1. Risk Reduction for Periodontal Disease In addition to more frequent dental visits (treatment/maintenance): Heredity –Perioceutics Smoking –Cessation and/or Perioceutics Diabetes –Improved control, work with M.D. –Perioceutics Stress –Management and/or Perioceutics Medications –Change Meds, work with M.D. and/or Perioceutics Nutrition –Supplements Obesity –Weight reduction strategies Poor oral hygiene –Improved oral hygiene and/or Perioceutics Faulty dentistry –Corrective dentistry Hormonal variations –Consult with M.D. –Perioceutics Immunocompromise –Consult with M.D. –Perioceutics Connective tissue diseases –Consult with M.D. –Perioceutics

2. Periodontitis An often silent disease Can present a significant challenge to the entire body Consider the surface area of the tissue in the oral cavity being approximately equal to the skin extending from the wrist to the elbow The pocket epithelium surface area is estimated to approximate the surface area of the palms of both hands (50-75 cm 2 )

4. Systemic Exposure to Periodontal Pathogens Loss of epithelial integrity in pockets Bacterial penetration Endotoxin penetration into the tissue Recurrent transient bacteremia Oral pathogens have been found in –fetal cord blood –atheromatous plaques

10. C-Reactive Protein One of several acute-phase plasma proteins produced by the liver in response to: –ischemia –trauma –burns –infection –inflammatory conditions CRP is upregulated by: –bacteremia –cytokines CRP levels increase the risk for cardiovascular disease –CRP may be a stronger predictor for heart attacks than cholesterol –Both CRP and cholesterol are now used for accurate risk assessment

11. Conditions Associated with Increased or Decreased Levels of CRP Elevated BP Elevated BMI Cigarette Smoking Metabolic Syndrome/DM Low HDL/High Trigs Chronic Infections Chronic Inflammation Periodontal Disease Moderate Alcohol Intake Increased Activity/Endurance exercise Weight Loss Medications –Statins –Fibrates –Niacin Increased LevelsDecreased Levels