Dental health and Medical health relationship

1. 1 Dental health Dental health And And Medical health relationship Medical health relationship Prepared by: Prepared by: Dr Mohammed Alruby Dr Mohammed Alruby ارما كلذ دعب ثدحي الله لعل يردت لا D Dental ental health and Medical health health and Medical health relationship relationship Dr. Mohammed Alruby Dr. Mohammed Alruby

2. 2 Important medical definitions: Blood pressure: Is the force that person’s blood exerts against the walls of their blood vessels, this pressure depends on the resistance of blood vessels and how the heart has to work Blood pressure has two numbers: -Systolic: represent the pressure in blood vessels when heart contract or beats -Diastolic: represent the pressure in the vessels when the heart rests between beats and contraction Hypertension: Or high blood pressure: is a common condition in which the long term force of blood against your artery walls is high enough that it may eventually cause health problem such as, heart disease Heart attack: Is a death of segment of heart muscle caused by loss of blood supply. The blood usually cut off when an artery supplying the heart muscles is blocked by blood clot Aneurysm: Enlargement of an artery caused by weakness in the arterial wall Cardiac arrest: Means heart stop, blood circulation stops, there is no pulse Cardiomyopathy: Damaged of heart muscle other than by artery or blood flow problems, may cause by drugs side effects Myocarditis: Inflammation of heart muscle, usually caused by virus, leading to left sided heart failure Heart arrhythmias: Abnormal heart rhythm, they may cause the heart beat too fast, creating more work for the heart, eventually the heart may weaken, leading to heart failure Atrial fibrillation: An irregular, often rapid heart beat Myocardial infarction: Medical name of heart attack: irreversible death (necrosis) of heart muscle secondary to prolonged lack of oxygen supply (ischemia) Heart rate: One of the vital signs, it measures the number of times / minutes that the heart contract or beats. It is your pulse rate. How to count: number of beat in 10 seconds X 6 = number of beats / minutes Age: 6--15: 70-- 100 beat / minutes Age: 18 y and over: 60—100 beats / minutes Respiratory rate: Number of breaths a person takes / minute, that measured when the person is at rest. Count the number of breath / minute increasing age as: From birth to 1 year: 30 – 60 From 12 – 18: 12—16 Tachycardia: Is a condition that makes your heart beat more than 100 times / minute Brain stroke or brain attack: Occurs when the blood supply to brain becomes blocked D Dental ental health and Medical health health and Medical health relationship relationship Dr. Mohammed Alruby Dr. Mohammed Alruby

3. 3 Atherosclerosis: Is a condition where the arteries become narrowed and hardened due to a build up of plaque around the artery wall, it is also known as arteriosclerotic vascular disease Pneumonia: Is an infection in one or both lungs, bacteria, virus, fungi Emphysema: Is a disease of the lungs, it occurs most often in smokers but it also occurs in people who regularly breath in irritant Endocarditis: Rare condition that involves inflammation of heart lining, heart muscles and heart valves Bacteremia: Bacteria present in blood Anorexia: Is a serious mental illness where people are of low weight due to limiting their energy intake It can affect any one of any age, gender, background Osteoporosis: Bone become weak and brittle. Bulimia: Is a serious mental illness where people are of high weight due to high food intake, it can affect anyone, at any age Diabetes Mellitus: Metabolic disease that cause high blood sugar, the hormone insulin moves sugar from the blood into your cells to be stored or used for energy with diabetes, your body does not make enough insulin or cannot effectively use. Types: Type I: is an auto-immune disease, the immune system attacks and destroyed cells in pancreas, where insulin is made Type II: occurs when your body becomes resistant to insulin, and sugar builds up in your blood Prediabetes: occurs when your sugar is higher than normal, but is not high enough for diagnosis of type II Gestational diabetes: is high blood sugar during pregnancy, insulin blocking hormones produced by placenta cause this type of diabetes Diabetes insipidus: not related to diabetes mellitus, it is different condition in which your kidneys move too much fluid from your body Periodontitis: Gum disease, is a serious gum infection that damaged the soft tissue and can destroy the bone that supports the teeth, can cause tooth loss Gingivitis: Mild form of gum disease, that cause irritation, redness and swelling of gingiva. If not treated can lead to more serious gum disease Hyperkalemia: Serum potassium in blood is increased than normal that may lead to change the heart rhythm Hypercalcemia: High concentration of calcium in your blood. Calcium is essential for the normal function of organ, cells, muscles and nerves. It is also important in blood clot Hyperventilation: Is fast breathing, people may breathe deeper than normal due to bleeding, severe pain, and lung infection D Dental ental health and Medical health health and Medical health relationship relationship Dr. Mohammed Alruby Dr. Mohammed Alruby

