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ALPINE SKI HOUSE

THE PATHOGEN PATHWAY: INFLAMMATION AND THE ORAL SYSTEMIC LINK

Bacteria, Viruses and Fungi- oh my!

Research first appeared in the 1950’s proving that oral bacteria enters the bloodstream. Today, research continues

to emerge on the mouth-body connection and the critical role oral health plays in overall health and wellness. This

course provides an in depth look at the many contributing factors to inflammation and the damage that it may lead to

not only inside the mouth but also the entire body.

Lancette VanGuilder, RDH, BSlancettevg@gmail.com

775-224-4323www.hygienistforhealth.com

Course Objectives:

• Learn the latest research on the relationship between oral pathogens and inflammation in the body

• Examine the association between poor oral health and many systemic issues, such as heart attack and strokes, cancer, obesity and airway

issues

• Review the potential link between poor oral health and brain diseases

• Describe the bidirectional link between poor oral health and diabetes and respiratory diseases

• Identify opportunities for medical-dental collaboration

The PathogenPathway

Lancette VanGuilder, RDH, BSwww.hygienistforhealth.com

lancettevg@gmail.com775-224-4323

Inflammationand

The Oral Systemic Link

Greater Philadelphia Valley ForgeDental Conference

March 5, 2020

• Think it’s just about brushing and flossing…Think again

• Public health crisis

• High risk lifestyles

• Dentistry can be prevention and education specialists

• If not you, who? and if not now, then when?

• Inflammatory cells are present, even if clinical symptoms are not visible

• Chronic Inflammation may be the root cause for most diseases

Functional Medicine: A New Operating System for 21st

Century Healthcare

• All body parts and organs are connected via the blood stream

• The lymphatic system, endocrine system, nervous system, GI system + the immune system

• Separation of BODY PARTS does not exist

• What happens in one body part affects the entire body

Functional Medicine

•Old model: (treat symptoms and body parts)

•New Model: (treat whole body, not WHAT but WHY?)

•Dr. Hyman, Dr. Roizen, Dr. Axe, Amy Doneen, Dr. Bale, Dr. Fuhrman

https://baledoneen.com/blog/the-oral-systemic-connection-how-bacteria-in-your-mouth-can-harm-your-heart/https://Aaosh.org/finding-the-root-cause-of-disease-its-all-connected/

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ALPINE SKI HOUSEALPINE SKI HOUSE

PERIODONTAL DISEASE IS NOT A LOCALIZED DISEASE

• Inflammation is the key driver

• Immune System

• Examine all sources of inflammation in the

body

• We treat periodontal disease as a localized

disease but it is a systemic disease

Periodontal disease is often the first visible sign

of chronic inflammatory diseases such as

diabetes

*Periodontitis is a sign of poor glycemic control

• Periodontal pathogens and inflammatory mediators

enter the bloodstream go off site and enter the rest of

the body.

• The consequences of periodontal disease can be

devasting on the mouth and the entire body

• If we continue to ignore these oral systemic links- we

are putting our patients health and their LIVES at risk

• Our responsibility:

• Looks for signs and symptoms

• document risk factors

• continually evaluate for changes

• rev medical history and vital signs

• document and communicate

ALPINE SKI HOUSEALPINE SKI HOUSE

SCREENING: THE MOUTH AS THE GATEWAY TO THE BODY

Screening should include:

• Caries Risk

• Periodontal Assessment and perio risk

• Medical/social history

• Oral cancer screening and risk assessment

• Screening for sleep apnea, airway issues, mouth breathing

• Screening for obesity, Weight

• Acid Reflux

• Diet/nutrition and stress, sleep

• Xerostomia, hormones

• Fungal infections, Food allergies and sensitivities

• GI disturbances

Identify underlying inflammation to help

identify or prevent or treat

• Infertility

• Pre-term birth

• Heart attack, Stroke

• Obesity

• Cognitive decline

• Alzheimer's

• Cancer : breast, lung, prostate, stomach, gallbladder,

skin

• Metabolic Syndrome, Diabetes

• More!

ALPINE SKI HOUSEALPINE SKI HOUSE

ORAL-SYSTEMIC LINK: THE LAST 70 YEARS!

How?

1. Chronic Inflammation in mouth=increases

inflammatory markers in bloodstream affecting

immune response, or adding to the body’s general

burden of disease.

2. Oral Cavity may act as a reservoir for pathogenic

bacteria that can enter the bloodstream and affect

distant-site or systemic pathologies (systemic

endotoxemia or bacteremia).

