7 - Periodontal risk factors Flashcards
Define periodontal health.
The balance of bacteria in the plaque and the host immune system
What are risk factors associated with general health and periodontal disease?
- stress
- fatigue
- smoking
- diet
- medications
- hygienic habits
What are risk factors associated with pathological conditions and periodontal disease?
- viral infections
- bacterial infections
- diabetes mellitus
- hypoxia
What are the local risk factors for periodontitis?
ACQUIRED
- plaque and calculus
- poor restorations or crowns
- orthodontic appliances
- occlusal trauma
ANATOMICAL
- malpositioned teeth
- root grooves
- concavities and furcations
- enamel pearls
What are the systemic risk factors for periodontitis? (3+9)
NON-MODIFIABLE
- ageing
- gender (males)
- genetic disorders
MODIFIABLE
- smoking
- poorly controlled diabetes
- HIV
- leukemia
- stress
- osteoporosis
- hormonal status
- poor nutrition
- medications
What genetic conditions pre-dispose patients to periodontitis?
- Down syndrome (abnormal leucocyte chemotaxis and phagocytosis)
- papillon-lefevre syndrome (defects in neutrophil adhesion, increased cathepsin production)
- Ehlers-danlos syndrome (collagen defect)
How does occlusal trauma affect periodontitis?
- occlusal trauma cannot cause periodontitis
- can cause bone loss
- can exacerbate effects of periodontitis
How does smoking affect periodontitis?
- affects oral microbiome
- increased activation of immune system
- decreased healing capacity due to reduced blood flow (vasoconstriction)
How does diabetes affect periodontitis?
- 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
How does obesity affect periodontitis?
Obesity can have a pro-inflammatory effect due to increased activity of adipocytes
How does nutrition affect periodontitis?
- rare in developed countries
- severe nutritional deficiency can impair the immune system
How does medication affect periodontitis?
- interactions between drugs and host fibroblasts result in increased deposition of connective tissue
- increased connective tissue in the gingiva causes hyperplasia
Give examples of drugs that can cause gingival hyperplasia.
- phenytoin (anticonvulsant)
- cyclosporin (immunosuppressant)
- amlodipine (calcium channel blockers, HTN)
How does HIV affect periodontitis?
- increased risk of necrotising conditions
- does not increased rate of progression in periodontitis
How does leukaemia affect periodontitis?
- reduced function of neutrophils and macrophages
- increased risk of NUG and progressive periodontitis
How does scurvy affect periodontitis?
Vit C deficiency causes abnormal collagen turnover which results in increased risk of LOA
How does pregnancy affect periodontitis?
Hormones increase the risk of gingivitis but do not affect progression of periodontitis
How does osteoporosis/osteopenia affect periodontitis?
- occlusal trauma is increased
- low bone mineral concentration can accelerate the bone loss due to periodontal inflammation
How does stress affect periodontitis?
Chronic stress increases the production of cortisol which stimulates the immune system