Oral health status and Cognitive impairment

Transcription

1 Oral health status and Cognitive impairment periodontal pathogens, inflammaging and tooth loss: an integrated view Congresso Studentesco MoReMED 5 Aprile 2017 CDL Odontoiatria e Protesi Dentaria Direttore - Prof Ugo Consolo Università degli Studi di Modena e Reggio Emilia

2 Corso di Laurea Odontoiatria e Protesi Dentaria Università degli Studi di Modena e Reggio Emilia Jessica GIANNATIEMPO V anno Marco Aurelio GIAVATTO VI anno docenti supervisori Prof Sergio BORTOLINI DDS, UniMoRe Prof Paolo Frigio NICHELLI MD, UniMoRe

3 Un corps débile affaiblit l âme Un corpo debole indebolisce la mente Jean-Jacques Rousseau, Émile, I

4 Periodontitis and Alzheimer s disease a reciprocal interaction

5 Periodontitis and Alzheimer s disease a reciprocal interaction

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7 gingivitis periodontal disease G PL ABP RC AP HEALTH STATE DISEASE PROGRESSION Lindhe s Clinical Periodontology and Implant Dentistry Carranza s Clinical Periodontology

8 I. GINGIVAL DISEASE V. NECROTIZING PERIODONTAL DISEASE II. CHRONIC PERIODONTITIS VI. ABSCESS OF THE PERIODONTIUM III. AGGRESSIVE PERIODONTITIS IV. PERIODONTITIS AS MANIFESTATION OF SYSTEMIC DISEASE VII. PERIODONTITIS ASSOCIATED WITH ENDODONTIC LESIONS VIII. DEVELOPMENTAL OR ACQUIRED DEFORMITIES AND CONDITIONS Armitage. Development of a classification system for periodontal diseases and conditions Ann Periodontol Dec;4(1):1-6

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14 sulcus 3 mm

15 pocket 5 mm 6 mm 9 mm

16 1. RECESSION 3. MOBILITY 2. BLEEDING 4. POCKET DEPTH Case definitions for use in population-based surveillance of periodontitis - Page, Elke, J Periodontol Jul;78(7 Suppl):

17 1. RECESSION 3. MOBILITY 2. BLEEDING 4. POCKET DEPTH Case definitions for use in population-based surveillance of periodontitis - Page, Elke, J Periodontol Jul;78(7 Suppl):

18 1. RECESSION 3. MOBILITY 2. BLEEDING 4. POCKET DEPTH Case definitions for use in population-based surveillance of periodontitis - Page, Elke, J Periodontol Jul;78(7 Suppl):

19 1. RECESSION 3. MOBILITY 2. BLEEDING 4. POCKET DEPTH Case definitions for use in population-based surveillance of periodontitis - Page, Elke, J Periodontol Jul;78(7 Suppl):

20 1. RECESSION 3. MOBILITY 2. BLEEDING 4. POCKET DEPTH Case definitions for use in population-based surveillance of periodontitis - Page, Elke, J Periodontol Jul;78(7 Suppl):

21 Lindhe s Clinical Periodontology and Implant Dentistry Socransky, Haffajee et al. Microbial Complex in subgingival plaque J Clin Periodontol Feb;25(2):

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24 «Alzheimer's disease is the most common cause of dementia, or loss of intellectual function, among people aged 65 and older. Alzheimer's disease is a progressive, degenerative disorder that attacks the brain's nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and behavioral changes. These neurons, which produce the brain chemical, or neurotransmitter, acetylcholine, break connections with other nerve cells and ultimately die.»

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26 Normal Alzheimer

27 PET images obtained with the amyloid-imaging agent Pittsburgh Compound-B ([11C]PIB) in a normal control (left); three different patients with mild cognitive impairment (MCI, center); and a mild AD patient (right). Harrison's Neurology in Clinical Medicine, 4th Edition (Harrison's Specialty)

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29 Aβ NFTs

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31 Oral bacterial invasion of epithelial and endothelial cells Bacteremia from inflamed periodontal pockets Biologically active mediators from inflamed periodontium spill into the circulation to exacerbate systemic inflammation

32 ASSOCIATION OF SPIROCHETES WITH ALZHEIMER S DISEASE - frequency of spirochetes significantly higher in the brains of AD patients compared with controls - association statistically significant in the 4 groups

33 ASSOCIATION OF ORAL INVASIVE PERIODONTAL TREPONEME SPECIES WITH ALZHEIMER S DISEASE 6/7 periodontal pathogenic species of spirochete analyzed were detected in the brains of AD patients

34 bacteriemia TNF-α IL 1 IL 6 NFTs Aβ plaque NEUROTOXIC FACTORS activated glial cells ROS RNS neurodegeneration POSITIVE FEEDBACK CYCLE phagocytosis proinflammatory cytokines proinflammatory mediators MICROGLIAL ACTIVATORS

35 35.6 million people worldwide have Major Neurocognitive Disorder

36 60-70% of all cases have Alzheimer s Disease

37 Severe periodontal disease, which may result in tooth loss, is found in 15 20% of middle-aged (35-44 years) adults.

38 80% of adults have at least mild periodontal disease form 30% of adults have at least moderate periodontal disease form Position paper - Epidemiology of periodontal disease - J Periodontol 2005;76:

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40 48% of the world population suffered disability from oral conditions Between 1990 and 2015, the global age-standardized prevalence of severe periodontitis was static at 7.4%, The number of incident cases of severe periodontitis in 2015 was % of the world population has total tooth loss ( )

41 PERIODONTAL DISEASE ALZHEIMER'S DISEASE TOOTH LOSS TOOTH LOSS Dental health, nutritional status and recent-onset dementia in a Korean community population Kim JM et al., Int J Geriatr Psychiatry Sep;22(9):850-5.

42 PERIODONTAL DISEASE ALZHEIMER'S DISEASE TOOTH LOSS TOOTH LOSS Dental health, nutritional status and recent-onset dementia in a Korean community population Kim JM et al., Int J Geriatr Psychiatry Sep;22(9):850-5.

43 PERIODONTAL DISEASE ALZHEIMER'S DISEASE TOOTH LOSS TOOTH LOSS Dental health, nutritional status and recent-onset dementia in a Korean community population Kim JM et al., Int J Geriatr Psychiatry Sep;22(9):850-5.

44 PERIODONTAL DISEASE TOOTH LOSS ALZHEIMER'S DISEASE Dental health, nutritional status and recent-onset dementia in a Korean community population Kim JM et al., Int J Geriatr Psychiatry Sep;22(9):850-5.

45 MD DDS - Red, swollen or tender gums or other pain in your mouth - Bleeding while brushing, flossing, or eating hard food - Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before - A change in the way your teeth fit together when you bite - A change in the fit of partial dentures - Loose or separating teeth - Pus between your gums and teeth - Assessment of the patient s symptoms - Clinical periodontal examinations: PSR - Tooth-by-tooth assessment of the periodontal condition: pocket depths, recession, mobility, furcations - Rx status and Perio charting - General diagnosis of the periodontal condition - Assessment of the patient s disease susceptibility and identification of risk factors that may influence this - Periodontal treatment - Sores in your mouth - Persistent bad breath Lindhe s Clinical Periodontology and Implant Dentistry

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47 Percepiamo chiaramente che la mente si rafforza e decade con il corpo Cum corpore ut una crescere sentimus pariterque senescere mentem Lucrezio, De Rerum Natura, III, 446