Association-Not Cause (yet!)

• While a number of associations have been found

between poor oral health and systemic conditions,

finding direct causality remains elusive.

• Poor oral health and systemic diseases share many

common risk factors, including smoking and poor diet

• https://www.ada.org/en/member-center/oral-health-

topics/oral-systemic-health

• more than 100 systemic diseases and upward of 500 medications have oral manifestations

• a unique population of 500-700 species of bacteria, viruses, fungi, and protozoa, a good number of which are significantly virulent and many of which have not been cultivated.

• The oral cavity is also bathed in a complex mixture of fluids, composed primarily of saliva and gingival crevicular fluid, that plays a major role in maintaining a healthy oral environment

• Individuals with good oral hygiene tend to have a simple flora dominated by gram-positive cocci and rods and some gram-negative cocci

• those with poor oral hygiene have a shift to a more diverse and complex flora dominated by anaerobic gram-negative organisms.

https://www.agd.org/docs/default-source/self-instruction-(gendent)/gendent_nd17_aafp_kane.pdfALPINE SKI HOUSE

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ALPINE SKI HOUSE ALPINE SKI HOUSE

How much does it weigh?1. 1 ounce2. 8 ounces3. 1 - 2 pounds4. 3 - 4 pounds

Bacteria, Viruses and Fungi-OH MY!

Bacterial + Fungal= CROSS-KINGDOM INTERACTIONS*dental caries (tooth decay) *mucosal infections

C. albicans partners with Streptococcus gordonii, S. oralis, and S. sanguinis to enhance bacterial colonization and biofilm formation.

C. Albicans + Streptococcal interactions

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292568/https://journals.plos.org/plospathogens/article/file?id=10.1371/journal.ppat.1007342&type=printablehttps://www.cdc.gov/fungal/diseases/index.html

Bacterial + Viruses=CROSS-KINGDOM INTERACTIONS*oral cancer*periodontal disease

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The Role of Viruses in Oral Disease

• Viruses create ulcerations in tissues• Viral infections-lead to production of cytokines

and increased inflammation in tissues

• HPV

• CMV

• EPV• HSV1

• HSV2

• HHV 8

• Viruses linked to oral cancer and periodontal disease, more severe tissue destruction-more harmful burden on immune system

• Innovations• Anti-herpes medication may be helpful in treating

periodontal disease

• HPV Vaccination to prevent oral cancer

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084576/

https://www.ncbi.nlm.nih.gov/pubmed/15840465

• Cytomegalo, Epstein Barr, Herpes related ( simple and foster)

• Viruses release damaging cytokines, stimulate bacterial overgrowth, play a role in progression of perio

• Due to poor oral hygiene

• Gram-negative anerobic bacterial infection, chronic periodontitis is closely associated with human cytomegalovirus and Epstein-Barr virus co-infection.

• It is supposed that these viruses act together to control immune response to bacterial challenges; these viruses and bacteria act together to lead to low-degree chronic inflammation and carcinogenesis.

• Periodontal disease is associated with an increased production of reactive oxygen species which, if not buffered sufficiently, cause damage to the host cells and tissues.

• The byproducts of the oral inflammation enter the bloodstream, which may enhance cellular proliferation and mutagenesis, allowing for the development and spread of cancer.

Do you have HPV in your mouth?

• Viral activity in periodontal tissues may impact the local immune response in a way that benefits opportunistic bacteria, and thus leads to aggravated symptoms

• Viral–bacterial interactions

• Herpesviruses are well known for their capacity to manipulate the immune system

• viruses produce cytokines

• Human papillomavirus (HPV) is a DNA virus that can cause chronic infection of either skin or mucosal epithelium.

• Aphthous ulcers- no single viral link has been found, but association has been linked to 28 viruses

1. HPVs are common in oral samples such as biopsies or brush samples of mucosa

2. One laboratory reported that 95% of superficial scrapes from healthy mouths were positive

3. Typically reported to be higher in biopsies from oral lesions such as leukoplakia or cancers.

LINK BETWEEN HERPES STRAIN AND DEVLEOPING MULTIPLE SCLEROSIS

• https://www.researchgate.net/publication/326536953_Oral_infection_with_P_gingivalis_exacerbates_autoimmune_encephalomyelitis

• http://www.mult-sclerosis.org/news/May2002/MedlinePorphyromonasGingivalisGlialCellsInEAE.html

