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Health, Oral Health, and Elderly Quality of Life

Health, Oral Health, and Elderly Quality of Life. Narumanas Korwanich Department of Family and Community Dentistry Chiangmai University. What is Oral Health? Linkage with General Health The Mouth as a Mirror of Health The Mouth as a Portal Entry of Infection

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Health, Oral Health, and Elderly Quality of Life

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  1. Health, Oral Health, and Elderly Quality of Life Narumanas Korwanich Department of Family and Community Dentistry Chiangmai University

  2. What is Oral Health? • Linkage with General Health • The Mouth as a Mirror of Health • The Mouth as a Portal Entry of Infection • Association of Oral Infection, Diabetes, Heart Disease/Stroke, and Adverse Pregnancy Outcome • Effect on Well Being and Quality of Life • Thailand Study

  3. What is Oral Health?

  4. The Meaning of Oral Health • Oral health means much more than healthy teeth • Traditionally, dentists have been trained to recognise and treat disease such as caries, periodontal disease and tumors

  5. The Meaning of Oral Health • Being free of chronic oral-facial pain conditions, oral and pharyngeal (throat) cancers, oral soft tissue lesions, birth defects such as cleft lip and palate, and scores of other diseases and disorders that affect the oral, dental, and craniofacial tissues, collectively known as the craniofacial complex. U.S. Department of Health and Human Services, 2000

  6. The Meaning of Oral Health • They represent the very essence of our humanity. • They allow us to speak and smile; sigh and kiss; smell, taste, touch, chew, and swallow; cry out in pain; and convey a world of feelings and emotions through facial expressions. • They also provide protection against microbial infections and environmental insults. U.S. Department of Health and Human Services, 2000

  7. The Meaning of Health • Oral health is a standard of the oral and related tissues which enables an individual to eat, speak and socialise without active disease, discomfort or embarrassment and which contributes to general well-being WHO, 1982

  8. The Meaning of Oral Health • A comfortable and functional dentition which allows individuals to continue in their desired social role Dolan, 1993

  9. Linkages with General health The mouth and face as a mirror of health The Mouth as a Portal Entry for Infection Association of Oral Infection and DM, Heart Disease, and Adverse Pregnancy Outcome

  10. The Mouth and Face as a Mirror of Health • A physical examination of the mouth and face: signs of disease, drug use, domestic physical abuse, harmful habits or addictions such as smoking, and general health status • Imaging of the oral and craniofacial structures: skeletal changes e.g. osteoporosis, salivary, congenital, neoplastic, and developmental disorders • Oral cells and fluids, especially saliva: assess health and disease

  11. HIV infection oral manifestration

  12. Nutrition Deficiency

  13. Iron Deficiency

  14. Vitamin B Deficiency

  15. Sampled analyte of Saliva

  16. The Mouth and Face as a Mirror of Health • Conclusion • For the clinician the mouth and face provide ready access to physical signs and symptoms of local and generalized disease and risk factor exposure • Oral biomarkers and surrogate measures are also being explored as means of early diagnosis

  17. The Mouth as a Portal Entry for Infection • Oral microorganisms and cytotoxic by-products associated with local infections can enter the bloodstream or lymphatic system and cause damage or potentiate an inappropriate immune response elsewhere in the body

  18. Oral Mucositis from Therapy • Chemotherapy alters the integrity of the mucosa and contributes to acute and chronic changes in oral tissue and physiologic processes (Carl 1995) • Bacterial, fungal, and viral causes of mucositis have been identified (Feld 1997)

  19. Sonis, et al 2007

  20. Infective Endocarditis • Endocarditis is caused by bacteria that adhere to damaged endocardium(Weinstein and Schlesinger 1974) • Bacteremias from oral infections that occur frequently during normal daily activities, coincidental even with chewing food, toothbrushing, and flossing, contribute more substantially to the risk of infective endocarditis (Bayliss et al. 1983, Dajani et al. 1997, Strom et al. 1998).

  21. Infective Endocarditis • Risk factors • Rheumatic and congenital heart disease complex • Cyanotic heart disease in children • Mitral valve prolapse with regurgitation

  22. Oral Infection and Respiratory Disease • Chronic obstructive pulmonary disease, characterized by obstruction of airflow due to chronic bronchitis or emphysema and by recurrent episodes of respiratory infection, has been associated with poor oral health status (Hayes et al. 1998, Scannapieco et al. 1998) • A positive relationship between periodontal disease and bacterial pneumonia has been shown (Scannapieco and Mylotte 1996)

  23. Oral Transmission of Infection • Several studies provide evidence that when the oral environment is compromised, the mouth can be a potential site of transmission of infectious microbes • Oral transmission represented 7.8 percent of primary HIV infections (Dillon et al. 2000)

  24. The Mouth as a Portal Entry for Infection • Conclusion • Although oral tissues and fluids normally provide significant protection against microbial infections, but under certain circumstances, can disseminate to cause infections in other parts of the body. • The control of existing oral infections is clearly of intrinsic importance and a necessary precaution to prevent systemic complications.

  25. Association of Oral Infection and DM, Heart Disease, and Adverse Pregnancy Outcome

  26. Periodontitis - DM • There is growing acceptance that diabetes is associated with increased occurrence and progression of periodontitis • Diabetics have increased levels of systemic pro-inflammatory mediators • Diabetics have an altered response to wound healing and an abnormal immune response

  27. Periodontitis - DM • Diabetic patients had a worse oral hygiene and higher severity of gingival and periodontal diseases, but they have the same extent of the periodontal diseases as compared to non-diabetics Khader et al. 2006

  28. DM - Periodontitis

  29. DM - Periodontitis • The interaction of periodontal bacterial byproducts with mononuclear phagocytic cells and fibroblasts is known to induce the chronic release of cytokines (IL-1, IL-6, TNF-), PGE2 and CRP • Several recent studies have suggested that periodontal disease is a crucial aggravating factor in the health of patients with diabetes, mainly because it maintains a chronic systemic inflammatory process

  30. DM - Periodontitis • Darre’s study (2008) • Aim - To investigate that periodontal disease may favour the incidence or aggravation of diabetes and its complications • Material and Methods – Literature search from 7 databases were as input of meta-analysis

  31. DM - Periodontitis • The standardized mean difference in HbA1c with the treatment of periodontal disease was 0.46 (95% CI: 0.11, 0.82) • These findings suggest that periodontal treatment could lead to a significant 0.79% (95% CI: 0.19, 1.40) reduction in HbA1c level • These results suggest that specific treatment of periodontal disease in diabetic subjects may improve their glycemic control

  32. Periodontitis – Heart Disease • Some studies have presented evidence of the presence of bacteria and viruses in atheromatous plaques (Chiu et al. 1997, Johnston et al. 2001) • Majority of the clinical studies are seroepidemiological, reporting on associations between CHD and presence of serum antibody against the infectious agents (Mendall et al. 1994, Pasceri et al. 1998, Patel et al. 1995, Ridker et al. 1998, Saikku et al. 1992, Zhu et al. 2000).

  33. Periodontitis – Heart Disease

  34. Periodontitis – Heart Disease

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