Course: Public Health Dental Hygiene II: DNH 227

Topic: Oral Health and it’s Link to Systemic Conditions

Audience: Adult African American men and women

Instructional
Objectives: Upon completion of the lecture, the student should be able to:

1. Understand the relationship between periodontal and systemic disease

2. List three systemic conditions that are linked to periodontal disease
3. State the nature of the relationship between periodontal disease and diabetes.
4. List the three adverse outcomes that periodontal disease can have on pregnancy
5. State the appropriate dental appt interval for an individual with periodontal disease

Materials: PowerPoint computer equipment and Handout

References:

Borrell, L. N., Beck, J. D., & Heiss, G. (2006). Socioeconomic disadvantage and periodontal
disease: The dental atherosclerosis risk in communities study. American Journal of Public Health,
96(2), 332-339. doi: 10.2105/AJPH.2004.055277

Goodson, E. J. (2015). Exploring the association between diabetes and periodontal disease
among black Americans. Negro Educational Review, 66(1-4), 55-67. https://web-a-ebscohost-
com.ezproxy.vccs.edu/ehost/pdfviewer/pdfviewer?vid=5&sid=7a6dcedb-2a14-493c-9e1d-
5d754ee0a31a%40sdc-v-sessmgr02

Miricescu, D., Totan, A., Stanescu, I., Radulescu, R., Stefani, C., Alexandra S. A. M., & Greabu, M.
(2019). Periodontal disease and systemic health. Romanian Medical Journal, 66(3), 197-201.
https://web-a-ebscohost-com.ezproxy.vccs.edu/ehost/pdfviewer/pdfviewer?vid=2&sid=
7a6dcedb- 2a14-493c-9e1d-5d754ee0a31a%40sdc-v-sessmgr02

Uwambaye, P., Munyanshongore, C., Rulisa, S., Shiau, H., Nuhu, A., & Kerr, M. S. (2021).
Assessing the association between periodontitis and premature birth: A case-control study. BMC
Pregnancy & Childbirth. 21(1), 1-9. doi: 10.1186/s12884-021-03700-0

Personnel: Erin Davis & Elise Allred

Time: 30 minutes
Time Lesson Content Notes/Media

I. Instructional Set

3 min A. Introduction Slide 1- Intro

The mouth is the gateway to the body, so it should not

come as a surprise that oral health is essential for

systemic health. There is growing evidence that there is

an association between periodontal and systemic

diseases. While dental professionals are well aware of

the evidence-based knowledge that links periodontal

disease to systemic disease, studies show that 2/3 of

patients are unaware of the relationship. Educating the

population on this link is essential to encourage

individuals to access regular dental care.

B. Established Mood
Slide 2- Personalize
Many of you sitting in this room today may be affected the topic to the
audience
or know someone who is affected by systemic disease.

It may be surprising for you to learn that these chronic

illnesses may actually be related to your oral health. By

attending this lesson today, you are taking a step

towards understanding steps you can take to help

manage these systemic diseases that you may not have

understood before.

C. Gain Attention/Motivate

Picture this: An adult male has recently been diagnosed Slide 3- present a
scenario we can
with type 2 diabetes. He is working to lower his A1C to return to at the end of
the lecture
an acceptable level but is having difficulty adjusting to

his new lifestyle. His last A1C reading was 8.5. This

same individual has not been into the dentist for a

cleaning in 10 years and his at home oral hygiene

habits are less than ideal. His gums often bleed when

he brushes, so he does not brush or floss consistently.

How might this individual’s systemic disease be

connected to his oral condition? How could the

management of one condition affect the other?

D. Established Rational

By understanding the relationship between periodontal

disease and chronic systemic disease, the student will

be better equipped to make decisions that will have a

positive impact on their health. The student will

understand the importance of regular dental visits to

not only control their periodontal disease, but also to

manage their systemic disease as well.

