal del índice dental y la isquemia cerebrovascular. Hay lesiones orales que son factores de riesgo para desarrrollar una enfermedad sistémica. La osteodistrofia renal y los cambios en el tejido oseo son consecuencia de la insuficiencia renal. Los cambios en el hueso alveolar asociados a la osteodistrofia renal son similares a los hallados en el hiperparatiroidismo primario e incluyen pérdida generalizada de densidad ósea, adelgazamiento de la cortical de los huesos y pérdida total o parcial de la lámina dura.

Multi‐organ injuries caused by lipopolysaccharide‐induced periodontal inflammation in rats: role of melatonin

Periodontitis, a chronic inflammatory disease caused by oral bacterial infection, is considered to be a risk factor for systemic diseases including diabetes mellitus, bacterial pneumonia, hyperlipidemia and atherosclerosis. The aim of this study was to evaluate the effectiveness of melatonin against periodontal inflammation-induced multiple organ injury in rats. Eighteen female Wistar albino rats were randomly divided into three groups of six rats each: control; lipopolysaccharide (LPS); and LPS + melatonin. During the experimental period (10d) all rats in the LPS and LPS + melatonin groups were given 10μL of LPS (from a 10mg/mL standard solution of LPS dissolved in saline) on days 1, 3 and 5. The rats in the LPS + melatonin group were given 50mg/kg of melatonin, daily for 10d, starting on day 1 after the administration of LPS. All rats were killed at the end of the experimental period. Liver, kidney and lung tissues were removed for investigation by light microscopy. The levels of serum aspartate aminotransferase (AST), alanine transaminase (ALT) and blood urea nitrogen (BUN) were significantly increased in the LPS group compared with the LPS+ melatonin group (p<0.05). There was no significant change in the serum creatinine levels in the groups. However, the changes in serum AST, ALT and BUN levels in the experimental groups did not correlate with changes in histological data. Both LPS and LPS + melatonin groups displayed structural features similar to those of the control group. The results revealed that increased serum AST, ALT and BUN levels following periodontitis are ameliorated with melatonin treatment.

FDI policy statement on oral infection/inflammation as a risk factor for systemic diseases: Adopted by the FDI General Assembly: 30 August 2013 – Istanbul, Turkey

FDI policy statement on oral infection/inflammation as a risk factor for systemic diseases: Adopted by the FDI General Assembly: 30 August 2013 – Istanbul, Turkey

Relation between Oral Health Status and Electrocardiogram ST Segment Changes in a Group of Patients with Myocardial Infarction.

Background and aims. Only half to two-thirds of cardiovascular diseases can be explained by the classic risk factors. It is believed that chronic oral inflammation is a potent risk factor for systemic diseases. Studies show that electrocardiogram ST segment changes can be predictive of myocardial infarction outcome. In this study the relation between electrocardio-gram ST segment changes and oral health is evaluated. Materials and methods. In this cross-sectional study, thirty-six patients (14 females and 22 males) with myocardial infarction were enrolled. Oral health indices including DMFT index, probing depth, clinical attachment loss and bleeding on probing were recorded for each patient. DMFT index, PD, CAL as continuous variables and BOP as a categorical variable were compared with ST segment changes by independent t-test and chi-squared test, respectively (α=0.05). Results. DMFT index, BOP and PD revealed no statistically significant relation with ST segment groups. CAL showed a statistically significant difference within ST segment groups (P=0.003, OR=1.68). Conclusion. Clinical attachment loss was significantly higher in patients with ST segment depression, while no correla-tion was seen between probing depth, bleeding on probing and DMFT index with ST segment elevation or depression.

