The Connection Between Oral Health and Systemic Diseases
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Yayun Siti Rochmah
Yayun Siti Rochmah
1.
Cause (etiology)
2.
The mechanisms of its development (pathogenesis)
3.
Structural alterations induced in the cells and organ
of the body (morphologic change)
4.
The functional consequences of the morphologic
changes (clinical significance)
The four aspects of a disease process that form
the core of pathology are its :
Distribution of organisms and their toxins throughout
the body is by various routes:
blood circulation through out the body
lymphatic distribution locally and then to blood
stream
retrograde axonal transport - transport along nerve
fibres and back to the brain.
There are two major mechanisms of focal infection:
a) an actual metastasis of organisms from a focus
b) the spread of toxins or toxic products from a
remote focus to other tissues by the blood stream.
Once the infection passes the abscess area about the
tooth:
a) they may multiply in the blood setting up an acute
or chronic septicaemia.
b) they may be carried live to a suitable nidus where
they infect the surrounding tissue.
c) they may produce a slow but progressive atrophy
with replacement fibrosis in various organs of the
body.
The bacteria at the focus may undergo autolysis or
dissolution. Some of the products of this dissolution,
diffusing into the blood or lymph , may sensitise in
an allergic sense, various tissues of the body."
"A later diffusion of these products on reaching the
sensitised tissue may call forth an allergic reaction."
A study by the University of Buffalo, the same bacteria
causing those gum problems end up either directly infecting
your heart arteries or somehow causing other blockages.
A study at the University of Minnesota in 1998 showed that
by injecting rabbits with tooth plaque bacteria, caused blood
clots which lead to heart attacks.
Patients between the ages 30-40 who showed evidence of
bone loss around teeth were 50% more likely to have a
coronary heart problem.
Fatal heart disease was twice as common in those with
periodontal infection.
Haraszthy et al. 1999. Identification of periodontal
pathogens in atheromatous plaques. J. Periodontol 2000
71(10): 1554-60.al
Wu T. 2000. Periodontal disease and risk of
cerebrovascular disease: the first national health and
nutrition examination survey and its follow-up study.
American Journal of Epidemiology 151: 273-282.
Cancer
Periodontal disease is a risk factor for prostate cancer
and probably breast cancer as well as many other
cancers.
Systemic Risks from the Oral Bacteria
In getting your teeth cleaned, bacteria will enter the
blood stream. This is called
bacteremia
.
These bacteria can settle out and grow in blood
vessels, heart valves, the heart, and many other
tissues in the body. Infections in the mouth can lead
to systemic problems.
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Toxins, which are generated as waste by periodontal
bacteria get into the blood and trigger the liver to
make more C-Reactive Protein.
Studies have shown that those with moderate or
advanced perio disease have much higher levels of
C-Reactive Protein than those that do not have
periodontal disease.
Chronic Inflammation anywhere in the body
compromises the rest of the body.
Protein C-reactif (C-reactive protein, CRP) dibuat
oleh hati dan dikeluarkan ke dalam aliran darah.
CRP beredar dalam darah selama 6-10 jam setelah
proses inflamasi akut dan destruksi jaringan.
Kadarnya memuncak dalam 48-72 jam.
CRP merupakan uji non-spesifik.
Protein C- reaktif
CRP merupakan salah satu dari beberapa protein yang
sering disebut sebagai protein fase akut dan digunakan
untuk memantau perubahan-perubahan dalam fase
inflamasi akut yang dihubungkan dengan banyak
penyakit infeksi dan penyakit autoimun. Beberapa
keadaan dimana CRP dapat dijumpai meningkat adalah
radang sendi (rheumatoid arthritis), demam rematik,
kanker payudara, radang usus, penyakit radang
panggung (pelvic inflammatory disease, PID), penyakit
Hodgkin, SLE, infeksi bakterial.
CRP juga meningkat pada kehamilan trimester akhir,
pemakaian alat kontrasepsi intrauterus dan pengaruh
obat kontrasepsi oral.