E. Established Knowledge Base

Do you or someone you know suffer from a chronic

systemic disease? Has a doctor or dentist ever

mentioned a link between your systemic condition and

periodontal disease? How important do you think it is

to visit the dentist regularly?

F. Instructional Objective Slide 4- State

objectives of the
After today’s lecture, you should be able to explain the lecture

relationship between periodontal disease and systemic

diseases. You should also be able to list systemic

diseases that are believed to be linked to periodontal

disease. Upon completion, you should be able to state

the appropriate dental appointment interval for an

individual with uncontrolled periodontal disease.

 LESSON CONTENT

5 min I. Periodontal Disease

A. Prevalence Slide 5- Overview of

1. 50% of the adult population are affected by periodontal disease
gingivitis, a reversible inflammatory condition prevalence
caused by plaque accumulations
2. 35% of the adult population have periodontitis,
the most common chronic inflammation of the
oral cavity in the adult population

B. Periodontitis
1. Chronic inflammatory disease that affects the Slide 6- Overview of
hard and soft tissues supporting the teeth. periodontitis
2. Multifactorial disease that results from a
complex interaction between pathogenic
microbes, host immune response, and genetics
3. Influenced by bacteria, such as P. gingivalis, that
induce both local and systemic inflammation.

C. Risk Factors for Periodontitis

1. Tobacco use is the strongest risk factor Slide 7- Risk factors
2. Low SES status- almost twice as likely to have
severe periodontitis when compared to
wealthier counterparts
3. Advanced age- due to changes in the immune
system that increase susceptibility to chronic
diseases, among other factors
4. Environmental factors- tobacco use, diet, oral
hygiene, presence of bacterial pathogens
5. Systemic factors- hormonal imbalance, immune
deficiency, diabetes, stress

D. Link to Systemic Conditions Slide 8- Systemic

1. Cardiovascular disease conditions with a link
2. Diabetes Mellitus to periodontal disease
3. Adverse pregnancy outcomes

II. Cardiovascular Disease & Periodontitis

5 min Slide 9- Cardiovascular
A. Shared Risk Factors disease
1. Diabetes
2. Tobacco use
 3. Inflammation

B. Relationship
1. Research does not prove a causative
relationship. However, there is a link between
the two.
2. P. gingivalis, which is a predominant pathogen
in periodontitis, has been detected in plaques in
arteries, indicating that oral periodontal
pathogens may migrate to other body sites
3. P. gingivalis is associated with alveolar bone loss
and aortic atherosclerosis. It can lead to platelet
aggregation
4. Endotoxins released by periodontal pathogens
contribute to dysfunction of the blood vessels
5. Treatment of periodontitis supplemented with
antibiotics has been shown to improve blood
vessel dysfunction

5 min III. Diabetes Mellitus and Periodontitis

Slide 10- diabetes
A. Prevalence of Diabetes mellitus
1. 8.3% of the US population have been diagnosed *prevalence & risk
with diabetes while an estimated 7 million have factors
undiagnosed diabetes
2. Incidence in African Americans is 11.4%, which
is 1.5 times higher than White Americans
3. Children in high risk ethnic groups have up to a
1 in 2 chance of developing diabetes in their
lifetime

B. Risk Factors for diabetes in African Americans

1. Genetics
2. High rate of obesity
3. Insulin resistance

C. Relationship
1. These diseases have a bi-directional Slide 11- relationship
relationship- poor glycemic control negatively between diabetes &
effects periodontal status and periodontal periodontal disease
disease negatively effects glycemic control *highlight that this is a bi-
2. Periodontal disease is considered the 6th most directional relationship
major complication of diabetes
 3. Diabetes can lead to diminished salivary flow,
altered salivary composition, & inflammation,
which can all predispose an individual to
periodontitis
4. Diabetes causes an altered host-inflammatory
response, alterations in collagen metabolism,
poor wound healing, alterations to the
composition of gingival crevicular fluid, &
altered subgingival microflora, which are all
associated with increased periodontal
inflammation and alveolar bone loss in diabetics
5. Periodontal infection can also negatively affect
glycemic control in diabetics, leading to higher
A1C readings
6. Chronic inflammation associated with
periodontal disease correlates with low
metabolic control of serum glucose and
increased insulin requirements