• https://pdfs.semanticscholar.org/1766/c008e6cf13c27bca3e929875563eab2d02d1.pdf

• https://www.msfocusmagazine.org/Magazine/Magazine-Items/Posted/8-Great-Reasons-for-Keeping-Up-with-Your-Dental-Ca

https://www.newsweek.com/researchers-find-link-between-herpes-strain-developing-multiple-sclerosis-1475168

Biofilm

Porphyromonas Gingivalis

• Prevalence of Anaerobic Bacteria (P.gingivalis) as Major Microbial Agent in the Incidence Periodontal Diseases by Meta-analysis

*Porphyromonas gingivalis is a Gram-negative anaerobic bacterium and is considered to be a major pathogen associated with periodontitis

https://www.sciencedirect.com/topics/immunology-and-microbiology/porphyromonas-gingivalis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092461/

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ACUTE INFLAMMATION

➢ Complex, biological response of the body to harmful stimuli❖ Pathogens❖ Damaged cells❖ Irritants

➢ A protective response ▪ Immune cells, blood vessels▪ Molecular mediators

➢ Reduce/Repair damage✓ Eliminate the initial cause of injury✓ Clear out necrotic cells and tissues

damaged from injury and inflammation process

✓ Initiate healing

Inflammation: Acute vs. Chronic

• Acute and Chronic• A: initial response

• Increased movement of plasma, leukocytes (granulocytes) and various cells

• Increased movement from blood to injured tissues

• Series of biochemical events propagates and matures the inflammatory response, involving the local vascular system, the immune system, and various cells within the injured tissues.

• C: prolonged inflammation• Shift (aggressive) progressive in the type of cells

present at the site of inflammation. Such as mononuclear cells and characterized by simultaneous destruction and healing of the tissue from the inflammatory process.

• Inflammation is NOT infection

• Infection= the interaction between the microbial invasion and the body’s reaction to the inflammatory response.

• Infection= the result of the 2 together

• Inflammation is just purely the body response to stimuli

• Inflammation can be present when there is no microbial invasion• Atherosclerosis, trauma, autoimmune

diseases

• Cases where microbial invasion does not cause inflammation: parasitosis, eosinophilia

The body’s white blood cells and substances they produce protect us from infection when foreign organisms, bacteria and viruses are present

Autoimmune ✓mediated by leukocytes (granulocytes)✓neutrophils must be able to move from

within the blood to the inflamed tissue✓ some ingest bacteria(phagocytes)✓ some release enzymes to damage pathogenic

invaders

Chronic Inflammationmediated by monocytes and lymphocytes

ACUTE CHRONIC

CAUSATIVE AGENT Pathogens: viral, fungal, bacterial Persistent acute inflammation due to pathogensViral infections, persistent foreign bodies/irritants, autoimmune reactions

Cells involved Neutrophils basophilseosinophils

Mononuclear cellsMonocytes, lymphocytes, plasma cells, fibroblasts

Cell mediators Vasoactive amineseicosanoids

IFN-y, cytokines, growth factors, reactive oxygen species, hydrolytic enzymes

onset Immediate Delayed

duration A few days Up to many months or years

Potential outcome ResolutionAbscess formationTransition to chronic inflammation

Tissue destructionFibrosisNecrosis

Pro-Inflammatory Mediators Anti-inflammatory Mediators Inflammatory Disorders-Examples

• Acne

• Asthma

• Autoimmune

• Autoinflammatory diseases

• Celiac disease

• Prostatitis

• Diverticulitis

• Rhinitis

• Atherosclerosis

• Hypersensitive ( hay fever, food allergies, allergies or sensitivities)• inappropriate immune response triggering

inflammation, vasodilation and nerve irritation. Severe end of spectrum is anaphylaxis

• IBD

• Lichen Planus

• PID

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Pharmacological• Certain drugs or compounds are known to affect inflammation

• Vit A deficiency causes increase in inflammation response

• Anti inflammatory drugs work by inhibiting enzymes that produce inflammatory eicosanoids.

• Illegal drugs like cocaine and ecstasy may exert determinate effects by activating transcription factors intimately involved in inflammation NF-KB

• Steroids can stimulate cancer cells or sometimes suppress them

• Vitamin D

• Vitamin B

Inflammation-Cancer

• 1863- Rudolf Virchow• Origin of cancer is at sites of chronic

inflammation

• 2020: chronic inflammation is estimated to contribute up to 25% of all cancers

Anti inflammatory Mediators• Messenger that acts in blood vessels and cells

to promote an antiinflammation response

• Inflammatory mediators: IL-1B, TNF, IL-6, IL-15 and chemokines contribute to neoplasia

• Orchestrate an environment that fosters cell proliferation and cell survival

• Inflammation also cause cell and DNA damage and introduce reactive oxygen species

Cancer• A normal cell may undergo carcinogenesis to become a cancer cell if it frequently

subjected to DNA damage during chronic inflammation. DNA damages may cause genetic mutations

• A human cancer cell may possess 100 mutations, 10-20 of them are driver mutations and linked to cancer development.