The conditions for infection and growth of bacteria:
Acid condition—leads to anaerobic metabolism
BURNS SUGAR – 4 ATP
Anaeroic environment
Continual sugar exposure
Mucosal defenses against invading
bacteria in the oral cavity
The oral mucosa has three
types of antimicrobial
defenses:
physical barrier of the
epithelial layer
nonspecific (innate)
immunity derived from
salivary constituents,
neutrophils, and epithelial
antimicrobial peptides
adaptive immunity
associated with mucosa-
associated lymphatic
tissues (MALT).
However, results of surveys with molecular tools
indicate a level of diversity in the human subgingival
microflora that cannot be recognized by
conventional culture techniques.
More than 700
bacterial species
from the oral cavity have been
identified. In most instances, the cultivatable
microflora probably represent
less than 1%
of the
total extant population, as estimated by microscopy
or other means.
Molecular analyses
Correlation between plaque and gingivitis
– There
is a positive correlation between the amount of
bacterial plaque and the severity of gingivitis and
amount of bone loss in cross-sectional studies of
human populations.
15
Antibody response to microbes
– Numerous studies
indicate that subjects with destructive periodontal
diseases show an elevated serum antibody response
to specific subgingival organisms.
16
Human bacterial plaque has demonstrated pathogenic
potential when implanted into outside the mouth to
sites such as subcutaneous destructive abscesses in
humans or in experimental animals.
A number of toxic products can be detected in dental
plaque, including
endotoxins
, and cell wall
mucopeptides. In addition, enzymes have been shown
to be produced by whole plaque or individual
microorganisms from plaque that can be demonstrated
to hydrolyze a wide variety of tissue constituents.
Finally, it must be pointed out that the bacterial masses
that accumulate at or in the gingival sulcus possess an
array of antigens and possibly polyclonal activators
capable of triggering sequences of host-mediated events
that have been postulated as mechanisms of tissue
destruction.
1
Pathogenic potential of plaque
bacteria
The relationship between oral health and systemic diseases is significant, with manifestations within the oral cavity providing clues to underlying systemic issues. Disease processes involve aspects like etiology, pathogenesis, morphologic changes, and clinical significance. Organisms and toxins spread through various routes in the body, impacting health in unexpected ways. Focal infections can lead to severe consequences beyond the oral cavity, affecting organs and tissues systemically. Recognizing the implications of oral health on overall well-being is crucial in preventing potential complications such as heart disease.
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Presentation Transcript
Manifestasi klinis intraoral penyakit sistemik Yayun Siti Rochmah
The four aspects of a disease process that form the core of pathology are its : 1. 2. 3. Cause (etiology) The mechanisms of its development (pathogenesis) Structural alterations induced in the cells and organ of the body (morphologic change) The functional consequences of the morphologic changes (clinical significance) 4.
Distribution of organisms and their toxins throughout the body is by various routes: blood circulation through out the body lymphatic distribution locally and then to blood stream retrograde axonal transport - transport along nerve fibres and back to the brain.
There are two major mechanisms of focal infection: a) an actual metastasis of organisms from a focus b) the spread of toxins or toxic products from a remote focus to other tissues by the blood stream.
Once the infection passes the abscess area about the tooth: a) they may multiply in the blood setting up an acute or chronic septicaemia. b) they may be carried live to a suitable nidus where they infect the surrounding tissue. c) they may produce a slow but progressive atrophy with replacement fibrosis in various organs of the body.
The bacteria at the focus may undergo autolysis or dissolution. Some of the products of this dissolution, diffusing into the blood or lymph , may sensitise in an allergic sense, various tissues of the body." "A later diffusion of these products on reaching the sensitised tissue may call forth an allergic reaction."
A study by the University of Buffalo, the same bacteria causing those gum problems end up either directly infecting your heart arteries or somehow causing other blockages. A study at the University of Minnesota in 1998 showed that by injecting rabbits with tooth plaque bacteria, caused blood clots which lead to heart attacks. Patients between the ages 30-40 who showed evidence of bone loss around teeth were 50% more likely to have a coronary heart problem.
