Jvd 2008 (#2)

Front 1

Bacterial plaque associated periodontal disease is the most common chronic infection in man and dogs

Back 1

True

Front 2

In man, there is an association b/w periodontal disease and myocaridal infarction and stroke, while in dogs it has also been associated with changes in internal organs

Back 2

True

Front 3

For each square centimeter of periodontal disease burden there was a 1.4-times higher likelihood of greater changes being present in the left atrio-ventricular valves. Plus 1.2 and 1.4 times higher likelihood for greater liver and kidney pathology (respectively)

Back 3

True

Front 4

The results in this article show that there is a link b/w the estimated periodontal disease burden (PDB) resulting from plaque-bacteria associated periodontal disease and the level of internal pathology in this population, implying that periodontitis might contribute to the development of systemic pathology in dogs

Back 4

True

Front 5

Periodontal disease results in inflammatory tissue damage and loss of tooth attachment with gingival recession &/or periodontal pocket formation

Back 5

Many factors contribute to the prevalence and severity of periodontal disease

Front 6

Cardiovascular diseases such as stroke, myocardial infarction, and coronary atherosclerosis, stroke, thromboembolic dz, hepatic dz, renal dz, low birth weight have been linked to man with periodontal disease

Back 6

A correlation has been reported b/w periodontal disease and histopathological changes in the heart and other internal organs in the dog

Front 7

Host response (inflammation) plays a central role in periodontal disease pathogenesis

Back 7

Lipopolysaccharide (LPS) and other products of periodontal pathogens activate monocytes, fibroblasts, endothelial and epithelial cells to release pro-inflammator cytokines that result in local inflammation and associated effects

Front 8

Some of these cytokines are absorbed into the bloodstream, where they are capable of eliciting or enhancing many of the vascular and coagulation complications (associated with atherosclerosis and coronary heart disease)

Back 8

BacT such as Streptococcus sp, Staphylococcus sp, and periodontopathogenic gram - anaerobes (Porphyromonas gingivalis and their products) also enter the circulation

Front 9

Transient bacteremia has been demonstrated after chewing, tooth brushing, and dental and oral surgical interventions in patients with gingivitis and periodontitis

Back 9

In clinically healthy indv'ls there is an insignificant risk from this.

Front 10

Infectious and inflammatory diseases including periodontal disease, resulting in chronic low-grade bacteremia have also been associated with deposition or in situ formation of immune complexes in the kidneys of dogs causing glomerulonephritis

Back 10

Pyleonephritis & intersitial nephritis may also result from bacteremia or sepsis related to oral infection

Front 11

What was the purpose of this study?

Back 11

Test the hypothesis that there is a correlation b/w the periodontal disease burden (PDB)--(extent of these periodontal lesions)--and the degree of pathology in distant organs in toy and miniature poodles

Front 12

In most cases there is no conclusive proof of a direct link b/w periodontal disease and other diseases, but there are many plausible explanations for this possibility

Back 12

True

Front 13

Periodontitis tends to be recurrent or persistent, often a life-long problem

Back 13

Therefore, it exposes the host to its systemic effects over a long period

Front 14

Endotoxemia and immune responses to bacteria and their products potentially also lead to distant toxic and immune mediated disease

Back 14

Distant effects are also likely from host factors such as the proinflammatory cytokines (IL-1, IL-6, PGE2 and TNF) that enter the circulation from sites of focal inflammation, including periodontal lesions

Front 15

The increased circumference associated with increased body weight actually resulted in a decdrease in PDB, supporting the finding of less periodontal disease in larger animals

Back 15

True

Front 16

Cardiovascluar dz was seen in dogs > 10 years with PD

Back 16

Most common pathology was chronic degeneration of the heart valves. The statistical model indicated a significant association b/w PDB and the degree of left atrio-ventricular dz

Front 17

Arthosclerosis was not a major finding in this study

Back 17

Few arteries were sampled and severe lesions are reported to be rare even in dogs with systemic atherosclerosis (this could be why not a major finding here)

Front 18

It is possible that in dogs with concurrent periodontal disease and endocardiosis there is impairment of microcirculation leading to capillary rarefaction and subsequent ischemia of both the periodontum and myocardium as reported in man

Back 18

It has been shown that pro-inflammatory cytokines such as TNF & IL-6 may cause anabolic changes in the myocytes through the activation of intracellular signaling, which leads to hypertrophy of the myocardium with its associated increased O2 demand

Front 19

Extrahepatic bacT infections that are associated with bacteremia can cause intrahepatic cholestasis, and both parenchymal inflammation and portal fibrosis have been associated with PD in dogs

Back 19

The level of hepatic histopathological changes was statistically significant according to gender---In male dogs there was typically a moderate or diffuse inflammation and/or mild focal or multifocal fibrosis.
Females had milder changes---primarily diffuse parenchymal or portal system inflammation

Front 20

Why might there be a variation of liver pathology b/w genders?

Back 20

May be related to differences in behavior patterns such as increased tendency for aggressive oral activities (biting/fighting/playing) in males and hormonal effects such as the immune suppression associated with progesterone secretion in females

Front 21

Significant relationship b/w the periodontal disease score and hepatic parenchymal inflammation

Back 21

Combined mild mononuclear infiltrates of portal tracts, foci of liver cells surrounded by neutrophils and macrophages, and mild hepatocellular vacular change were common findings

Front 22

Therefore, it is probable that the significant correlation b/w PDB & liver pathology may be an accurate indicator of the tendency for LPS from gram - periodontopathogenic bacteria, intact bacteria filtered the circulation, and inflammatory cytokines absorbed from periodontal lesions to activate the local hepatic immune system resulting in the liver parenchymal changes seen in this study

Back 22

True

Front 23

Pyelonephritis and interstitial nephritis may also result from bacteremia related to oral infection in dogs

Back 23

These bacT appear to have an affinity for endothelium and filtration in the kidneys would increase the likelihood of glomerular capillary walls being affected

Front 24

BacT, free LPS and other antigens react with specific immunoglobulins to form immune complexes locally within the kidney or elsewhere in the body

Back 24

These complexes then become concentrated within glomeruli by the process of plasma filtration as urine is produced

Front 25

Glomerular and interstitial changes seen in this study:

Back 25

mild, variable mesangial thickening, lymphocytic and plasmacytic interstitial infiltration.
Chronic renal failure can result from such changes

Front 26

Other factors likely to be involved in the development of the renal pathology noted in this study include platelet-activating factor which can be produced by neutrophils, macrophages, platelets, and glomerular endothelial cells, plus nitric oxide produced by platelets, neuts, macrophages and endothelial cells within inflamed glomeruli

Back 26

These factors induce cytotoxicity forming and ironnitrosyl-sulfur complex that inhibits iron dependent enzymes and causes cessation of cellular DNA replication

Front 27

Preventative methods for perio dz should be established

Back 27

Daily tooth brushing, appropriate perio diagnosis, tx of established perio dz