THE MI GRAI NE- VERTI GO- PERI ODONTAL DI SEASE CONNECTION: EVIDENCE-BASED CASE AND VERIFICATION IN AN ANIMAL STUDY
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Recently, two CNS disorders, migraine and anxiety have been recognized as being commonly associated with dizziness (Vertigo).These associations may be an expression of an etiological relationship, for example, dizziness caused by migraine, or dizziness causedby anxiety and termed as MARD. Chronic dizziness may become more disabling during the added stress of a migraine headache orpanic attack. In addition, dizziness occurred comorbidly with both migraine headache and anxiety disorders. Even though the etiologyof migraine had been suggested from trigeminal nerve sensitivity and neurogenic inflammation, its linking to periodontal disease thatinnervated by the same nerve was still uncertain. However, an animal study revealed that Porphyromonas gingivalis lipopolysaccharidestimulation was able to increase neurogenic inflammation. A male patient suffered with symptoms mimicking MARD for years andconcomitantly had chronic periodontitis. Scaling and root planning combined with the assisted drainage therapy resulted in instantdisappearing of most of the symptoms. This case report is to propose the mechanism of periodontal disease involvement in theetiopathogenesis of migraine and vertigo which could be treated with periodontal treatment. Regarding to remarkable result, it wasconcluded that periodontal disease could be a source of neurogenic and immunogenic inflammation which if not treated periodicallycould perpetuate symptoms mimicking MARD.
related Dizziness (MARD): a new disorder. J Neurol Neurosurg
Psych, 2005; 78: 1–8.
2. Green MW. Diagnosing and treating migraine: low tech diagnosis,
high-tech treatment. Available online at URL: http://www.ama-assn.
org / ama1/pub/upload/mm/31/24pres-green.pdf. Accessed February
5, 2005.
3. Li XJ, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused
by oral infection. Clin Microbiol Rev 2000; 13(4): 547–58.
4. Utomo H. Sensitization of The sphenopalatine ganglion by periodontal inflammation: a possible etiology for headache and sinusitis in children. Majalah Kedokteran Gigi FKG Universitas Airlangga. 2006; 39(2): 63–7.
5. Utomo H, Prahasanti C. Periodontal disease in headache and menstrual pains. Lustrum FKG Universitas Gadjah Mada 2005; 14: 101–6.
6. Utomo H, Prahasanti C. Periodontal disease as an etiology of orofacial and musculoskeletal pains in women. J Dentistry 2006.
7. Utomo H. Elimination of oral focal infection: a new solution in chronic fatigue syndrome management? Majalah Kedokteran Gigi Surabaya 2005; 38(4): 169–72.
8. Victor M, Ropper AH. Principles of neurology. 7th ed. New York: Mc Graw Hill; 2001. p. 175–6.
9. Strauss SE. Chronic fatigue syndrome. In: Kasper DL, Braunwald
E, Fauci AS, Hauser SL, Longo D, Jameson JL, eds. Harrison�s
principles of internal medicine. 16th ed. New York: McGraw Hill; 2005. p. 2545–6.
10. Craig TJ, Kakumanu S. Chronic fatigue syndrome: evaluation and
treatment. Am Fam Phys 2002; 65: 1083–90.
11. Padgett DA, Glaser R. How stress influence the immune response.
Trends in Immunology 2003; 24: 444–8.
12. Kamma JJ, Giannopoulou C, Vasdekis VDS, Mombelli A. Cytokine
profile in gingival crevicular fluid of aggressive periodontitis:
influence of smoking and stress. J Clin Periodontol. 2004; 31:
894–902.
13. Utomo H. Immunoneuromodulatory effect of the assisted drainage therapy in allergic rats induced by Porphyromonas gingivalis
lipopolysaccharide. Dissertation. Doctorate Program Airlangga
University. 2009.
14. Bellamy JL, Cady RK, Durham P. Salivary levels of CGRP and VIP
in rhinosinusitis and migraine patients. Headache 2006; 46: 24-33.
15. Newman MG, Takei H, Klokkevold PR, Carranza FA, 2006.
Carranza�s Clinical periodontology. 10th ed. Elsevier-Saunders. p. 146, 749–56.
16. Licinio J, Frost P. The neuroimmune-endocrine axis: pathophysiological implications for the central nervous system cytokines and hypothalamus-pituitary-adrenal hormone dynamics. Braz J Med Biol Res 2000; 33: 1141–8.
17. Kiecolt-Glaser JK, Glaser R. Depression and immune function: central pathways to morbidity and mortality. J Psychosomatic Res 2002; 53: 873–76.
18. Dantzer R. Cytokine-induced sickness behavior: where do we stand? Brain Behav Immunity 2001; 15: 7–24.
19. Stirparo G, Zicari A, Favilla M, Lipari M, Martelletti P. Linked
activation of nitric oxide synthase and cyclooxygenase in peripheral
monocytes of asymptomatic migraine without aura patients.
Cephalalgia 2000; 20(2): 100–6.
20. Lundy W, Linden R. Neuropeptides and neurogenic mechanism in
oral and periodontal inflammation. Crit Rev Oral Biol Med 2004;
15(2): 82–98.
21. Meggs WJ. Neurogenic switching: a hypothesis for a mechanism for shifting the site of inflammation in allergy and chemical sensitivity. Env Health Persp 1997; 105: S2 1–10.
22. Putra ST, Asnar ES. Perkembangan konsep stres dan penggunaannya dalam paradigma psikoneuroimunologi. In: Putra ST, eds. Psikoneuroimunologi Kedokteran. 1st ed. Surabaya: GRAMIK; 2005. p. 12. (in Indonesian language).
23. Shapira L, Wilensky A, Kinane D. Effect of genetic variability on the inflammatory response to periodontal infection. J Clin Periodontol 2005; 32 (S6): 72–86.
24. Madianos PN, Bobetsis YA, Kinane DF. Generation of inflammatory stimuli: how bacteria set up inflammatory responses in the gingiva. J Clin Periodontol 2005; 32(S6): 57–71.
25. Walsh LJ. Mast cells and oral inflammation. Crit Rev Oral Biol Med 2003; 14(3): 188–98.
26. Boyd JP. Pathophysiology of migraine: and rationale for a targeted approach of prevention. Available on line at URL http://www.
drjimboyd.com. Accessed, Nov 22, 2005.
27. Jeong HJ, Hong SH, Nam YC. Effect of acupuncture in inflammatory cytokine production in patients with chronic headache. Am J Chin Med 2003; 31(6): 945–54.
28. Okeson JP. Bell�s orofacial pain. 6th ed. Carol Stream. Quintessence Pub; 2005. p. 52–3.
29. Cady RK, Schreiber CP. Sinus headache or migraine.Sinus headache or migraine. Neurology 2002; 58: S10–4.
30. Unger J, Cady RK, Farmer-Cady K. Understanding migraine:
pathophysiology and presentation. 2005. Available online at URL
http://www.femalepatient.com. Accessed March 20, 2006.
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