• More likely, chronic inflammation may lead to DNA methylations- several hundreds, or thousands of cancer cells are genes are methylated in a single cancer cell. Oxidative damage happens and cells recruit complexes of DNA methyltransferases.

Resolution of Inflammation

• Inflammatory Response must be actively terminated

• Failure to do may result in chronic inflammation and cell death

• Production and release of • TGF and macrophages

• IL 10

• Antiinflammation mediators

• Deregulation of pro inflammatory molecules

• Desensitization of receptors

• Increased survival of cells in area of inflammation

• Acute normally resolves by mechanism that may remain elusive

• Connection to depression

• Stress, violence, deprivation, negative cognitions can cause inflammation and lead to depression

• Brain in = sickness mode

• Levels of cytokines raise sharply in bipolar and drop off during remission

• Anti-inflammatory medicines taken in addition to antidepressants • improve outcomes

• increase chances of responding positively to Inflammations that lead to depression can be caused by bacteria, viruses or parasites.

Systemic Effects

•An infectious organism can escape the confines of the immediate tissue via the circulatory system or lymphatic system

•When inflammation overwhelms the host➢Systemic inflammation ➢Bacteremia➢Septic shock➢Death

Poor Oral HealthAnd Diseases of the GI Tract

➢ Mouth and Throat (beginning)➢ Liver➢ Stomach➢ Pancreas➢ Colon➢ Rectum/Anus (end)

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Oral and Oropharyngeal Cancers

• esophageal cancer

• associations were also found between poor oral health and lung, gallbladder, breast, and skin cancer

• With each mm of bone loss: 5.23x more like to develop tongue cancer

Poor Oral Health andthe Liver

• Fusobacterium nucleatum

• T. denticola

• A. actinomycetemcomitans

• originates in the oral cavity

https://www.sciencedaily.com/releases/2019/06/190617125124.htm

https://onlinelibrary.wiley.com/doi/10.1002/ijc.31614

https://www.healio.com/gastroenterology/stomach-duodenum/news/online/%7B3bdd98fd-03f1-476e-9263-7484644587c8%7D/poor-oral-health-linked-to-precancerous-stomach-lesions

https://aap.onlinelibrary.wiley.com/doi/abs/10.1902/jop.2017.160829

Poor Oral Health andthe Liver

POOR ORAL HEALTH AND LIVER CANCER

• https://www.sciencedaily.com/releases/2019/06/190617125124.htm

• https://onlinelibrary.wiley.com/doi/10.1002/ijc.31614

• https://www.healio.com/gastroenterology/stomach-duodenum/news/online/%7B3bdd98fd-03f1-476e-9263-7484644587c8%7D/poor-oral-health-linked-to-precancerous-stomach-lesions

• https://aap.onlinelibrary.wiley.com/doi/abs/10.1902/jop.2017.160829

Poor Oral Health andthe Stomach

Stomach Cancer

• T. denticola

• A. actinomycetemcomitans

• T. forsythia

• Less bacterial diversity in their saliva

• Not flossing regularly significantly predicted an increased risk for precancerous lesions of gastric cancer

Based findings:

Treatment for chronic periodontal disease and control of periodontal pathogen infections should be included in future strategies for preventing stomach cancer

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ColorectalColon and Rectum

https://www.sciencedaily.com/releases/2019/03/190304100009.htm

How a common oral bacteria makes colon cancer more deadly

• Researchers have determined how a type of bacteria commonly found in the mouth accelerates the growth of colon cancer.