Thesis, antithesis, and synthesis in periodontal and systemic interlink

The theory of focal infection, which was promulgated during the 19th and early 20th centuries, stated that "foci" of sepsis were responsible for the initiation and progression of a variety of inflammatory diseases such as arthritis, peptic ulcers, and appendicitis. In the oral cavity, therapeutic edentulation was common as a result of the popularity of the focal infection theory. Since many teeth were extracted without evidence of infection, thereby providing no relief of symptoms, the theory was discredited and largely ignored for many years. Recent progress in classification and identification of oral microorganisms and the realization that certain microorganisms are normally found only in the oral cavity have opened the way for a more realistic assessment of the importance of oral focal infection. It has become increasingly clear that the oral cavity can act as the site of origin for dissemination of pathogenic organisms to distant body sites, especially in immunocompromised hosts such as patients suffering from malignancies, diabetes, rheumatoid arthritis, or in patients undergoing other immunosuppressive treatment. A number of epidemiological studies have suggested that oral infection, especially periodontitis, may be a risk factor for systemic diseases.

Suboptimal Image Focus Broadens Retinal Vessel Caliber Measurement

Studies have used central retinal arteriolar (CRAE) and central retinal venular (CRVE) calibers, measured from images produced with computerized image analysis, to detect risk factors for systemic diseases. The authors explored suboptimal image focus as a possible contributing factor to artificially larger vascular caliber measurements. From the reading center image collections, 30 digital retinal images were selected for optimum quality. Image analysis software was used to derive nine progressively blurred versions of the originals. IVAN measurement software was used to measure CRAE and CRVE in the original and the blurred series derived from them. To check the adequacy of the simulation, progressively defocused series of images were taken of several volunteers. For CRAE, each level of simulated blurring produced a statically significant increase in apparent vessel caliber from the original (P<0.01, Wilcoxon signed rank test). For an average CRAE of 160 μm, mean broadening with minimal/moderate/severe blurring was 3 μm/12 μm/33 μm. For CRVE, every blurring level beyond the first was found to be significant (P<0.01). From an average CRVE of 200 μm, mean broadening ranged from 0 to 11 μm with minimal to severe blurring. Analysis of the progressively defocused series taken of volunteers yielded similar results overall. Suboptimal focus can result in erroneously larger vessel caliber measurements. Slight blurring has a minimal effect, but more severe blurring has a progressively greater effect.

Selected Abstracts from the Annual Meeting of the Scandinavian Society of Peridontology, Bergen, June 9-12 2011

BackgroundOver the last decades, periodontal diseases have been discussed as a possible risk factor for systemic diseases with an inflammatory origin.ObjectiveTo investigate if adult patients with periodontitis attending the dental school in Huddinge, Sweden, had more signs of systemic diseases such as cardiovascular disease, diabetes mellitus, pulmonary diseases, specifically asthma bronchiale, compared to healthy patients or those patients with gingivitis.DesignIn this retrospective study, dental charts were examined where the periodontal diagnoses were known. A total of 325 patients with severe periodontitis and 149 patients without periodontitis born 1928–1968 were identified. The diagnosis regarding the systemic diseases was self-reported. Odd ratios for all cardiovascular diseases, diabetes mellitus and pulmonary diseases were calculated with a logistic regression model adjusted for age, gender, and smoking.ResultsA total of 44.3% of those with severe periodontitis also had cardiovascular diseases, 19.1% had asthma bronchiale and 21.2% suffered from diabetes mellitus. Among the controls 30.9% had cardiovascular disease, 23.5% suffered from asthma and 6.7% had diabetes mellitus. Both among the controls and among those with severe periodontitis hypertension was the most frequent diagnosis. There was a significant association between periodontitis and cardiovascular disease (OR = 1.79 (0.0143)), but not between asthma bronchiale and periodontitis. The risk for diabetes mellitus was greater among those with periodontitis, OR = 2.95 (<0.0001).ConclusionThis study shows that there is an association between periodontitis and certain systemic diseases such as cardiovascular disease and diabetes mellitus. However, the underlying mechanism is unknown and it is too early to conclude whether periodontitis is a predictor for other systemic inflammatory diseases.

