Oral Inflammation And Respiratory System Pathologies
Oral Pathology

Di : Denisova Tatiana
Gerardi Luca
Gastaldo Fabrizio

Pneumonia: Pneumonia is a pulmonary inflammation derived from bacterials or viral infection. It can crop up with seven typical representations, and the pathogenic species are typical in each manifestation:

Community Acute Pneumonia:Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Legionella pneumophila, Enterobateriaceae (Klebsiella pneumoniae) e Pseudomonas spp.

Communitary Atypical Pneumonia:Mycoplasma pneumoniae, Chlamydia spp. (C.pneumoniae, C.psittaci, C.trachomatis), Cloxiella burnetii, virus: adenovirus, SARS (Severe Acute Respiratory Syndrome).

• Nosocomional Pneumonia:
  • Klebsiella spp.,
  • Serratia marcescens,
  • Escherichia coli) e Pseudomonas spp., Staphylococcus aureus. 13-17% of the infections aquired in hospitals

-Aspiration Pneumonia:Bactrioides, Prevotella, Fusobacterium, Peptostreptococcus, Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa.
-Necrotic Pneumonia: taphylococcus aureus, Klebsiella pneumoniae, Streptococcus piogenes e pneumococco tipo 3

COPD: Chronic obstructive pulmonary disease (COPD) is a disease of the lungs in which the airways become narrowed. This leads to a limitation of the flow of air to and from the lungs causing shortness of breath. In contrast to asthma, the limitation of airflow is poorly reversible and usually gradually gets worse over time.

POSSIBLE MECHANiSM IN WHICH ORAL BACTERIAS CAN INFLUENCE POLMONARY DISEASE:

1. They can be inspired directly from the air or they can pass from the dental plaque or from the saliva to the respiratory system and in case of immunodeficiency, the can cause infection
2. The action of bacterial enzymes on epithelial cells can cause the colonization by bacterias pathogenic for the respiratory system (it happens only in bad igienical condition)
3. Bacterial enzymes lower the protection given by mucous cells against colonization. the proteins produced by mucous cells prevent oral bacterias to attack themselves at the mucous
4. Cytochines can contribute to the colonization of the bronchial epithelial, periodontal disease stimulate the gum tissue to produce cytochines, which can change the surface of epithelial cells. Cytochines, moreover, recruit neutrophils towards the site of inflammation.
   Cytochines like IL-1, IL-8, TNFalfa, go out from the alveolar space where are activated. Here they are responsible of local tissuetal damage, air space edema, inactivation of surfactant and formation of ialin membranes.

Associations between poor oral health and chronic lung disease have been reported:

• A cross-sectional retrospective study of the NHANES III database included a study population of 13,792 subjects > or = 20 years of age with at least 6 natural teeth which lasted from 1988 to 1994 in which patients had to report in a medical questionnaire all respiratory pathololgies, proved this assotiation.
  This was proved because people who were affected by gingival bleeding, gingival recession, gingival probing depth, and loss of periodontal attachment level were more affected by polmonary pathologies than people who didn't have periodontal pathologies.

• Another article from 2003 written by Scannapieco FA, Bush RB, Paju S. proved that:
  1. Oral colonization by respiratory pathogens, fostered by poor oral hygiene and periodontal diseases, appears to be associated with nosocomial pneumonia.
  2. Additional large-scale RCTs are warranted to provide the medical community with further evidence to institute effective oral hygiene procedures in high-risk patients to prevent nosocomial pneumonia.
  3. The results associating periodontal disease and COPD are preliminary and large-scale longitudinal and epidemiologic and RCTs are needed.
• Another article from Mojon P. proved the association between oral bacteria and respiratory pathologies. In this study several anaerobic bacteria from the periodontal pocket have been isolated from infected lungs. In elderly patients living in chronic care facilities, the colonization of dental plaque by pulmonary pathogens is frequent. Notably, the overreaction of the inflammatory process that leads to destruction of connective tissue is present in both periodontal disease and emphysema. This overreaction may explain the association between periodontal disease and chronic obstructive pulmonary disease, the fourth leading cause of death in the United States.
• Azarpazhooh A, Leake JL. published in 2006 on Journal of Periodontology a resarch about evidence for a possible etiological association between oral health and pneumonia or other respiratory diseases. They examinated 728 arcticles and they arrived to theese conclusions:
  1) There is fair evidence (II-2, grade B recommendation) of an association of pneumonia with oral health (odds ratio [OR]=1.2 to 9.6 depending on oral health indicators).
  2) There is poor evidence of a weak association (OR<2.0) between COPD and oral health (II-2/3, grade C recommendation).
  3) There is good evidence (I, grade A recommendation) that improved oral hygiene and frequent professional oral health care reduces the progression or occurrence of respiratory diseases among high-risk elderly adults living in nursing homes and especially those in intensive care units (ICUs) (number needed to treat [NNT]=2 to 16; relative risk reduction [RRR]=34% to 83%).
• In 2008, Hajishengallis G, Wang M, Bagby GJ, Nelson S, they proved that the periodontal pathogen Porphyromonas gingivalis is implicated in certain systemic diseases including atherosclerosis and aspiration pneumonia. This organism induces innate responses predominantly through TLR2, which also mediates its ability to induce experimental periodontitis and accelerate atherosclerosis. Using a validated mouse model of intratracheal challenge, they investigated the role of TLR2 in the control of P. gingivalis acute pulmonary infection.
• An interesting arcticle written by Serefhanoglu K, Bayindir Y, Ersoy Y, Isik K, Hacievliyagil SS, Serefhanoglu S. and published in Quintessence International in 2008, talked abuot a 24-year-old female, who was admitted to an infectious diseases unit with complaints of dyspnea and fever. She had suffered from multiple episodes of fever for 1 year. The diagnostic workup revealed multiple pulmonary nodules on the chest CT scan, suggesting septic pulmonary embolism, and a periapical abscess around the maxillary right central incisor. Because no other infectious source was found and resolution of the fever and the pulmonary lesions occurred only after extraction of the affected tooth and antibiotic therapy, the condition was diagnosed as a periapical abscess complicated by septic pulmonary embolism.

• Scannapieco FA, Ho AW. Potential association between chronic respiratory disease and periodontal disease: Analysis of national health and nutrition examination survey III. J Periodontal, 2001
• Scannapieco F.A., Bush R.B., Paju S. Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. Ann Periodontal, 2003

• Philippe Mojon, DMD, PhD Oral Health and Respiratory Infection

• Azarpazhooh A, Leake JL.: Systematic review of the association between respiratory diseases and oral health.

• Hajishengallis G, Wang M, Bagby GJ, Nelson S. Importance of TLR2 in early innate immune response to acute pulmonary infection with Porphyromonas gingivalis in mice.

• Serefhanoglu K, Bayindir Y, Ersoy Y, Isik K, Hacievliyagil SS, Serefhanoglu S. Septic pulmonary embolism secondary to dental focus.