5 min IV. Adverse Pregnancy Outcomes and

Periodontal Disease

A. Adverse Pregnancy Outcomes

Slide 12- adverse
1. Preterm birth- among the leading causes of
pregnancy outcomes
perinatal mortality & morbidity
2. Low birth weight
3. Pre-eclampsia

B. Relationship
1. Studies show women with periodontitis have 6
times higher odds of giving birth to premature
infants than those without periodontitis
2. Periodontitis can contribute to premature birth
through bacteremia
3. Toxins derived from periodontal pathogens can
reach the bloodstream and cause injury to the
placenta, leading to amniotic infections
4. Inflammation in periodontal tissues increases
the secretion of different inflammatory
cytokines throughout the body
5. Localized inflammation from periodontal
disease can lead to systemic inflammation
which can contribute to low birth weight
 6. Studies have shown that periodontal treatment
is effective in preventing low birth weight
deliveries

4 min V. Prevention

A. Education
1. 2/3 of patients with chronic periodontal disease Slide 13- Prevention of
are unaware of the association between periodontal disease
periodontal condition and systemic disease
2. Collaboration between medical practitioner’s and
dental professionals is imperative to ensure
patients are knowledgeable of the link between
the two

B. Regular Dental Appointments

1. Patients with active periodontal disease should
be on a 3 or 4- month re-care interval to
maintain oral health.
2. Pregnant patients should make sure to keep their
regular dental appointment to ensure a healthy
oral cavity during pregnancy, as pregnancy
hormones can exacerbate gingival inflammation.

3 min VI. Conclusion Slide 14- Conclusion-

*revisit scenario from
Chronic disease is a rapidly rising burden on our beginning of lecture and
society, so it is more important than ever to discuss with students to
understand evidenced based research that links test their knowledge
periodontal disease and systemic disease. Medical
professionals and dental professionals must work
collaboratively to educate patients on the importance
of maintaining and controlling both systemic and oral
disease. A healthy mouth can lead to a healthier and
happier body overall.
 Test Questions

1. Objective #1: Understand the relationship between periodontal and systemic disease.

Test Item: Periodontal disease causes systemic disease such as cardiovascular disease
and diabetes, but these systemic diseases do not have any negative effect on periodontal
health.

a. Both statements are true

b. Both statements are false
c. The first statement is true, the second statement is false
d. The first statement is false, the second statement is true

2. Objective #2: List three systemic conditions that are linked to periodontal disease.

Test Item: Which of the following is a systemic condition that is negatively affected by
periodontal disease?

a. Cardiovascular disease
b. Diabetes mellitus
c. Pregnancy
d. All of the above

3. Objective #3: State the nature of the relationship between periodontal disease and
diabetes.

Test Item: All of the following are accurate regarding the relationship between
periodontal disease and diabetes EXCEPT

a. Periodontal disease has a causative relationship to diabetes

b. Poor glycemic control negatively effects periodontal health
c. Periodontal disease negatively effects glycemic control
d. Periodontal disease and diabetes have a bi-directional relationship

4. Objective #4: List the three adverse outcomes that periodontal disease can have on
pregnancy.

Test Item: All of the following are adverse pregnancy outcomes linked to periodontal
disease EXCEPT

a. Pre-eclampsia
b. Low birth weight
c. Gestational hypertension
d. Pre-term birth
5. Objective #5: State the appropriate dental appointment interval for an individual with
periodontal disease.

Test Item: A patient with active periodontal disease should visit a dental professional for
a cleaning every:

a. 2 months
b. 6 months
c. 5 months
d. 3 or 4 months