INTRODCTION Observational studies provide strong evidence for a
• INTRODCTION • Observational studies provide strong evidence for a close association between advanced periodontitis with atherosclerotic vascular disease. • These two diseases share an inflammatory component in their pathogenesis. It is now widely accepted that increased levels of plasma CRP, a marker of chronic inflammation, is a reliable predictor of CAD in both men and women. Similarly, the chronic low-level bacteria and increased levels of inflammatory markers with oral source prevalence of dental infections was higher in patiants with cerebral infarction as compared to that in controls.
• Population studies have indicated a 1. 5 to 2 times greater risk factors of fatal CAD in patiants with periodontitis.
• Exotoxines from cell wall of GRAM negative bacteria present in periodontal disease cause the release of inflammatory mediators IL 1 B which can result in the formation of atheromas and subsequent atherosclerosis. Studies have shown that certain strains of STREPTOCOCCUS SANGUIS and PORPHYROMONAS GINGIVALIS were found to have a role in the platelet aggregation.
H khademi HEART ATTACKS Heart attacks are the number one cause of death for men and women in CANADA. Approximately 80, 000 CANADIAN suffer a heart attack every year. I n people under age 75, heart attack are much more prevalent in men than women, but after age 75, men and women get heart attack in equal numbers. Heart attack are most common in people over age 55 who are overweight , have high fat- diet and get little or no execise.
PATHOGENESIS • The pathogenesis basis of CAD is the creation of a atherosclerotic plaque which is the basis of additional CAD
Cholesterol is a waxy fat-like substance called lipid. Our livers make about 80% of the cholesterol in our bodies and the rest comes from the foods we eat. It is found only in animal products such as meat and dairy foods. The cholesterol we take in through food is called dietary cholesterol. The combination of our dietary cholesterol plus the cholesterol our livers make is known as our blood cholesterol. When our cholesterol is tested , it is the blood cholesterol levels that are measured. LDL cholesterol is often called bad cholesterol because it plugs the arteries of the heart. HDL cholesterol is often called good cholesterol because it protects the arteries by helping to remove the bad cholesterol.
5 Complications of Arterial Fibrous Plaque Formation • 1. Density and bulk of the fibrous capsule surrounding the plaque increases the vessel, s stiffness (hardening of the arteries). • 2. Rapture of the fibrous plaque causes a thrombus at the site of rupture. • 3. Occlusion of the vessel causes a myocardial infection(MI)and stroke(CVA) • 3. Hemorrhagic from the small vessels surrounding a larger vessel cause the area of the vessel lumen to be reduced. This constricts the blood flow in the vessel. (angina) • 4. Rapture of the fibrous cap into the vessel releases contained debris into the vessel(embolus). • 5. The vessel wall may weaken as the fibrous plaque causes atrophy of the elastic tissue surrounding the vessel. The vessel may thus expand dilate (aneurysm).
EPIDIMIOLOGICAL STUDIES ON ORAL INFECTIONAL ATHEROSCLEROSIS PUBLISHED 1989 TO 2000 AND FULFILING THE SELECTION CRITERIA INDICATED IN THE MATERIAL AND METHODS SECTION. 1 6/4/2021
SYRJANENet al. 1989 case- control study , N=80 , MAIN COCLUTION Statistically significant association between bacterial infection (both oral and non-oral)and cerebral infarction. 2 6/4/2021
MATTILA et al. 1989, CASECONTROL, N=202. MAIN CONCLUTION Statistically significant association between oral health and acute MI.
DESTEFANO et al. 1993 PROSPECTIVE , n=9760. Main conclusion: Incised risk(25%) for CAD and association with periodontitis and poor oral hygiene.
PAUNIO et al. 1993 DURATION: 14 YR cross -sectional , N=1348, MAIN CONCLUTION: Statistically significant association between missing teeth and CAD. 3 6/4/2021
BECK et al. 1996 PROSPECTIVE, N=1147, MAIN CNCLUTION: Statistically significant association between periodontitis CAD and stroke. 4 6/4/2021
JUSIPURA et al. 1996, PROSPECTIVE, N=44119, MAIN COCLUTION: No association between periodontal disease and CAD, EXCEPT FOR A SUBGROUP WITH PERIODONTITIS AT START 5 6/4/2021
RIDKER et al. 1997, PROSPECTIVE, n=1086, MAIN CONCLUTION: Plasma biomarker of inflammation shows association with myocardial infarction and stroke. 6 6/4/2021
LOESCHE et al. 1998 , CROSSSECTIONAL, N=320, MAIN CONCLUTION: Statistically significant association between oral health and CAD. 7 6/4/2021
FOLSOM et al. 1998, PROSPECTIVE, N=14700, DURATION: 6 -9, MAIN COCLUTION: Plasma biomarker of inflammation shows association with stroke. Items
ST. PAULS HOSPITAL: hkhademi MENDEZ et al. 1998 PROSPECTIVE, N=2073 DURATION: 30 YR, CONCLUTION: Association between inflammatory conditions and atherosclerosis. 4 6/4/2021
ST. PAULS HOSPITAL: hkhademi 6/4/2021 MORRISON et al. 1999: RETROSPECTIVE, N=21619 DURATION: 21 YR CONCLUTION: Statistically significant association between periodontal disease and CAD. ?
ST. PAULS HOSPITAL: hkhademi HUJOEL et al. 2000: PROSPECTIVE, N=8032 DURATION: 10 YR COCLUTION: Slight, but not statistically significant association between periodontitis , gingivitis and CAD. 6/4/2021
ST. PAULS HOSPITAL: WU et al. 2000: PROSPECTIVE, N=9962, DURATION: 10 yr , CONCLUTION: Statistically significant association between periodontitis and CAD hkhademi » WU et al. 2000 PROSPECTIVE N=10146 , DURATION: 10 yr, CONCLUTION: Association between plasma levels of CAD risk factors and periodontitis » Chris Lavelle 2002 march 6/4/2021
- Slides: 48