4. 4 Hyperthyroidism: Occurs when thyroid gland produces too much of thyroxine hormone Can accelerate body metabolism, causing unintentional weight loss and rapid or irregular heart beat Hyperparathyroidism: Occurs when parathyroid gland makes more parathyroid hormone PTH that regulate the level of calcium, vit D and phosphorus in blood and bone Leukemia: Blood cancer caused by raise in the number of white blood cells in your body WBC is a vital part of immune system that protect the body from invasion by bacteria, virus, fungi Thrombocytopenia: Low platelets count -- (colorless blood cells help to stop bleeding) Pemphigus vulgaris: Rare auto-immune disease that cause blistering on the skin and mucous membrane Cataract: Is clouding of normal clear lens of your eye for people who have cataract, seeing through cloudy lenses Glaucoma: Damage of eye’s optic nerve, one of leading causes for blindness Iritis: Swelling and irritation in colored ring around eye’s pupil Retinitis: Term of eye disease that can lead to loss of sight Colored vision issue: Poor or deficient color vision, in ability to see the difference between certain color Cavernous sinus thrombosis: Blood clot blocks a vein that runs through a hollow space underneath the brain and behind the eye socket, these veins carry blood from the face and head back to the heart Orbital cellulitis: Infection of the soft tissue within the eye socket, it is serious condition that without treatment can lead to permanent vision loss Double vision: diplopia: Occurs when a person sees a double image where there should only be one Heart Murmur: Sound of blood flowing, it may be passing through an abnormal heart valve OR, the condition that makes your heart beat faster and forces your heart to handle more blood quicker than normal Mitral valve prolapses: MVP Click Murmur syndrome or floppy valve syndrome The condition in which the two valve flaps of mitral valve do not close smoothly or evenly Angina pectoris: Chest pain happens because there is not enough blood going to part of your heart, it like heart attack with pressure or squeezing in your chest sometimes it called ischemic chest pain Coronary angioplasty: When heart arteries can block or narrow from a buildup of cholesterol, cells and other substances. This can reduce blood flow to heart and cause chest discomfort Angioplasty: opens blocked arteries and restore normal blood flow to heart muscle. It is not a major surgery. It is done by threating a catheter (thin tube) through small puncture in a leg or arm artery to heart, the blocked artery is opened by inflating a tiny balloon in it D Dental ental health and Medical health health and Medical health relationship relationship Dr. Mohammed Alruby Dr. Mohammed Alruby

5. 5 Coronary bypass graft: Surgery to redirect blood around a section of a blocked artery in heart to improve blood flow to heart muscles. Rheumatic heart disease: RHD A serious disease of heart involving damage to one or more of the four heart valves. The valve damaged remain after an illness called acute rheumatic fever ARF During ARF the heart tissue, and sometimes other parts of heart lining or muscles become swollen and this called carditis, following carditis, the heart valves can remain damaged then become scarred, and the result is an interruption to normal blood flow through damaged valves Coronary thrombosis: Formation of blood clot inside a blood vessels of the heart, this blood clot may then restrict blood flow within the heart, leading to tissue damaged Ischemic heart disease: Is a condition of recurring chest pain or discomfort that occurs when a part of heart does not receive enough blood, this condition occurs most often when heart requires greater blood flow Hematologic disease: Disorders which primarily affect the blood and blood forming organs, include rare genetic disorder as: -Disease of RBC: anemia -Disease of WBC: leukemia -Hemorrhagic disease: hemophilia -Leucocyte disorders -Blood platelets disorders -Blood coagulation disorders -Blood group incompatibility Anemia: Condition in which the number of red blood cells or hemoglobin concentration Within them is lower than normal, hemoglobin is needed to carry oxygen and if you have too few or abnormal red blood cells or not enough hemoglobin, there will be decreased capacity of blood to carry oxygen to body tissues, this results in symptoms such as: fatigue, weakness and shortness of breath Blood coagulation factors: I: fibrinogen II: prothrombin III: thromboplastin IV: calcium V: proaccelerin: labil factor VI: unassigned factor VII: proconvertin: stable factor VIII: anti hemophilic factor: A B, globulin IX: plasma thromboplastin component, Christmas factor X: sturat factor- power factor XI: plasma thromboplastin antecedent XII: hegman factor: hemophilia C: Rosenthal syndrome XIII: fibrin stabilizing factor: Laki lorand factor D Dental ental health and Medical health health and Medical health relationship relationship Dr. Mohammed Alruby Dr. Mohammed Alruby

