7 - Periodontal risk factors

Question 1

Define periodontal health.

Answer 1

The balance of bacteria in the plaque and the host immune system

Question 2

What are risk factors associated with general health and periodontal disease?

Answer 2

• stress
• fatigue
• smoking
• diet
• medications
• hygienic habits

Question 3

What are risk factors associated with pathological conditions and periodontal disease?

Answer 3

• viral infections
• bacterial infections
• diabetes mellitus
• hypoxia

Question 4

What are the local risk factors for periodontitis?

Answer 4

ACQUIRED
- plaque and calculus
- poor restorations or crowns
- orthodontic appliances
- occlusal trauma

ANATOMICAL
- malpositioned teeth
- root grooves
- concavities and furcations
- enamel pearls

Question 5

What are the systemic risk factors for periodontitis? (3+9)

Answer 5

NON-MODIFIABLE
- ageing
- gender (males)
- genetic disorders

MODIFIABLE
- smoking
- poorly controlled diabetes
- HIV
- leukemia
- stress
- osteoporosis
- hormonal status
- poor nutrition
- medications

Question 6

What genetic conditions pre-dispose patients to periodontitis?

Answer 6

• Down syndrome (abnormal leucocyte chemotaxis and phagocytosis)
• papillon-lefevre syndrome (defects in neutrophil adhesion, increased cathepsin production)
• Ehlers-danlos syndrome (collagen defect)

Question 7

How does occlusal trauma affect periodontitis?

Answer 7

• occlusal trauma cannot cause periodontitis
• can cause bone loss
• can exacerbate effects of periodontitis

Question 8

How does smoking affect periodontitis?

Answer 8

• affects oral microbiome
• increased activation of immune system
• decreased healing capacity due to reduced blood flow (vasoconstriction)

Question 9

How does diabetes affect periodontitis?

Answer 9

• poorly controlled diabetes
• hyperglycaemia modulates RANKL:OPG ratio which contributes to alveolar bone destruction
• hyperglycaemia increases production of AGE (advanced glycation end products) which increases inflammation

Question 10

How does obesity affect periodontitis?

Answer 10

Obesity can have a pro-inflammatory effect due to increased activity of adipocytes

Question 11

How does nutrition affect periodontitis?

Answer 11

• rare in developed countries
• severe nutritional deficiency can impair the immune system

Question 12

How does medication affect periodontitis?

Answer 12

• interactions between drugs and host fibroblasts result in increased deposition of connective tissue
• increased connective tissue in the gingiva causes hyperplasia

Question 13

Give examples of drugs that can cause gingival hyperplasia.

Answer 13

• phenytoin (anticonvulsant)
• cyclosporin (immunosuppressant)
• amlodipine (calcium channel blockers, HTN)

Question 14

How does HIV affect periodontitis?

Answer 14

• increased risk of necrotising conditions
• does not increased rate of progression in periodontitis

Question 15

How does leukaemia affect periodontitis?

Answer 15

• reduced function of neutrophils and macrophages
• increased risk of NUG and progressive periodontitis

Question 16

How does scurvy affect periodontitis?

Answer 16

Vit C deficiency causes abnormal collagen turnover which results in increased risk of LOA

Question 17

How does pregnancy affect periodontitis?

Answer 17

Hormones increase the risk of gingivitis but do not affect progression of periodontitis

Question 18

How does osteoporosis/osteopenia affect periodontitis?

Answer 18

• occlusal trauma is increased
• low bone mineral concentration can accelerate the bone loss due to periodontal inflammation

Question 19

How does stress affect periodontitis?

Answer 19

Chronic stress increases the production of cortisol which stimulates the immune system