Berks County Medical Society Medical Record Fall 2017 - 27

1) Periodontal bacteria and the host response cause an increase
in pro-inflammatory cytokines which are released into systemic
circulation leading to systemic/peripheral inflammation. These
prinflammatory molecules are capable of crossing the blood brain
barrier and enter cerebral regions leading to activation of microglial
cells and adverse neuronal damage.
2) The second mechanism includes invasion of the brain by the
dental bacteria entering via the blood stream or peripheral nerves.
The microorganisms then produce inflammation within the central
nervous system which results in cognitive impairment, as in AD.2
In summary, the mouth bacteria can elicit effects throughout
the entire body through several mechanisms including: aspiration
into the pulmonary system (sinuses and lungs), entering the blood
stream and colonizing in distant sites of the body (endocarditis
and brain abscess), flowing through the blood stream and crossing the placenta to induce inflammation in pregnancy resulting in
preterm low birth weight babies, and increasing systemic cytokines
which may be associated with risk of heart disease, stroke, poorly
controlled type 2 diabetes, and Alzheimer's disease.2
Ensuring patients who have heart disease, diabetes, pregnancy,
or Alzheimer's disease see their dentist regularly should be part of
a treatment plan to improve their overall health. Improving oral
health has been shown to reduce systemic infection and inflammation and allow the body to heal. Eliminating oral infections
may lead to disease reversal. Other ways to improve overall health
include: stress management, eating a healthy balanced diet, losing
weight, regular exercise, and getting proper sleep. Patients need
both a medical team and dental team to keep the whole body
healthy!
Dr. Tammy Balatgek obtained a
Doctor of Dental Surgery Degree
from the Ohio State University
and a Master's Degree in Craniofacial Pain from Tufts University.
She maintains a private practice
in Reading, PA that is limited to
treatment of TMJ Disorders and
Sleep Disordered Breathing.

Bibliography
1. Kim J, Amar S. Periodontal disease and systemic conditions: a bidirectional
relationship. Odontology 2006;94:10-21.
2. Abbayya K, Puthanakar NY, Naduwinmani S, Chidambar Y. Association
between periodontitis and Alzheimer's disease. North American journal of
medical sciences 2015;7:241.
3. Loesche WJ, Grossman NS. Periodontal Disease as a Specific, albeit
Chronic, Infection: Diagnosis and Treatment. Clinical Microbiology Reviews
2001;14:727-52.
4. Humphrey LL, Fu R, Buckley DI, Freeman M, Helfand M. Periodontal
Disease and Coronary Heart Disease Incidence: A Systematic Review and
Meta-analysis. Journal of General Internal Medicine 2008;23:2079.

Editor's Note:
Oral health is critical to overall health. We forget
that infections in the oral cavity are chronic and
therefore behave as chronic infections in the rest
of the body. Physicians have little or no training in
oral health - in fact, recent information indicates
that many physicians are among the missing from
preventive services performed by dental offices!
Recent deaths of a 24-year-old healthy male
truck driver from California and others from spread
of infection from a dental abscess to the brain
and blood stream highlight the need for medical
providers to pay attention to abscesses in the oral
cavity as well as periodontal disease. In Pediatrics,
the most frequent occurrences are parents calling
to say that their children have fallen and loosened a
tooth. These parents should be reminded to check
the gums above the injury for redness and report
it to their pediatrician or dentist immediately for
treatment to prevent development and spread of
abscess.
We all need to begin to look at the teeth on our
way into the oral cavity and emphasize the need for
preventive oral health visits to families. Better still,
consider employing Dental Navigators/Dental Hygienists to provide oral health education and "warm
handoffs" to dental offices to overcome the barriers
of fear, and avoidance of dental visits. Reimbursement is available to cover their salaries through
preventive risk counseling codes.
Dr. Eve Kimball is a member of the Executive
Council of the BCMS.

5. Joshipura KJ, Wand HC, Merchant AT, Rimm EB. Periodontal Disease
and Biomarkers Related to Cardiovascular Disease. Journal of Dental Research
2004;83:151-5.
6. Mealey BL. Periodontal disease and diabetes. The Journal of the American
Dental Association 2006;137:S26-S31.
7. Offenbacher S, Boggess KA, Murtha AP, et al. Progressive Periodontal Disease and Risk of Very Preterm Delivery. Obstetrics & Gynecology
2006;107:29-36.
8. López NJ, Smith PC, Gutierrez J. Higher risk of preterm birth and low
birth weight in women with periodontal disease. Journal of Dental Research
2002;81:58-63.

FALL 2017

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Berks County Medical Society Medical Record Fall 2017

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