Periodontal disease &

Systemic

Drg. Ade Ismail Abdul Kodir., MDSc., Sp. Perio

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 Relationship Between
Periodontal Disease and
Systemic Health
• Inflammation is the primary pathologic feature of
periodontal disease, and bacterial plaque is the essential
etiologic factor responsible for inducing the host
inflammatory process.
• Systemic diseases and variations in the host response to
the bacterial challenge lead to differences in the severity
of periodontal disease from one individual to another.
• Whereas, increasing evidence supports the premise that
chronic inflammatory periodontal disease has a significant
effect on systemic health conditions such as coronary
heart disease, stroke, or adverse pregnancy outcomes.

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 • a two-way road, with systemic host
factors acting locally to reduce resistance
to periodontal destruction and the local
bacterial challenge generating an
inflammatory response with the
potential to induce adverse systemic
outcomes.

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 What is the Oral-Systemic
Connection
• Oral health and overall health are intimately
related/connected
• General health risk factors also affect oral and craniofacial
health (ex. tobacco use, poor diet)
• The mouth and face can serve as a mirror of health and
disease (ex. HIV infection)
• The mouth can serve as a portal for infection (ex.
endocarditis)
• Several studies have shown that oral flora/infections
are associated with higher morbidity and mortality,
esp in certain patient populations (ex. neutropenic
chemo pts, transplant patients)
• Oral bacteria have potential for causing respiratory
infections (ex. COPD pts, bacterial pneumonia)
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 • Oral transmission of infections (ex. STDs)
• Periodontal disease—Diabetes connection
• having diabetes increases incidence and progression of
periodontal disease
• Periodontal disease can affect glucose control in
diabetic patients
• Oral infection—Cardiovascular disease (heart
disease/stroke) connection
• Periodontal disease—Adverse pregnancy
outcomes connection (ex. preterm labor, preterm
rupture of membranes)
• Poor oral health has effects on quality of life and
general well-being

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Impact of Periodontal
Disease
Bad Periodontal Systemic
Breath
Disease Systemic
Inflammation
Diseases

Recession
Mobility Tooth Loss

Aesthetics Root Chewing

Caries Difficulty

Hypersensitivity Pain Diet

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 systemic the host’s
diseases, host tissues barrier periodontal
and function and
disorders, and disease.
physiology immune
conditions defense

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 The Influence Of Several Notable
Systemic Diseases, Disorders, And
Conditions On The Periodontium.
• Endocrine disorders and hormonal changes.
• Hematologic disorders and immune deficiencies.
• Genetic disorders
• Stress and psychosomatic disorders
• Nutritional influences
• Medications
• Other systemic conditions

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DIABETIC PATIENT
 Oral signs and symptoms
• Xerostomia, increased caries
• Dry atrophic cracked oral mucosa, angular
chellitis
• Mucositis, ulcers, and desquamative
gingivitis, burning mouth syndrome
• Difficulty swallowing
• Opportunistic bacteria, fungal, viral
infection
• Poor Wound Healing
• Periodontal Disease-usually in poorly
controlled or undiagnosed diabetics
• Incidence of Perio Disease increases
among patients with diabetes as they age
• Diabetics with advanced systemic
conditions have periodontal disease more
frequently and severe.
 Dental Management
o Important to get a complete health history
o Ask the undiagnosed diabetic about signs
and symptoms, family history, and
determine if they are at risk
o Ask the known diabetic about their
glucose levels, how they control their
glucose, their last doctor’s visit, and if
they are displaying any symptoms of
diabetes now
 Treatment Modifications

• Short morning appointments

• Instruct patient to eat normal AM meal
• Frequent hygiene recalls
• Stress reduction protocol
• Antibiotic management for acute infections
 CONCLUSION
 familiar with the medical management of
patients with DM
 recognize the signs and symptoms of
undiagnosed or poorly controlled disease. By
taking an active role in the diagnosis and
treatment of oral conditions associated with DM
 may contribute to the maintenance of optimum
health in patients with this disease.
HYPERTENSION
 HYPERTENSION
Dental
STRESS
procedure

Acute Complications
(cardiac arrest,
cerebrovascular
accident)
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 Managing the care of patients
with hypertension.
• Dentists have a unique opportunity to detect
cases of hypertension,, patient visits at routine
intervals.
• It is a professional responsibility of a dental
clinician to inform the patient of their
hypertensive state and to offer medical advice,
including appropriate referrals.
• must focus on the actions, interactions and
adverse effects of the antihypertensive
medications, as well as the overall management of
blood pressure of the patient in the dental chair.
There are no recognized oral manifestations
of hypertension but antihypertensive drugs
can often cause side-effects, such as:
 xerostomia,
 gingival overgrowth,
 salivary gland swelling or pain,
 lichenoid drug reactions,
 erythema multiforme,
 taste sense alteration, and
 paresthesia.
 Medical Consultation
 Make sure you understand why you are
seeking a consultation, and exactly what it
is that you want to know
 Ask specific questions
 Be brief and to the point
Medical consult
Problem: Pt reports a history of heart failure and an inability to
be able to climb a flight of stairs without getting short of breath
or having chest pain
Reason for Consult: Can this patient tolerate routine dental
treatment including fillings, and gingival surgery using local
anesthetic with 1:100,000 epinephrine?
 Classification of adult Blood
Pressure and dental treatment
Classification
modifications
Systolic blood Diastolic blood Dental Treatment Modification
pressure pressure (mm Hg)
(mm Hg)
Normal < 130 <85 No changes in dental treatment

High normal 130 -139 85-89 No change in dental treatment

Hypertension
Stage 1 140-159 90-99 -Inform patient of findings
-Routine medical consultation/referral
-No changes in dental treatment; minimize stress

Stage 2 160-179 100-109 -Inform patient of findings

-Routine medical referral
-Selective dental care (routine exam, prophylaxis,
restorative, non surgical endodontics and
periodontic); minimize stress.

Stage 3 ≥180 ≥110 -Inform patient of findings

-Immediate medical consultation/referral
-Emergency dental care only (to alleviate pain,
bleeding, infection); minimize strees
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 TIMING OF DENTAL
APPOINTMENTS
• The increase of blood pressure in hypertensive
patient is associated with the hours surrounding
awakening that peaks by midmorning. This
fluctuation of blood pressure tends to be less
likely in the afternoon. Afternoon appointments
are recommended over mornings for this reason.
 Stress reduction protocol
• shorter appointments
• good night's sleep before the appointment
• avoiding caffeine before the appointment
• eating a regular meal before the appointment
• ample time allowed to get to your appointment
• premed as needed
• checked to make sure daily hypertensive medications
were taken
• raising dental chair slowly
• allowed to sit upright in dental chair for several
minutes after procedure to avoid hypotension