Figure 4.

Gingival hyperplasia in a patient treated with calcium channel blocker.

In additional in local complications, periodontal disease may have systemic consequences.
Bacterial respiratory tract pathogens colonize dental plaque and are believed to contribute to
pulmonary infections and exacerbations of chronic obstructive pulmonary disease through
aspiration, generation of cytokines, and alterations in the antibacterial properties of saliva. In
patients in intensive care units, this colonization has been prospectively linked to the
development of nosocomial pneumonia and bacteremia. Further research is needed to
determine whether improved oral health and reduction in the presence of pathogenic oral
bacteria can reduce the risk of respiratory tract infection in high-risk patients.
Recently, much attention has been given to the possible relationship between periodontitis
and the development of atherosclerosis. This was postulated after showing that bacterial
species such as porphyromonas gingivalis can activated thrombotic pathway and that
periodontal infections are associated with release with release of cytokines and other
inflammatory mediators. Although some studies have shown an increased risk of subclinical
atherosclerosis and coronary artery disease in persons with periodontitis, treatment of
periodontal disease has not yet been proven to reduce the incidence or severity of these
conditions.
Edentulous persons
An important predictor of health is the retention of natural teeth with age. In 1993, however
33% of americans over the age of 65were edentulous , and only 16% these person visited a
dentist. Physicians may, therefore, play an important role in the oral health of edentulous,
persons.
The loss of natural teeth affects the ability to eat, speak, and chew , and may lead to costly
restorative and rehabilitative care. Dental caries and periodontal disease cause the majority of
tooth loss, though other causes include trauma and complications from treatment of oral
cancer. Disabilities that result from tooth loss may not be reversible, even with proper-fitting
dentures. Tooth loss is considered largely preventable through education, personal hygiene
dental care, and community preventive measure such as water fluoridation.
One option to replace lost teeth is the use of dental implants. These contain a titanium serew
and are permanently osseointegrated into alveolar bone. Full dentures or single tooth units are
then attached for cosmetic and functional purpose. Removable dentures made of acrylic
resins are less expensive and are more commonly used. The preparation of any prosthetic
device may be complicated by anatomic considerations, comorbid illnesses, and medications
side effects. Although stability and alignment of the prosthesis are important, denture s may
be rejected by