• F. nucleatum -- a common oral bacteria often implicated in tooth decay -- accelerates the growth of colon cancer

• Scientists have also demonstrated that about a third of colorectal cancers are associated with a common oral bacterium called F. nucleatum. Those cases are often the most aggressive,

• low or lower-middle income groups

• have higher BMI

• Future study on this topic

Oral health and risk of colorectal cancer: results from three cohort studies and a meta-analysis-2016

• Colorectal cancer (CRC) is the third most common cancer in both men and women worldwide• New cases each year

• Men: 132,700 and 376,300 Women

• Inflammatory bowel disease is one established risk factor

• Several other known or suspected risk factors • Smoking• dietary fat intake

• obesity and physical inactivity, are known to be associated with systemic inflammation -suggesting that inflammation plays a major role in CRC development.

https://academic.oup.com/annonc/article/27/7/1329/1741878

PANCREAS• Gland Organ

• Secretes enzymes, digestive juices into the small intestine

• Breaks down food left in the stomach

• Produces the Insulin hormone and secretes it in to the blood (there it regulates the body’s glucose or sugar level)

RISK FACTORSPoor Oral HealthMissing TeethPoor Diet (high fat, low fiber)ObesityAlcoholTobaccoGenetics*Men, African American Women

Signs of cancer: ➢ Jaundice

➢ Dark urine, light colored stool

➢ General fatigue symptoms like back pain, weakness

How to detox the liver:Water

Probiotics

Fiber

Eat fruits and veggies

Protein

• In some studies, the periodontal pathogen, P gingivalis was not associated with increased risk of pancreatic cancer, while the presence of A. actinomycetemcomitans did confer additional risk.

• Large, prospective cohort studies are required to further validate these findings. Ultimately, the identification of oral microbiota related to cancer development may provide predictive biomarkers for the early detection of pancreatic cancer.

https://www.deltadentalins.com/oral_health/pancreatic.htmlhttps://www.pancan.org/news/oral-bacteria-increasing-pancreatic-cancer-risk/https://bitemagazine.com.au/study-finds-oral-microbiota-linked-to-pancreatic-cancer/?fbclid=IwAR1AxbsoiVnqgKSs76qFqzdBM7v1PYVblG-N9oHskzixcLayS49xFLxLnXshttps://medicalxpress.com/news/2019-03-poor-oral-health-pancreatic-cancer.html

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Poor Oral Health and theHeart

https://fightgumdisease.com/total-health/heart-disease/

Bacteria that cause gum disease are also found to increase cholesterol and inflammation in heart arteries

https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/heart-disease-prevention/faq-20057986

In 2012, experts from the American

Heart Association reviewed the available

scientific evidence and concluded that poor oral health hasn't been proved to cause heart disease — and that treating

existing gum disease hasn't been proven

to reduce the risk of heart disease.

Still, studies have shown:

Poor oral health linked to higher blood pressure, worse blood pressure controlHypertension Journal Report 2018 https://www.health.harvard.edu/diseases-and-

conditions/gum-disease-and-the-connection-to-heart-disease

Gum disease and the Connection to Heart Disease

https://newsroom.heart.org/news/poor-oral-health-linked-to-higher-blood-pressure-worse-blood-pressure-control

Gum Disease is linked with blood vessel disease, heart

attacks, strokes, Alzheimer's Disease, and many forms of cancer.

Bones and Joints

• Imbalance between bone loss and formation results in decreased bone mineral density.

• Decreased bone density in the jawbone

• greater alveolar bone resorption

• increasing the depth

• Increase in the number of gingival pockets

• invasion by periodontal pathogens

• This chronic infection leads to local and systemic increases in interleukin 6, which is a known predictor of bone loss.

• As with many of the conditions already discussed, it is impossible to state that periodontal disease is causal to osteoporosis, but the studies seem to lean toward a positive relationship between the conditions.

• Currently there is no strong evidence to suggest that treating periodontal disease will have an impact on osteoporosis

https://www.agd.org/docs/default-source/self-instruction-(gendent)/gendent_nd17_aafp_kane.pdf

P. gingivalis: best known for causing periodontitis

Periodontal disease is an inflammatory disease that steadily eats away at gums and bone that support teeth, due in part the production of gingipains, powerful enzymes that chop up other proteins.

It contains the enzyme peptidyl-arginine deiminase, which is involved in citrullination

The bacteria is linked to the chronic inflammatory disease, Rheumatoid arthritis (RA) and Alzheimer’s and other brain diseases.

