Post on 27-Dec-2015
transcript
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PERIODONTAL (GUM) DISEASE A PUBLIC HEALTH CONCERN
LCDR Nellis D. Patterson, BS, RDHDepartment of Justice Federal Bureau of Prisons
FCI Fort Dix, Fort Dix New Jersey
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OVERVIEWPeriodontal (Gum) Disease
Caused by more than 200 species of bacteria.
This disease is commonly ignored
#1 cause of adult tooth loss in the United States
“The prevalence of periodontal disease in the United States may be significantly
higher than originally estimated. Research published in the Journal of Dental
Research from the Centers for Disease Control and Prevention (CDC) and the
American Academy of Periodontology (AAP) suggests that the prevalence of
periodontal disease may have been underestimated by as much as 50 percent. The
implication is that more American adults may suffer from moderate to severe gum
disease than previously thought”(Phys.org)
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LEARNING OBJECTIVES
What is Periodontal Disease Associations to overall patient health
Management systems and strategies used to prevent and promote oral health that may improve one’s overall health
Define risk factors that may associate Periodontal Disease to Heart Disease and Stroke
Smoking
Diabetes
Genetic factors
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ORAL INFECTIONS & INFLAMMATION
Oral Infections
Potentially stress the immune system
Lowering the body’s resistance to infections
Oral Infections cause inflammation
Localized inflammation in the oral cavity is associated with the gums, and a systemic inflammatory response may occur in people who also suffer periodontal disease
Previous research stated that treating the individual's periodontal disease may reduce inflammation, and may alleviate some additional symptoms from other chronic illnesses
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INFLAMMATION
Inflammation is part of a healthy immune response
Continuous stimulation inflammation ( Periodontal issues that are
not addressed
May cause acute and chronic infections
Eventually these infections may interfere with the body's healthy
tissues, increasing the risk of heart attacks, stroke, diabetes, cancer,
and autoimmune diseases
STAGES
OF
GUM
DISEASE
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SUPPORTING AND NON-SUPPORTING EVIDENCE
“Periodontal disease and heart disease are both
inflammatory conditions. There appears to be
an association between periodontal disease and
heart disease, but it is not yet clear if having one
condition increases the risk of developing the
other”. The American Journal of Cardiology in
2009
The correlation between Periodontal Disease
and chronic illnesses was made years ago when
experts noticed that people with gum disease
tended to have more heart attacks or strokes
than people in better dental health. The
thinking was that the bacteria causing the
infection in the gums got into the blood stream
and traveled to the fatty plaques in blood
vessels where they attached and helped form
blood clots which can lead to a heart attack or
stroke”. (Newsroom.heart.org)
“However in a report dated CHICAGO, April 18,
2012 – The American Dental Association (ADA)
Council on Scientific Affairs agrees with the
conclusions of a recent report that current
scientific evidence does not establish a direct cause
and effect relationship between gum disease and
heart disease or stroke. Additionally, the evidence
does not establish that gum disease increases the
rate of heart disease or stroke”.
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THE MOUTH AND BODY CONNECTION
Two separate health problems
Periodontal Disease
Cardiovascular Disease
Both produce similar biological signs of inflammation
C-reactive proteins
Risk factors for both diseases include age, diabetes, and smoking status These common factors may
help explain why diseases of the blood vessels and mouth occur
BACTERIAL INFECTIONS
Bacteria (Streptococcus Viridans) responsible for gum disease may enter the bloodstream
Attach to the fatty plaques causing arteries to clog up
Infective Endocarditis
An infection found in the heart
manifest within the valves or chambers
Caused by the same bacteria present in the mouth
May responsible for periodontal disease
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C-Reactive Proteins and & TESTS
Inflammation can damage the inner lining of the arteries and make
having a heart attack more likely
C-Reactive Proteins are not normally found in the blood of healthy people
C-Reactive Proteins Blood Tests check for infections
A special type of C-Reactive Proteins Test
high-sensitivity CRP test (hs-CRP)
May be done to find out if there may be an increased chance of having a sudden
heart problem or an attack
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C-Reactive Protein range / level
Low Risk for Cardiovascular Disease
hs-CRP levels are lower than 1.0mg/L
Average Risk for Cardiovascular Disease
hs- levels are between 1.0 and 3.0 mg/L
High Risk for Cardiovascular Disease
hs-CRP levels are higher than 3.0 mg/L
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Periodontal Disease Associated with Blood related Cancers
Chronic inflammation
A risk factor in many types of cancers
Systemic inflammation
Triggered by periodontal diseases along with high levels of nitrate producing
bacteria in the mouth of people with periodontal disease may interact with
gastric acids to trigger the development of pancreatic cancer.
