9 - Influence of Systemic Conditions on the Periodontium

Question 1

___ host immune response may lead to more severe forms of periodontitis
___ alter host tissues and physiology, impairing immune defense

Answer 1

altered, deficient, or exaggerated;
systemic diseases

Question 2

do systemic diseases initiate periodontitis

Answer 2

they DO NOT

Question 3

systemic disorders may ___ periodontal disease

Answer 3

predispose/accelerate

Question 4

can perio infection affect systemic health

Answer 4

yes

Question 5

1 and #2 most frequent factor as modifable contributor to systemic inflammatory burden

Answer 5

1: obesity
2: periodontitis

Question 6

how does periodontitis contribute directly to pathogenesis of atherosclerosis?

Answer 6

thru bacterial challenges to arterial endothelium -> inflammation -> atheromatosis

Question 7

what hypothesis:

synthesis of inflammatory molecules caused by periodontitis, increasing the cerebral inflammation state

Answer 7

inflammatory mechanism hypothesis

Question 8

what hypothesis:

bacteria involved in periodontitis pathogenesis could also be involved in Alzheimer’s disease pathogenesis (A. actinomycetemcomitans, P. gingivalis, T. denticola, and F. nucleatum can invade the CNS, triggering neurodegenerative disease)

Answer 8

bacterial mechanism hypothesis

Question 9

periodontitis is the ___th complication of diabetes

Answer 9

6th

Question 10

poorly controlled diabetics lead to what

Answer 10

1. severe inflammation
2. deep periodontal pockets
3. rapid bone loss
4. frequent perio abscess

Question 11

effects of diabetes on periodontium

Answer 11

1. greater loss of attachment
2. increased BOP
3. increased tooth mobility (compared to non-diabetics)

Question 12

etiology of perio in diabetic patients

Answer 12

1. increased glucose in gingival fluid and blood
2. PMN deficiencies
3. macrophage deficiencies
4. altered collagen metabolism
5. advanced glycation end products (AGEs)

Question 13

do uncontrolled diabetics have a good or poor respons to periodontal therapy? why?

Answer 13

POOR! due to delayed post-surgical healing

Question 14

what should you avoid in uncontrolled diabetic patient? what is HbA1c percent

Answer 14

elective periodontal surgery on an uncrontrolled diabetic patient

HbA1c >7%

Question 15

what is used to monitor a patient’s overall glycemic control? at what percent do you diagnose DM

Answer 15

HbA1C at greater or equal to 6.5%

Question 16

how does HbA1c test work

Answer 16

• Glycohemoglobin forms continuously as a reaction between glucose and the hemoglobin protein, which carries oxygen.
• Binding of glucose to hemoglobin remains stable for lifespan of RBC.

Question 17

HbA1c estimates average blood glucose levels over preceding ___ days

Answer 17

30-90 days

Question 18

what HbA1c level is prediabetes

Answer 18

5.7-6.4%

Question 19

what is the linear relationship between A1c and average daily blood glucose?

Answer 19

estimated average glucose (EAG)

Question 20

how does periodontitis affect the diabetic state?

Answer 20

improved glycemic control following scaling and root plaining (found ~10% reduction in HbA1c levels)

Question 21

scaling and root planing in diabetic patients lead to what

Answer 21

• Decreased IL-1B and TNF-a in GCF.
• May decrease HbA1c values.
• Wide inter-individual variability (some worsened glycemic control)

Question 22

what is a metabolic syndrome

Answer 22

Obdominal obesity + 2 or more of: Hypertension, dyslipidemia, hyperglycemia

Question 23

is there significant association between obesity and periodontitis

Answer 23

yes

Question 24

how does obesity result in inflammation

Answer 24

1. adipose tissue dysfunction -> increased macrophages, B cells, T cells, eosinophils, neutrophils, mast cells
2. proinflammatory cytokine production: IL-6 and TNF-alpha -> recirculate and contribute to systemic inflammation

Question 25

examples of when change of hormones occur

Answer 25

puberty, pregnancy, and hyperparathyroidism

Question 26

explain gingivitis in puberty and pregnancy treatment?

Answer 26

- exaggerated response to plaque - treat by removing local factors (plaque)

Question 27

does pregnancy/puberty CAUSE gingivitis?

Answer 27

NO!

Question 28

what bacterium can increase in pregnancy? what does this substitute

Answer 28

prevotella intermedia substitues estradiol and progesterone for Vitamin K

Question 29

whaat this: Parathyroid hypersecretion Generalized demineralization of skeleton Proliferation of connective tissue in enlarged marrow spaces von Recklinghausen's disease of bone

Answer 29

hyperparathyroidism

Question 30

oral changes in hyperparathyroidism

Answer 30

1. tooth mobility (first clue) 2. widened PDL 3. lamina dura absent 4. brown tumors

Question 31

what are hematologic disorders

Answer 31

Neutropenia Agranulocytosis Leukemia Thrombocytopenia Leukocyte Disorders Antibody Deficiency Disorders

Question 32

what this: Low levels circulating neutrophils Caused by: Disease, Medications (chemotherapy), Infections, Idiopathic, Hereditary May result in severe periodontal destruction PMN is first line of defense

Answer 32

neutropenia

Question 33

what this: Gingival changes recur with recurrent exacerbation of neutropenia Periodontitis as a manifestation of systemic diseases