Weight/Obesity Brain Diseases

Alzheimer'sParkinson'sDementiaDepression

Porphyromonas gingivalis, a bacterium commonly associated with chronic gum disease, is capable of traveling from mouth to brain where it triggers chemical changes that damage cognitive function

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Depression

https://www.webmd.com/parkinsons-disease/news/20181031/could-the-appendix-be-key-to-parkinsons-disease#1

https://articles.mercola.com/sites/articles/archive/2019/08/29/vitamin-d-deficiency-parkinsons-disease.aspx

https://parkinsonsnewstoday.com/2017/08/07/importance-oral-health-parkinsons-disease/

https://www.parkinsonsnsw.org.au/wp-content/uploads/2015/03/Fact-Sheet-2.4-Oral-Health-and-Parkinsons-1.pdf

Parkinson’s and Oral HealthAlzheimer’s DiseaseP. Gingivalis

96%

▪ Blood

▪ Saliva

▪ Spinal Fluidhttps://www.medicalnewstoday.com/articles/264164.php#1https://www.ncbi.nlm.nih.gov/pubmed/30964560https://www.health.com/condition/alzheimers/alzheimers-gum-disease

https://medicalxpress.com/news/2019-01-bacterial-pathogen-porphyromonas-gingivalis-contribute.html

When the researchers introduced P. gingivalis into the mouths of eight mice, they found that the bacteria migrated into all of their brains within a few weeks

Oral Health and Diabetes

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Bidirectional Link

• Hyperglycemia negatively impacts oral health and severe periodontitis can negatively impact glycemic control

• Individuals with diabetes have at least a 3 times greater risk of periodontitis than those without diabetes

• Studies have shown that patients with well-controlled diabetes have no increased risk of periodontitis compared to individuals without diabetes

• Greater amounts of alveolar bone loss, abscess formation, and poor healing• local inflammation and a loss of connective tissue

• The prolonged exposure to glycation end products

• Rapid destruction of the PDL

• Crevicular fluid- higher amount of inflammatory mediators

Asthma

COPD

Pneumonia

Diabetes

Multiple studies have looked at the best way to treat periodontitis and positively impact glycemic control.

mechanical removal of the biofilm + use of oral antibiotics has the greatest impact on glycemic control and periodontal disease in diabetic patients.

Aggressive prevention and treatment of periodontal disease in diabetic patients is an effective way to mitigate the medical complications of this chronic disease.

Oral Health and the Respiratory System

• Bi-Directional Link

• Poor oral health

• 5X more likely to develop asthma

• Nearly 10% of all youth have asthma

• 40% of children have allergies

Most common chronic disease under the age 18

• Mouth breathing

• Post nasal drip

• Medications to manage symptoms

Can all lead to dry mouth and inflammation

http://oshnewsnetwork.com/2016/04/06/lung-cancer-periodontal-disease-association/?platform=hootsuite

Are Lung Cancer & Periodontal Disease Linked?

Traditional clinical parameters of periodontal disease are associated with the development of lung cancer, according to new research published in the Journal of Experimental Oncology. 2016

Deep periodontal pockets, bleeding on probing, and clinical attachment loss were all associated with an increased risk for lung cancer after adjusting for confounding factors like smoking and socioeconomic status

future research may demonstrate the association between specific periodontal pathogens and lung cancer

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283933/

Causal relationship between periodontitis and chronic obstructive pulmonary disease (COPD)

Bacteria present in the gingival sulcus or the subsequently formed periodontal pockets, may have easy access to the blood vessels.

The microorganisms may also enter the lungs by inhalation, but the most common route of infection is aspiration of oropharyngeal secretions.

Therefore, it is plausible that oral microorganisms might infect the respiratory tract, causing COPD.

• No specific oral pathogens tested

• Used perio, gingival, papilla bleeding and plaque indexes

• More inflamed and bleeding tissues= greater link to COPD and greater tissues loss, more advanced perio-greater link

• Still need more evidence

• To date- not proven to be causal association

Pneumonia and Respiratory Diseases

Staphylococcus aureus and other aerobic organisms (F. Scannapieco, personal communication) Oral and dental causes of

aspiration pneumonia These studies have linked the outcome of aspiration

pneumonia with dental decay, periodontal disease, poor hygiene, the need for help feeding, and trouble

swallowing

https://academic.oup.com/cid/article/40/12/1807/314357

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Obstructive Sleep Apnea▪ Systemic inflammation and obesity

▪ IL, the concept of systemic inflammation was discovered

▪ Involves the endothelium an other organ systems’

▪ Chronic inflammation is often observed in obesity

▪ IL6,8,18, TNF, CRP

▪ Insulin, Blood glucose

▪ Low grade chronic inflammation is 2-3X increase in systemic concentrations of cytokines, CRP

▪ Waist circumference corelates significantly with systemic inflammatory repose.