PERIODONTAL INFECTION AS A POTENTIAL RISK FACTOR FOR SYSTEMIC DISEASE

Oral infection can have an adverse effect on other organs of the body. Oral infections, especially periodontitis, may affect the course and pathogenesis of a number of systemic diseases, such as diabetes mellitus, cardiovascular disease, pre-term low birth weight infant and respiratory disease. The purpose of this article is to evaluate the current status of oral infection especially periodontitis as a potential risk factor of systemic diseases. Three main pathways linking oral infection to secondary systemic effects have been proposed: metastatic infection, metastatic injury and metastatic inflammation. Periodontitis can cause bacteria to enter the blood stream and activate immune cells. These activated cells produce inflammatory cytokines that have a destructive effect throughout the entire body. Therefore, periodontitis as a major oral infection may affect the host’s susceptibility to systemic disease.

Severity of periodontal disease correlates to inflammatory systemic status and independently predicts the presence and angiographic extent of stable coronary artery disease

Periodontal disease (PD) has been recognized as a risk factor for systemic diseases, but its involvement in the pathogenesis of coronary artery disease (CAD) remains debated. We sought to evaluate the potential relations between severity of the PD, inflammatory response and angiographic lesions extent in patients with stable CAD. A total of 131 subjects referred to our centre for coronary angiography were evaluated for presence and extension of CAD, then divided into two groups, one with presence of lesions (cases, n = 85) and other one with absence of lesions (controls, n = 46). Mean periodontal pocket depth (PPkD), high sensitivity C reactive protein (hs-CRP), serum amyloid A protein (SAA) and fibrinogen levels were measured in all patients. Cases and controls did not differ according to their baseline characteristics and prevalence of traditional cardiovascular risk factors. PPkD was greater in patients with CAD than in controls (2.24 +/- 1.28 mm vs 1.50 +/- 0.93 mm, P < 0.001 by Student's t-test). Systemic inflammatory response was more pronounced in cases than in controls, with higher values of hs-CRP, SAA and fibrinogen. Furthermore, PPkD values correlated with hs-CRP (r = 0.80, P < 0.001), SAA (r = 0.71, P < 0.001), fibrinogen levels (r = 0.72, P < 0.001) and the American College of Cardiology/American Heart Association angiographic score (r = 0.68, P < 0.001) in cases. Multivariate analysis indicated a persistent independent correlation between PPkD and angiographic score after adjustment for inflammatory markers levels. In the present study, PD lesions predicted presence of CAD stenosis in patients with cardiovascular risk factors. PD severity was correlated to angiographic extent of coronary lesions, independent of systemic inflammatory status. Those results suggest that these patients might benefit from an intensive periodontal therapy to prevent CAD progression.

Oral Health and Nutrition in Older People

The theoretical link between foods choice and masticatory efficiency has long been established. Recent evidence has confirmed this association, demonstrating a progressive alteration in food choice with decreasing numbers of teeth, with the greatest effect being among those who are edentulous. This altered food selection results in significant differences in the hematological status for some key nutrients in the one study in which this association was investigated. This paper summarizes some of the literature relevant to diet as a risk factor for systemic disease and identifies areas where altered food choice as a consequence of reduced masticatory efficiency might be placing individuals at increased risk of life-threatening conditions, such as atherosclerosis and cancer.

Back Pain

Backache is a nearly universal experience, and is a common complaint in the elderly. Systemic, metabolic, and degenerative disorders that may manifest as back pain occur more frequently in the geriatric age group. The first responsibility of the clinician in evaluating the elderly back pain sufferer is to identify etiologies for which specific treatment is available or mandatory, including neoplasm, infection, and referred back pain of visceral origin. Degenerative changes in the spine are ubiquitous radiographic findings in the geriatric population, but correlate poorly with clinical symptoms; back pain associated with degenerative disease of the spine, with few exceptions, does not require specific therapy. Radiographic and laboratory studies are required in patients with specified risk factors for systemic disease, but are not always indicated. Optimal therapeutic intervention requires attention to the underlying concerns of the elderly patient, which may include fear of loss of function as much as anxiety about disease pathology