Advanced Periodontitis
C-Reactive Protein levels 30% higher in people with Perio. Dis.
as opposed those with normal healthy gingival tissues
May increase malignancy
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Periodontal Disease Associated with Diabetes
Periodontal Disease and Diabetes Especially Type II Diabetes
Have major inflammatory components
Indicators of periodontal disease, are seen more frequently in diabetic patients.
Symptoms
Include increased gingival pocket depth
loss of alveolar bone and tooth loss.
Diabetics have poorer glycemic control
Hemoglobin A1C Test and scores
Used to monitor the level of glucose control in people with diabetes.
A1c is frequently used to help newly diagnosed diabetics determine how elevated their
uncontrolled blood glucose levels have been
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Periodontal Dis. Associated with Pre-mature & Low Birth Weight Pregnant women w/Periodontal Disease
7 times more likely to have a baby that is born too early
or too small, due to a labor-inducing chemical found in oral
bacteria called prostaglandin
Prostaglandins are produced by the body and are
responsible for inflammation.
Prostaglandins are hormone-like chemicals that are s
significant to our well-being
High levels of prostaglandins are found in women with severe cases of periodontal disease
A Research team of periodontists, obstetrician-gynecologists and epidemiologists emphasized that their findings, based on a detailed analysis of 124 births, were preliminary and needed to be confirmed by “larger prospective multicenter investigations. “Nonetheless, they estimated from their findings that periodontal infection might be responsible for as many as 18 percent of the 250,000 premature babies that are born weighing less than 5.5 pounds in the United States each year
(New York Times Women's Health 1996)
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COMMUNITY DENTISTRY
Prevalence of Periodontal Disease
85% of adults in the United States are affected with some form of Periodontal Disease. Research also indicates that there is a great percentage of the inmate population who come from lower socioeconomic backgrounds Therefore, the overall oral health of patients in a community environment generally is poor, and they are more likely to have advanced periodontal disease
The Federal Bureau of Prisons along with Joint Commission has set standards for inmates that are consistent with the community, and within the correctional environment, it is imperative to promote oral health education
The average patient within the BOP have had little or no treatment prior to their incarceration, and at the time of intervention, many have poor oral hygiene to include significant signs of gum disease ranging from Gingivitis to Periodontitis. Therefore by the time they actually get to us many times the patient is in an advanced state of Periodontitis
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Although it has not been proven that systemic diseases are caused from Periodontal
Disease continually Education, Prevention and Early treatment
PATIENT CARE MONITORING Patients who have had heart attacks or who have a family
history of heart attacks or have a tendency toward strokes
Patient monitoring of the gum health status of patients who have had heart valve problems
or have had heart valve replacements
Prevention Dental health professionals play a vital role in improving the quality of life in
preventing, controlling and reducing oral diseases and conditions as well as promoting
healthy behaviors
Oral diseases are a major health concern that affect almost every person in The United
States. Dental caries and periodontal diseases have a huge economic and social cost and can
result in serious systemic problems, pain, and suffering. Most oral diseases are preventable,
and promoting oral health is continuing to make every effort to promote and implement
preventive measures for all citizens
Conclusion
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REFERENCES1. American Heart Association (2012)
2. CHICAGO, April 18, 2012 – The American Dental Association (ADA)
3. www.dentistryiq.com/index/display/article-display/7323600486/articles/dentistryiq/f
4. www.newsroom.heart.org/pr/aha/professional-dental-cleanings-217760.aspx
5. www.perio.org/consumer/mbc.heart.htm
6. MedLine Plus, NIH, C-Reactive Protein
7. New York Times, Womens Health October 1996
8. NIH, Ann N Y Acad Sci. 2006 Nov;1088:251-64
9. Phys.Org, September 22, 2010
10. (ScienceDaily (Jan. 16, 2007)