Malampatti and Throat Score

Throat Score

This Photo by Unknown Author is licensed under CC BY-SA

Malampatti and Throat Score Malampatti

This Photo by Unknown Author is licensed under CC BY-SA

https://dimensionsofdentalhygiene.com/article/Screening-for-Obstructive-Sleep-Apnea/

FEMALEREPRODUCTIVE

MenstruationHigh levels of progesterone causes dilation ofblood vessels✓ Blocks the repair of collagen✓ Birth control: Synthetic progesterone

:

Menopause

✓ Estrogen deficiency reduces bone density

✓ Gingivostomatitis✓ Gums shiny and bleed easily✓ Change in taste sensation

✓ Burning mouth

Crosstalk: Hormones and Oral Health in Women

• Cytokines and Periodontitis• Estrogen deficiency leads to upregulation of immune cells

(macrophages and monocytes) and osteoclasts

• Oral manifestations of menopause(estrogen receptors in oral mucosa, gingiva, salivary glands):

• Burning mouth syndrome

• Xerostomia

• Skeletal Bone Loss:• There is an established association between low estrogen

levels and bone loss. Rapid changes lead to systemic bone loss

• Lichen planus:• immunologically mediated disease in which the basal cell layer

of mucosa and/or skin is attacked.:

• Neurological disorders: Trigeminal neuralgia (TN) Post menopausal

• Eating disorders

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247552/

Women’s HealthWomen with gum disease are 14% more likely to develop cancer than those with healthy teeth and gums, according to a study published in Cancer Epidemiology, Biomarkers & Prevention

https://time.com/4891340/inflammation-mouth-breast-cancer/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178963/

Inflammatory phenomenon of periodontitis on the

systemic dissemination of the locally produced

mediators, such as C-reactive protein (CRP),

interleukins-1 beta (IL-1β) and -6 (IL-6), and tumor

necrosis factor-alpha (TNF-α)

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Porphyromonas gingivalis and adverse pregnancy outcome

Fusobacterium nucleatuminfection was found to be the cause of a stillbirth

Bacteria in Umbilical Cord Linked to Preeclampsia

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5646603/http://oshnewsnetwork.com/2016/02/01/bacteria-in-umbilical-cord-linked

Pre-Term and Low Birth Rate Babies

Men’s Health

MALEREPRODUCTIVE

InflammationRestricted blood

flowAlterations with

hormonesProstate

enlargementAnd dysfunction

May lead to infertility and

cancerED

als

o h

ad p

erio

53%

1 o

ut

of

4

25%Linkbetween ED and gum disease is tied to

the inflammation of the gums thatpasses to the other systems throughoutthe body

Effects on SpermErectile dysfunctionLow sperm countLow sperm qualityProstate cancer

https://fightgumdisease.com/total-health/erectile-dysfunction/

Gum Disease Affects More Than Just Your Mouth...

Men with signs of gum disease have higher levels of Prostate-Specific Antigen present in prostate cancer

Oral Health and Eye Health

EYESexcess bacteria in

the mouth could be a catalyst for the

development of a certain type of

glaucoma called open-angle glaucoma

Open-Angle

Glaucoma

2017

fluid build up in the front of your eye

increases the pressure in your eye, which then damages the optic nerve*most common in US

infection and inflammation at the base of your tooth could release inflammatory agents which travel to the eye

• oral microbiome contributes to glaucoma pathophysiology• Increased bacterial loads can lead to neurodegeneration• TLR4, over-expression of IL-1β• Higher bacterial load rather than species

https://www.accessdental.com/news/connection-between-dental-oral-health-glaucoma-eye/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4152129/

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Manage Risk Factors

Genetics

Genetics, lifestyle have a strong impact on biomarkers for inflammation, cancer.

The results of the study show that hereditary factors play a significant role with proteins associated with 16 genes

Genetics- 12X more likely to develop periodontal disease

30% of all perio cases may be genetic related

https://www.sciencedaily.com/releases/2014/08/140822083901.htm

OPPORTUNITES

• ANTI-INFLAMMATORY DIET AND LIFESTYLE

• NEW FOOD PRYAMID

• WHO GUIDELINES

• MIND/BODY PRACTICES

• PROBIOTICS

• EXERCISE

• ANTIOXIDANTS

• Sleep

• Tobacco Cessation, limit alcohol

• Manage weight

• Use supplements, if needed, like probiotics

• Professional dental care

• Manage hormones

• Education, prevention, screenings, early intervention

https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation

Foods that cause inflammation

• Try to avoid or limit these foods as much as possible:

• refined carbohydrates, such as white bread and pastries

• French fries and other fried foods

• soda and other sugar-sweetened beverages

• red meat (burgers, steaks) and processed meat (hot dogs, sausage)

• margarine, shortening, and lard

• Your immune system becomes activated when your body recognizes anything that is foreign—such as an invading microbe, plant pollen, or chemical. This often triggers a process called inflammation. Intermittent bouts of inflammation directed at truly threatening invaders protect your health.