Answer 33

cyclic neutropenia

Question 34

what this: Absolute neutrophil count <100 cells/ul Low levels Basophils and eosinophils Drug-induced or idiopathic Gingival bleeding, necrosis, severe infections

Answer 34

agranulocytosis

Question 35

oral manifestations of leukemia

Answer 35

1. leukemic infiltration 2. ***BLEEDING*** in absence of gingivitis 3. oral ulcerations 4. infections

Question 36

what this: Reduced platelet count Spontaneous gingival bleeding Gingiva is edematous and friable Removal of local factors (plaque) reduces severity

Answer 36

thrombocytopenia purpura

Question 37

what this: Increased susceptibility to periodontitis NG, NP, NS

Answer 37

acquired immunodeficiency syndrome

Question 38

what are genetic disorders that cause perio

Answer 38

1. chediak-higashi syndrome 2. leukocyte adhesion deficiency 3. papillon-lefere syndrome 4. down syndrome 5. aggamaglobulinemia

Question 39

what this: Affects melanocytes, platelets, phagocytes Leading to: partial albinism, bleeding disorders, bacterial infections Impaired killing of microorganisms by neutrophils Periodontitis as a manifestation of systemic diseases

Answer 39

chediak-higashi syndrome

Question 40

what this: Failure to express CD18 necessary for leukocyte adhesion to vessel wall at site of infection (No transendothelial migration) Absence of neutrophils in gingival tissues Rapid destruction of periodontal bone Early tooth loss of primary and permanent dentition

Answer 40

leukocyte adhesion deficiency

Question 41

what this: Autosomal recessive Hyperkeratotic skin lesions on palms, soles, knees, elbows Periodontal inflammation, increased osteoclastic activity, thin cementum Severe destruction of periodontium Periodontitis as a Manifestation of Systemic Disease Severe bone loss Early tooth loss of primary and permanent dentitions

Answer 41

papillon-lefevre syndrome

Question 42

prevalence of periodontal disease is almost 100% in what

Answer 42

down syndrome

Question 43

waht this: Almost 100% Deep periodontal pockets Generalized periodontitis Poor PMN chemotaxis, phagocytosis, and killing Poor oral hygiene

Answer 43

down syndrome

Question 44

what this: ***Inadequate antibody production*** due to deficiency in B cells Increased susceptibility to severe, rapidly progressing periodontitis

Answer 44

agammaglobulinemia

Question 45

is stress capable to potentiate periodontal breakdown

Answer 45

yes

Question 46

can stress lead to poorer oral hygiene and suppressed immunity

Answer 46

yes

Question 47

do nutritional deficiences cause gingivitis or periodontitis?

Answer 47

NO! alone do not cause gingivitis or perio

Question 48

do nutritional deficiencies accentuate plaque-induced inflammation

Answer 48

yes

Question 49

vitamin c deficiency leads to what

Answer 49

bleeding, swollen gingiva

Question 50

is gingivitis caused by vitamin c deficiency

Answer 50

no

Question 51

what medication cause periodontitis

Answer 51

bisphosphonates

Question 52

what bisphosphonates for osteoporosis/osteopenia

Answer 52

Fosamax ® (Alendronate) Actonel ® (Risedronate) Boniva ® (Ibandronate) Reclast ® (Zoledronate) (IV)

Question 53

what are IV bisphosphonates for bone cancer

Answer 53

Zometa ® (Zoledronate) Aredia ® (Pamidronate injection)

Question 54

how does medication-related osteonecrosis of jaw occur

Answer 54

Exposure of bone in mandible or maxilla persisting for more than 8 weeks in a patient who has taken or is taking a bisphosphonate or similar medication and who has no history of radiation therapy to the jaws. May be spontaneous. May occur following invasive surgery.

Question 55

T/F: ONJ from oral bisphosphonates differs from ONJ from IV bisphosphonates.

Answer 55

true Longer period of exposure to oral drug required. Smaller amount of exposed bone. Discontinuation of oral bisphosphonate may lead to improvement and spontaneous healing.

Question 56

continuous oral bisphosphonate therapy of ___ years associated with increased risk of ONJ

Answer 56

3 or more years

Question 57

how do the drugs linked to osteonecrosis of the jaws lead to osteonecrosis

Answer 57

Inhibits maturation of osteoclasts Binds to and inhibits RANKL Mimics action of osteoprotegerin

Question 58

osteoprotegarin and denosumab prevent binding of what

Answer 58

RANKL to RANK

Question 59

sites with active periodontitis have [increased/decreased] RANKL and [increased/decreased] OPG

Answer 59

increase RANKL decrease OPG

Question 60

what systemic disease causing perio is associated with menopause

Answer 60

osteopenia/osteoperosis

Question 61

Estrogen Deficiency and Osteopenia/Osteoporosis associated with what

Answer 61

Increased attachment loss Increased crestal bone density loss Increased bone loss when combined with smoking

Question 62

what have links to periodontitis for systemic diseases

Answer 62

CVD, stroke, diabetes, PTLBW (preterm low bith weight), infants, respiratory disease, alzheimer's

Question 63

is diabetes and important contributing factors to perio

Answer 63

yes

Question 64

gingival enlargement and bleeding in the absence of inflammation can be an early sign of what

Answer 64

leukemia

Question 65

T/F: Nutritional deficiencies may be minor contributing factors to gingival inflammation. Plaque biofilm is primary etiology.

Answer 65

TRUE