2015 Michigan Periodontal Association Lecture Topic
The Basic Science of Periodontal Medicine
In addition to the emergence of non-surgical, medical therapies for periodontal diseases, recent studies have suggested a relationship between oral infection, in particular periodontal disease and systemic diseases. Epidemiologic studies have implicated periodontal disease as a risk factor for the development of cardiovascular disease and stroke, and a risk factor for pre-term low birth weight babies in pregnant women. In addition, studies in diabetics have revealed that untreated periodontal disease can lead to diabetic complications and have a direct impact on glycemic control. It has become clear in recent years that periodontitis is an inflammatory disease that is initiated by oral microbial biofilm. This distinction implies that it is the host response to the biofilm that destroys the periodontium in the pathogenesis of the disease. As our understanding of pathways of inflammation has matured, a better understanding of the molecular basis of inflammation has emerged. This presentation will review inflammation in the context of periodontal disease and the risk for systemic disease. The strengths and weaknesses of studies reported on this topic will be examined as well as the need for specific studies to confirm or refute the association. The potential for modification of resolution pathways for the prevention and treatment of periodontal diseases will be discussed in detail. More importantly, the potential, as well as real, associations between periodontal diseases and systemic diseases underline the importance of proper diagnosis and treatment of these extremely common oral diseases. In this lecture, the rationale for periodontal medical approaches will be presented and the potential benefits to systemic health will be explored.
Objectives:
- Review the relationship between periodontitis and systemic disease
- Discuss the data relating to the mechanism of action of the periodontitis/systemic interaction
- Discuss potential modifications of treatment regimens for the patient with periodontitis and complicating systemic disease
Resolution of Inflammation in Periodontal Regeneration
Resolution of inflammation is an active; agonist mediated well-orchestrated return of tissue homeostasis. Lipoxins and Resolvins are endogenous lipid mediators (eicosanoids) that actively regulate the resolution of acute inflammation. Lipoxin A4 and Resolvin E1, derived from arachidonic acid and eicosapentaenoic acid, respectively, are endogenous anti-inflammatory and pro-resolving mediators that regulate leukocyte migration and enhance macrophage phagocytosis of apoptotic neutrophils. These small lipid molecules act through specific G-protein linked receptors on inflammatory cells. Resolution receptor agonists have been shown to have significant impact in inflammatory bone diseases, such as periodontitis and arthritis. Periodontitis is an inflammatory disease that is initiated by oral microbial biofilm. It is the host response to the biofilm that destroys bone (osteoclastic resorption) in the pathogenesis of the disease. Resolution agonists have been demonstrated to promote regeneration of bone lost to disease and to prevent inflammatory bone loss in animals. Mechanistic studies have revealed that bone cells, particularly osteoclasts and osteoblasts, express functional resolution receptors on their surface that regulate RANKL:OPG ratios and the consequent osteogenic and osteolytic responses. The potential for therapeutic benefit of resolution agonists in clinical periodontal regeneration is being examined in large animal models.
Objectives:
- Review the relationship between inflammation and bone loss in periodontitis
- Discuss the data relating to the mechanism of action of periodontal regeneration
- Discuss potential modifications of treatment regimens for the patient with periodontitis in need of regenerative therapy