6. 6 Disease involving blood factors: 1-Hemophilia: It is a rare condition in which the blood does not clot properly, man is mostly affected A: most affected type and is caused by deficiency in factor VIII B: caused by deficiency of factor IX: Christmas factor C: mild form of disease that caused by deficiency of factor XI N: B: Hemophilia: is an inherited genetic condition that is curable but it can be treated to minimize symptoms and prevent future health complication 2- Pseudo-hemophilia: Clotting disorder caused abnormal factor VIII activity and characterized by prolonged bleeding time but without delayed coagulation 3-Para-hemophilia: Owren’s disease: rare condition bleeding disorder that result in poor clotting after injury or surgery due to defect in factor V or proaccelerin factor Factor V: protein is made V: protein is made in liver that helps to convert prothrombin into thrombin which is important in blood clotting process 4-Hypo-fibrinogenemia: Fibrinogen: critical blood clotting factor I: it is rare disorder in which one of the two genes responsible for producing fibrinogen unable to make functional fibrinogen because of an inherited mutation Type I: quantitative abnormalities: a fibrinogenemia and hypo-fibrinogen Type II: qualitative abnormalities: hypodys-fibrinogenemia, dys-fibrinogenemia 5-Hypoprothrombinemia: Rare blood disorder in which a deficiency in immune-reactive prothrombin (factor II) produced in liver, results in impaired blood clotting reaction lead to an increased physiologic risk for spontaneous bleeding Types of anemia: 1-Iron deficiency anemia: Caused by shortage of iron in your body- bone marrow needs iron to make hemoglobin and without adequate iron the body cannot produce enough hemoglobin for red blood cells 2-Vitamin deficiency anemia: Besides iron the body needs folate and vit B12 to produce enough healthy red blood cells, lacking in these nutrient can cause decreased red blood cells production 3-Anemia of inflammation: Certain disease such as cancer, HIV, AIDS and rheumatoid arthritis can interfere with the production of red blood cells 4-A plastic anemia: Rare anemia occurs when body does not produce enough red blood cells may caused by: -Auto-immune disease -toxic chemicals -certain medicines 5-hemolytic anemia: when blood cells are destroyed faster than bone marrow can replace them D Dental ental health and Medical health health and Medical health relationship relationship Dr. Mohammed Alruby Dr. Mohammed Alruby

7. 7 6-sickle cell anemia: caused by defective form of hemoglobin that forces red blood cells to assume an abnormal crescent shape (sickle) these irregular blood cells die prematurely, result in chronic storage of red blood cells 7-thalassemia: an inherited blood disorder that cause your body to have less hemoglobin than normal Adrenal insufficiency: AI The adrenal gland located on top of the kidneys make hormones that are essential for body function, the outer-layer (cortex) of the gland makes three types of steroid hormones Type I: also called Addison disease: rare condition, in which the adrenal gland do not make enough cortisol (stress hormone) Type II: secondary AI: more common type of AI, result when the pituitary gland. A small gland near the brain does not signal the adrenal gland to make cortisol Bronchial asthma: Is a chronic inflammatory disorder in airway associated with airway hyper-responsiveness that lead to recurrent episodes of wheezing, breathlessness, chest lightness and coughing particularly at night in the early morning chronic obstructive pulmonary disease: COPD: is the name of a group of lung conditions that caused breathing difficulties, it include: emphysema: damage to the air sac in the lung chronic bronchitis: long term inflammation of airways liver cirrhosis: is a complication of liver disease that involves loss of liver cells and irreversible scaring of the liver, cause weakness, loss of appetite, yellow skin complication: swelling of the abdomen (ascites) alcoholic liver disease: refers to liver damage caused by excess alcohol intake stages: 1-Alcoholic fatty liver disease 2-Alcoholic hepatitis 3-Cirrhosis Renal failure: Also called end stage of renal disease or the last stage of chronic disease Kidney filter the blood and remove toxin from the body- kidney send toxins to your bladder which the body later removes toxins during urination Epilepsy: Is a disorder of brain characterized by repeated seizures Seizures: sudden alteration of the behavior due to temporary change in electric function of brain Osteoradionecrosis: Bone death due to radiation because radiation damaged the blood vessels of the bone D Dental ental health and Medical health health and Medical health relationship relationship Dr. Mohammed Alruby Dr. Mohammed Alruby

