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fracture prior to attempting extraction of the offending tooth.
The fourth local consequence of severe periodontal disease results from inflammation close to the orbit which could potentially lead to blindness. The proximity of the tooth root apices of the maxillary molars and fourth premolars, places the delicate optic tissues in jeopardy.
The fifth local consequence is described in recent studies which have linked chronic periodontal disease
to oral cancer. The association in this case is likely
due to the chronic inflammatory state that exists with periodontitis. In this way, periodontal inflammation acts as a ‘promoter” of cancer, similar to the chronic inflammation from smoking increases the incidence of lung cancer.
The final significant local consequence of periodontal disease is chronic osteomylitis, which is an area of dead, infected bone. Dental disease is the number one cause of oral osteomyelitis. Furthermore, once an area of bone is necrotic, it does not respond effectively to antibiotic therapy. Therefore, definitive therapy generally requires aggressive surgical debridement.
In some cases, the bacterial infection may also result
in a septicemia. In one case treated by this author, the patient presented with an entire hemi-mandible which was necrotic secondary to osteomyelitis. In this case, the patient required a complete hemi-mandibulectomy.
Severe systemic manifestations:
Systemic ramifications of periodontal disease are also well documented. The inflammation of the gingiva and periodontal tissues that allows the body’s defenses
to attack the invaders also allows these bacteria to
gain access to the body. It is important to note that
just established gingivitis (i.e. no attachment loss) is enough to create these systemic effects. In humans,
the periodontal surface area comprises a surface area the size of the palm of your hand. This is a large area
of infection for the body to deal with. However, if you consider the size of the mouth and teeth of a small breed dog in relation to their body, there is actually a far greater level of infection affecting these patients.
There are a plethora of studies both in the human and veterinary literature which document a link between periodontal inflammation and organ dysfunction. Affected organs include the kidneys and liver, leading to decrease in function of these vital organs over
time. Furthermore, it has also been suggested that these bacteria can become attached to previously damaged heart valves (IE valvular dysplasias) and cause endocarditis, which in turn can result in intermittent infections, and potentially thromboembolic disease. Other studies have linked oral bacteremias to cerebral and myocardial infarctions and other histological changes. Additional human studies have linked
periodontal disease to an increased incidence of chronic respiratory disease (COPD) as well as pneumonia. Oral bacteremias have also been linked to arthritis and adverse pregnancy affects.
There are many studies that strongly link periodontal disease to an increase in insulin resistance, resulting in poor control of diabetes mellitus as well as increased severity of diabetic complications (wound healing, microvascular disease). Additionally, it has been shown that diabetes is also a risk factor for periodontal disease. Periodontal disease and diabetes are currently viewed as having a bidirectional interrelationship where one worsens the other.
Most critically, periodontal disease is now associated with early mortality. In other words, humans with bad periodontal disease die earlier than those in good periodontal health. In fact, periodontal disease is now viewed as a higher risk factor for early death than smoking!
Conversely, proper therapy of periodontal disease has been shown to have beneficial effects on systemic maladies. The kidney, liver, and heart function have all been shown to improve when periodontal disease is properly treated. Further, glycemic control is increased in patients with good periodontal health. periodontal therapy
Methods and products for periodontal disease treatment and prevention can be grouped into three distinct treatment areas:
· 1) Control the infection (pathogen control)
· 2) Decrease the amount inflammation and/or bone destruction by the host (host modulation)
· 3) Re-grow lost bone (guided tissue regeneration)
Pathogen control
It is well known that periodontal disease is initiated by plaque bacteria. Therefore, the basis for periodontal therapy is, and likely always will, be plaque control. Proper plaque control is a four pronged attack based on the level of disease.
· Dental prophylaxis
· Home care
· Periodontal surgery
· Extraction
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