One day, a man walks into a
dentist's office and asks how much it will cost to extract wisdom teeth.
"Eighty dollars," the dentist says.
"That's a ridiculous amount," the man says. "Isn't there a cheaper way?"
"Well," the dentist says, "if you don't use an anesthetic, I can knock
the price down to $60."
"That's still too expensive," the man says.
"Okay," says the dentist. "If I save on anesthesia and simply rip the
teeth out with a pair of pliers, I can knock the price down to $20."
"Nope," moans the man, "it's still too much."
"Well," says the dentist, scratching his head, "if I let one of my
students do it, I suppose I can knock the price down to $10."
"Marvelous," says the man, "book my wife for next Tuesday!"
C-reactive protein and Periodontal disease Part III
by- Dr.Vinayak Joshi
Periodontal disease especially in form of
chronic periodontitis forms a chronic source of inflammation in any subject.
The increased CRP during the periodontal infection can have a dual effect
i.e a local and a systemic effect. The local inflammation in the periodontal
structure along with the bacterial toxins could drive the CRP levels higher
in the local tissues. The role or CRP in the local periodontal environment
is quite unclear at this moment, however its role in stimulating the tissue
factor and in turning on the humoral immunity may play role in altering the
balance between health and disease1, 2. The recent invitro and
invivo studies regarding CRP causing increased nitric oxide (NO) production3,
affecting the monocyte adhesion4 and in expression of the
adhesion molecules like intercellular adhesion molecules (ICAM) and vascular
adhesion molecule (VCAM) support the hypothesis that CRP plays a
I hypothesize that in presence of
periodontal disease the subgingival bacteria and its toxins increases the
level of the various proteinases, cytokines (which Interleukin6 (IL6) is
known to regulate CRP) and acute phase proteins. Increase in acute phase
protein of which CRP in specific could act as a proinflammatory factor by
expressing the adhesion molecules, and NO production, causing a vicious
cycle to build up. Its atherosclerotic effects of CRP could occur in the
local vessels which could decrease the total blood flow in the already
diseased area. The known affect of CRP in complement binding and humoral
response along with its above mentioned actions could exacerbate the already
persistent inflammation and thus alter the course of the periodontal
The increase in the CRP during the
periodontal infection is seen to emerge as a risk factor with results of
various clinical trials associating it with cardiovascular disease and
preterm delivery. A recent study found that the periodontitis may increase
the CRP levels in pregnant women and it could mediate the association of
periodontitis with advance pregnancy outcomes6. The relationship
between cardiovascular disease and periodontitis has been extensively
researched in recent times. It is proposed from these studies that the
periodontal infection and subsequent release of the proteinases ( matrix
metalloprotienases 9) and cytokines (IL6, TNFα) and acute phase proteins (
CRP being one of them) can systemically affect the events like platelet
aggregation, thrombus formation and atherogenesis and thus increase the risk
for atherosclerosis, coronary heart disease and stroke. (Figure1)9
A study by Ebersole et al7 showed that periodontal debridement
reduced the serum level of CRP and another study by Ridker et al8
have showed that lower serum levels of CRP is associated with reduced risk
of myocardial infraction. These studies indirectly support the hypothesis
that periodontal treatment can potentially reduce the likelihood of systemic
Data regarding CRP and its affect
periodontal disease is insufficient and calls foe more studies. However
further research is needed to understand the association between periodontal
disease, inflammation and its range of effect on the systemic health.
…….So is my own
criticism and discussions on the above topic is welcome
Saran de Ferranti, Nadir Rifai,
C-reactive protein and cardiovascular disease: a review of risk prediction
and interventions. Clinical Chimica Acta 2000; 317: 1-15
G.M. Hirschfield and M.B.
Pepys, C-reactive protein and cardiovascular disease: new insights from an
old molecule. Q J Med 2003; 96: 793 – 807.
Clapp BR,et.al. Inflammation
and endothelial function: direct vascular effects of human C-reactive
protein on nitric oxide bioavailability, Circulation. 2005;111(12):1530-6.
Woollard KJ, et.al. Direct
modulatory effect of C-reactive protein on primary human monocyte adhesion
to human endothelial cells. Clin Exp Immunol. 2002 ;130(2):256-62.
Vincenzo Pasceri, MD et.al. Direct Proinflammatory Effect
of C-Reactive Protein on Human Endothelial Cells, Circulation.
Waranuch Pitiphat, et.al. Periodontitis and Plasma
C-Reactive Protein During Pregnancy, Journal of Periodontology 2006, Vol.
77, No. 5, Pages 821-825
Paquette DW, et al. The concept of “risk” and the emerging
discipline of periodontal medicine, The journal of contemporary dental
practice 1999;1: 1-8
Ebersole JL, et al. Systemic acute-phase reactants,
C-reactive protein and haptoglobin, in adult periodontitis. Clin Exp
Immunol 1997;107: 347-352.
Ridker PM, et al.
Inflammation, aspirin, and the risk of cardiovascular
disease in apparently healthy men. N Eng J Med 1997;336: 973-979.
5 Reasons You Should Be More
by- Cathy Warschaw
Some people think being organized requires a lot of
work or maybe a complete system where you have to do a complicated set of
tasks. In short, many people view being organized as impossible to achieve.
While that is not really true, it takes a disciplined person not to resort
back to his/her old habits. It’s really easy to do and you get many benefits
when you’re organized. Here are some of them.
1. You will have more room.
Being organized will provide you additional
“uncluttered” space. You won’t need to necessarily throw anything out, you
just need to place things in some sort of order and maintain that order at
2. You will be able to save time.
Looking for files at work? It’s organized
alphabetically in the cabinet. Being organized lets you look for files that
you might need in a hurry in the future. Looking for your book? It’s safely
stashed behind your bed. This is a really good time-saving technique which
would help you when you’re in a hurry.
3. You will also save money.
You don’t believe that? Try thinking why you bought
another ballpoint pen today? Isn’t it because you lost your old one? Or
think of the countless items you bought because you thought you didn't have
one of them at your house. Just think of how much you could save in a year
just by being organized.
4. You will feel more in control.
Did you know that clutter around your house and at work
causes the stress you’re feeling from time to time? It’s no wonder you’re
feeling more irritated at work. As your clutter goes, you’ll feel that it is
easier to breathe and take charge of your own life.
5. You will make a great impression to others.
This should be a good enough reason why you should make
a considerable effort to be organized. Just think of your employer or office
manager not pestering you to clean your work area again. Or just think how
you’ll never forget that you have a scheduled meeting.
Being organized requires a lot of discipline to
maintain. Nobody ever said it was easy. You need to make sure you don’t
lapse back to your old habits or all of what you have done will be for
© Warschaw Learning Institute 2006
Cathy Warschaw is
the Director of the Warschaw Learning Institute an online educational site
offering; Dental Office Management Program, Telephone Training, HIPAA and
various e-books. For more information go to
www.WarschawLearningInstitute.com or call (323) 822-0917(323) 822-0917