8. 8 Rare side effect, that develop some time after radiation therapy end. Mandible is more affected side Tuberculosis: Bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of an infected person It is mainly affects the lungs, but it can affect by any part of the body including, abdomen, gland, bones and nervous system Obstructive sleep apnea: OSA: A condition in which breathing stops involuntary for brief periods of time during sleep Normally: airflow smoothly from the mouth and nose into the lungs at all times It occurs when the muscles that support the soft tissues in your throat such as tongue and soft palate, temporarily relax so the airway is narrowed or closed and breathing is momentarily cut Von willebrand disease: VWF Von wellbrand factor: is synthetized and secreted by vascular endothelium to form part of perivascular matrix It is factor that promotes the platelets adhesion phase of hemostasis by binding with a receptor on the platelets surface membrane This disease can classify into: Type 1: quantitative deficiency of VWF which of most common form of an autosomal disorder Type II: qualitative impairment in synthesis of VWF that can result from various genetic abnormalities and is an autosomal dominant disorder Type III: a rare autosomal recessive disorder Delirium: State of mental confusion that starts suddenly and is caused by physical condition of some sort, it difficult to remember, sleep, pay attention and more Systemic disease caused by oral infection = Foci of sepsis were responsible for the initiation and prognosis of a variety of inflammatory disease such as arthritis, peptic ulcer = teeth are the non-shedding surface on the body and bacterial levels can reach more than 10^11 micro-organisms Bacteremia: presence of bacteria in blood stream, may result from ordinary activities as: vigorous tooth brushing Or infection: as urinary tract infection Bacteremia can occur after tooth extraction, endodontic treatment, periodontal surgery and root planning == Several studies observed bacteremia: 100%: after extraction 70%: after dental scaling 55%: after third molar surgery 20%: after endodontic treatment 55%: after bacterial tonsillectomy D Dental ental health and Medical health health and Medical health relationship relationship Dr. Mohammed Alruby Dr. Mohammed Alruby

9. 9 Possible pathways of oral infection and non-oral disease: 1-Infection from oral cavity via transient bacteremia: to: = subacute bacterial endocarditis = brain abscess = orbital cellulites = skin ulcer, sinusitis 2-Metastasis from circulation of oral microbial toxins: = acute cardial infarction = cerebral infarction = abnormal pregnancy outcome = trigeminal neuralgia 3-Metastasis caused by immunological injury from oral organisms: = chronic urticarial = inflammatory bowel disease Systemic disease associated with oral infection: 1-Cardiovascular disease: As atherosclerosis and myocardial infarction Mechanisms: a-Oral bacteria as streptococcus and prophyromonus gingivitis induce platelets aggregation which lead to thrombus formation b-Lip- polysaccharides from periodontal organisms being transferred to the serum as a result of bacteremia which have direct effect on endothelial parts Periodontitis stimulate the liver to produce c-reactive protein CRP (marker of inflammation) which in turn will form deposits on injured blood vessels CRP binds the cells that are damaged and fixed complement 2-Infective endocarditis: Bacterial infection of heart valve or endothelium of heart, it occurs when bacteria in blood stream lodge on abnormal heart valve or damaged heart tissue 3-Myocardial infarction: Damaging or death of an area of heart muscle resulting from reduced blood supply to that area almost due to formation of an occlusive thrombus at the site of rupture of an alternates plaque in coronary artery 4-Bacterial pneumonia: An infection of pulmonary parenchyma caused by a wide variety of infectious agent, including bacteria and fungi Most commonly bacterial pneumonia result from aspiration of oropharyngeal flora into lower respiratory tract Pneumonia can result from infection by anaerobic bacteria, dental plaque would seem to be a logical source of these bacteria, especially in patients with periodontal disease. 5-Low birth weight: = changes in hormone levels during pregnancy promotes ab inflammation termed pregnancy gingivitis D Dental ental health and Medical health health and Medical health relationship relationship Dr. Mohammed Alruby Dr. Mohammed Alruby