Fatal heart disease was twice as common in those with periodontal infection. Haraszthy et al. 1999. Identification of periodontal pathogens in atheromatous plaques. J. Periodontol 2000 71(10): 1554-60.al Wu T. 2000. Periodontal disease and risk of cerebrovascular disease: the first national health and nutrition examination survey and its follow-up study. American Journal of Epidemiology 151: 273-282. Cancer Periodontal disease is a risk factor for prostate cancer and probably breast cancer as well as many other cancers.
Systemic Risks from the Oral Bacteria In getting your teeth cleaned, bacteria will enter the blood stream. This is called bacteremia. These bacteria can settle out and grow in blood vessels, heart valves, the heart, and many other tissues in the body. Infections in the mouth can lead to systemic problems.
C C- -Reactive Protein Reactive Protein Medical researchers now think that periodontal disease is related to increased levels of C-Reactive Protein. Toxins, which are generated as waste by periodontal bacteria get into the blood and trigger the liver to make more C-Reactive Protein. Studies have shown that those with moderate or advanced perio disease have much higher levels of C-Reactive Protein than those that do not have periodontal disease. Chronic Inflammation anywhere in the body compromises the rest of the body.
Protein C- reaktif Protein C-reactif (C-reactive protein, CRP) dibuat oleh hati dan dikeluarkan ke dalam aliran darah. CRP beredar dalam darah selama 6-10 jam setelah proses inflamasi akut dan destruksi jaringan. Kadarnya memuncak dalam 48-72 jam. CRP merupakan uji non-spesifik.
CRP merupakan salah satu dari beberapa protein yang sering disebut sebagai protein fase akut dan digunakan untuk memantau perubahan-perubahan dalam fase inflamasi akut yang dihubungkan dengan banyak penyakit infeksi dan penyakit autoimun. Beberapa keadaan dimana CRP dapat dijumpai meningkat adalah radang sendi (rheumatoid arthritis), demam rematik, kanker payudara, radang usus, penyakit radang panggung (pelvic inflammatory disease, PID), penyakit Hodgkin, SLE, infeksi bakterial. CRP juga meningkat pada kehamilan trimester akhir, pemakaian alat kontrasepsi intrauterus dan pengaruh obat kontrasepsi oral.
The conditions for infection and growth of bacteria: Acid condition leads to anaerobic metabolism BURNS SUGAR 4 ATP Anaeroic environment Continual sugar exposure
Mucosal defenses against invading bacteria in the oral cavity The oral mucosa has three types of antimicrobial defenses: physical barrier of the epithelial layer nonspecific (innate) immunity derived from salivary constituents, neutrophils, and epithelial antimicrobial peptides adaptive immunity associated with mucosa- associated lymphatic tissues (MALT).
Molecular analyses However, results of surveys with molecular tools indicate a level of diversity in the human subgingival microflora that cannot be recognized by conventional culture techniques. More than 700 bacterial species from the oral cavity have been identified. In most instances, the cultivatable microflora probably represent less than 1% of the total extant population, as estimated by microscopy or other means.
Correlation between plaque and gingivitis There is a positive correlation between the amount of bacterial plaque and the severity of gingivitis and amount of bone loss in cross-sectional studies of human populations.15 Antibody response to microbes Numerous studies indicate that subjects with destructive periodontal diseases show an elevated serum antibody response to specific subgingival organisms.16
Pathogenic potential of plaque bacteria Human bacterial plaque has demonstrated pathogenic potential when implanted into outside the mouth to sites such as subcutaneous destructive abscesses in humans or in experimental animals. A number of toxic products can be detected in dental plaque, including endotoxins, and cell wall mucopeptides. In addition, enzymes have been shown to be produced by whole plaque or individual microorganisms from plaque that can be demonstrated to hydrolyze a wide variety of tissue constituents. Finally, it must be pointed out that the bacterial masses that accumulate at or in the gingival sulcus possess an array of antigens and possibly polyclonal activators capable of triggering sequences of host-mediated events that have been postulated as mechanisms of tissue destruction.1