Anti-inflammatory foods

• Bright green and red, orange veggies

• olive oil

• green leafy vegetables, such as spinach, kale, and collards

• nuts like almonds and walnuts

• fatty fish like salmon, mackerel, tuna, and sardines

• fruits such as strawberries, blueberries, cherries, and oranges

• Studies have also associated nuts with reduced markers of inflammation and a lower risk of cardiovascular disease and diabetes. Coffee, which contains polyphenols and other anti-inflammatory compounds, may protect against inflammation, as well.

• https://www.mdlinx.com/internal-medicine/article/5662

• https://www.theguardian.com/lifeandstyle/2018/aug/03/no-alcohol-beer-all-the-flavour-without-the-booze

• https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/red-wine/art-20048281

• https://www.cancer.org/latest-news/is-chocolate-good-for-you.html

• https://www.webmd.com/heart-disease/ss/slideshow-foods-bad-heart

• https://www.medicalnewstoday.com/articles/320233.php

Anti-inflammatory diet: What to knowMedical News Today, Jan 3., 2020

• Diet choices may help manage/reverse chronic inflammation

• NUTRIENT DENSE PLANT BASED FOODS• Fruits, Veggies, Omega 3,lean protein,

healthy fats, spices

• Eliminate free radicals from body

• Ward off cancer cells

• Discourages: processed foods, red meat and alcohol• Trigger free radicals in body

• Can trigger tumor growth

• Can contribute to chronic pain

• DASH DIET, Mediterranean Diet

• Chronic Pain

• Chronic Inflammatory Diseases• Periodontal Disease

• Rheumatoid Arthritis

• IBS

• Crohns

• Asthma

• Psoriasis

• Hashimotos

• Lupus

• Heart Disease, Obesity and Type 2 Diabetes

https://www.medicalnewstoday.com/articles/320233.php

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Additional Recommendations

•Nightshades•Gluten•Carbs

•Vegetarian?

Does sugar cause inflammation in the body?

• systematic review from 2018 linked consuming more dietary sugar with chronic inflammation

• People with higher sugar diets have more inflammatory markers in their blood, including a marker called C-reactive protein.

• Sugar stimulates the production of free fatty acids in the liver. When the body digests these free fatty acids, the resulting compounds can trigger inflammatory processes

• However, a systematic review found no difference in inflammation from fructose and glucose

• Highest risk: high fructose corn syrup

https://www.medicalnewstoday.com/articles/326386.php

Sleep Loss and Inflammation Sub-clinical shifts in basal inflammatory cytokine

• Sleep, therefore, clearly responds to challenges to the host and is affected by the activation of our bodily defense mechanisms

• sleep is important for other inflammatory homeostatic function

• or the activation of inflammatory systems that fail to resolve completely

• IL-1beta, IL-6, and TNF-alpha: Inflammatory mediators are elevated

• Increased insulin resistance

• Increased mortality

• elevated circulating inflammatory mediators-Obesity

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548567/

How Much Sleep Do You Need?

https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html

Age #of Hours Sleep Needed Per Night

Toddler 1-2 11-14 (24 hr period)

Preschool 3-5 10-13 (24 hr period)

School Age 6-12 8-10 (24 hr period)

Teen 13-18 8-10 (24 hr period)

Adult 18-6061-6465+

7+ hours per night7-9 hours per night7-8 hours per night

https://www.livescience.com/59988-exercise-fights-inflammation.html

EXERCISE

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MINDFULLNESS:THE NEW SCIENCE OF HEALTH AND HAPPINESS

Professional Care

• Dentists

• Dental Therapists

• Dental Hygienists

• Dental Assistants

• Dental Administrators/Coordinators/Support Staff

➢ Public Health Focus on Disease Management

➢ Referral/Collaboration with the medical community

https://www.youtube.com/watch?time_continue=173&v=1IDXhLr0ULU&feature=emb_logo

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Resources/Additional References

Resources/Additional References Resources/Additional References

Resources/Additional References

Lancette VanGuilder, RDH, BS

www.Hygienistforhealth.com

775-224-4323

Lancettevg@gmail.com

Questions?

Let’s Chat!

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