10. 10 = birth control pills may cause changes in alternation of micro-vasculature and gingival permeability = oral infection also seems to increase the risk for contribute to low birth weight in new born 6-Diabetes mellitus: Is a risk factor for severe periodontal disease Severe periodontal disease increases the severity of diabetes and complicate metabolic control One may propose that control of chronic gram-ve periodontal infection should be part of standard treatment of diabetic patient Effect of oral health on systemic disease Introduction: Oral cavity are focal points for interaction of the body with the external environment There are multiple surface types in the oral cavity and each is colonized with unique of 500—700 species of bacteria, virus, fungi The level of oral hygiene significantly impacts the makeups of oral microbes = individuals with good oral hygiene tends to have a simple flora dominated by g+ve cocci and rods with some g-ve cocci = individuals with poor oral hygiene have shift ti more diverse and complex flora dominated by anaerobic g-ve organisms = bacteria and saliva play a direct role in the development of the dental biofilm which commonly referred to as plaque = oral cavity bathed in complex mixture of fluids composed primarily of saliva and gingival cervicular fluids that play a role in maintaining a healthy environment = periodontal diseases are a group of chronic immune- inflammatory disease caused by bacteria in biofilm = periodontitis: the loss of CT and bone caused by persistence presence of pathologic bacteria in biofilm, the bacteria accumulate in the pocket and pull the gingiva away from the teeth (1)- atherosclerotic disease: Patient with history of myocardial infarction or cerebro-vascular attacks have worse oral health than control individual Patient with severe gingival inflammation and frequent bacteremia which activate the lost inflammatory response, this chronic inflammatory state trigger multiple cytokines as: -C reactive protein -Tumor necrosis factor -Interleukin 1B -Interleukin 6 Which in conjunction with bacteremia appear to stimulate the process of orthogenesis = several studies have demonstrated that periodontal disease and poor oral hygiene have a strong association with risk of coronary heart disease and acute myocardial infarction = improvement of oral health decrease the risk of atherosclerotic disease (2)- pulmonary diseases: (3)- diabetes mellitus: The relationship between diabetes and periodontal and periodontitis is truly bi-directional as it well proven that hyperglycemia negatively impact glycemic control D Dental ental health and Medical health health and Medical health relationship relationship Dr. Mohammed Alruby Dr. Mohammed Alruby

11. 11 = individuals with diabetes have at least 3 times greater risk of periodontitis than those without diabetes = gingival pockets, deeper than 4mm are more common in diabetes than non-diabetic patient = patient with pocket greater than 2mm deeper are at an increased risk of diabetes compared to patient with pocket less than 1.3mm deep = individuals with diabetes also suffer from: greater amount of bone loss, abscess formation, and poor healing Why diabetes affect mouth? Prolonged exposure to hyperglycemia results in the production of advanced glycation and product which have systemic impact that result in the increased execration of cytokines that leading to local inflammation and loss of connective tissues (4)- pregnancy: = during pregnancy: gastric acid secretion and reflux of the acid into oral cavity leading to: Enamel erosion Xerostomia Increased caries index Increased teeth mobility and loss = the changes in the gingiva that occur during pregnancy are associated with the changes in estrogen and progesterone level = the hormones cause capillary dilatation that results in gingival hypertrophy and inflammation, also there is a change in the oral flora, including the increase in the amount of anaerobic bacteria, these anaerobes initiate an inflammatory process that has systemic impact = the presence of periodontal disease in the mother results in 7 times greater risk of this complications (5)- osteoporosis: Decreased bone density in the jaw bone lead to greater alveolar bone resorption and increase depth of pocket (6)- kidney disease: - periodontal disease - poor oral health Pathway linking oral infection to secondary non-oral disease 1-Metastatic infection: Oral infection and dental procedure can cause transient bacteremia The micro-organism that gain entrance to the blood and circulate throughout the body are usually eliminated by the reticulo-endothelial system within minutes 2-Metastatic injury: Some g+ve bacteria have the ability to produce diffusible protein or exotoxins which include cytotoxic enzymes The exotoxins have a specific pharmacological action and are considered the most powerful and lethal poison known 3-Metastatic inflammation: Soluble antigen may enter the blood stream, react with circulating specific antibody, and form a molecular complex, these immune-complex may give rise to a variety of acute and chronic inflammatory reactions at the sites of deposition D Dental ental health and Medical health health and Medical health relationship relationship Dr. Mohammed Alruby Dr. Mohammed Alruby

12. 12 Relations between dental health and eye = infection and inflammatory process at the base of tooth could release inflammatory agent travel to the eye lead to development of glaucoma = toxic element of mercury filling have been found to cause the formation of cataract, retinitis, iritis and color vision issue = an infected tooth can cause pain and infection in other areas of your body including eyes = spread of infection can also lead to cavernous sinus thrombosis = spread of infection to eye socket through bone or veins can lead to orbital cellulitis = toxic effect of mercury filling, fungal and bacterial infection from root canal and other periodontal infection may directly contribute to vision loss The microbes are neuro-toxic and can destroyed healthy nerve tissue in eye and brain D Dental ental health and Medical health health and Medical health relationship relationship Dr. Mohammed Alruby Dr. Mohammed Alruby