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23 Periodontology > 9 - Influence of Systemic Conditions on the Periodontium > Flashcards

9 - Influence of Systemic Conditions on the Periodontium Flashcards

1
Q

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

A

altered, deficient, or exaggerated;
systemic diseases

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2
Q

do systemic diseases initiate periodontitis

A

they DO NOT

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3
Q

systemic disorders may ___ periodontal disease

A

predispose/accelerate

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4
Q

can perio infection affect systemic health

A

yes

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5
Q

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

A

1: obesity
2: periodontitis

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6
Q

how does periodontitis contribute directly to pathogenesis of atherosclerosis?

A

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

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7
Q

what hypothesis:

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

A

inflammatory mechanism hypothesis

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8
Q

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)

A

bacterial mechanism hypothesis

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9
Q

periodontitis is the ___th complication of diabetes

A

6th

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10
Q

poorly controlled diabetics lead to what

A
  1. severe inflammation
  2. deep periodontal pockets
  3. rapid bone loss
  4. frequent perio abscess
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11
Q

effects of diabetes on periodontium

A
  1. greater loss of attachment
  2. increased BOP
  3. increased tooth mobility (compared to non-diabetics)
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12
Q

etiology of perio in diabetic patients

A
  1. increased glucose in gingival fluid and blood
  2. PMN deficiencies
  3. macrophage deficiencies
  4. altered collagen metabolism
  5. advanced glycation end products (AGEs)
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13
Q

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

A

POOR! due to delayed post-surgical healing

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14
Q

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

A

elective periodontal surgery on an uncrontrolled diabetic patient

HbA1c >7%

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15
Q

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

A

HbA1C at greater or equal to 6.5%

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16
Q

how does HbA1c test work

A
  • 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.
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17
Q

HbA1c estimates average blood glucose levels over preceding ___ days

A

30-90 days

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18
Q

what HbA1c level is prediabetes

A

5.7-6.4%

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19
Q

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

A

estimated average glucose (EAG)

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20
Q

how does periodontitis affect the diabetic state?

A

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

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21
Q

scaling and root planing in diabetic patients lead to what

A
  • Decreased IL-1B and TNF-a in GCF.
  • May decrease HbA1c values.
  • Wide inter-individual variability (some worsened glycemic control)
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22
Q

what is a metabolic syndrome

A

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

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23
Q

is there significant association between obesity and periodontitis

A

yes

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24
Q

how does obesity result in inflammation

A
  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
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25
Q

examples of when change of hormones occur

A

puberty, pregnancy, and hyperparathyroidism

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26
Q

explain gingivitis in puberty and pregnancy treatment?

A
  • exaggerated response to plaque
  • treat by removing local factors (plaque)
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27
Q

does pregnancy/puberty CAUSE gingivitis?

A

NO!

28
Q

what bacterium can increase in pregnancy? what does this substitute

A

prevotella intermedia

substitues estradiol and progesterone for Vitamin K

29
Q

whaat this:

Parathyroid hypersecretion
Generalized demineralization of skeleton
Proliferation of connective tissue in enlarged marrow spaces
von Recklinghausen’s disease of bone

A

hyperparathyroidism

30
Q

oral changes in hyperparathyroidism

A
  1. tooth mobility (first clue)
  2. widened PDL
  3. lamina dura absent
  4. brown tumors
31
Q

what are hematologic disorders

A

Neutropenia
Agranulocytosis
Leukemia
Thrombocytopenia
Leukocyte Disorders
Antibody Deficiency Disorders

32
Q

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

A

neutropenia

33
Q

what this:

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

A

cyclic neutropenia

34
Q

what this:

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

A

agranulocytosis

35
Q

oral manifestations of leukemia

A
  1. leukemic infiltration
  2. BLEEDING in absence of gingivitis
  3. oral ulcerations
  4. infections
36
Q

what this:

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

A

thrombocytopenia purpura

37
Q

what this:

Increased susceptibility to periodontitis
NG, NP, NS

A

acquired immunodeficiency syndrome

38
Q

what are genetic disorders that cause perio

A
  1. chediak-higashi syndrome
  2. leukocyte adhesion deficiency
  3. papillon-lefere syndrome
  4. down syndrome
  5. aggamaglobulinemia
39
Q

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

A

chediak-higashi syndrome

40
Q

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

A

leukocyte adhesion deficiency

41
Q

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

A

papillon-lefevre syndrome

42
Q

prevalence of periodontal disease is almost 100% in what

A

down syndrome

43
Q

waht this:

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

A

down syndrome

44
Q

what this:

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

A

agammaglobulinemia

45
Q

is stress capable to potentiate periodontal breakdown

A

yes

46
Q

can stress lead to poorer oral hygiene and suppressed immunity

A

yes

47
Q

do nutritional deficiences cause gingivitis or periodontitis?

A

NO! alone do not cause gingivitis or perio

48
Q

do nutritional deficiencies accentuate plaque-induced inflammation

A

yes

49
Q

vitamin c deficiency leads to what

A

bleeding, swollen gingiva

50
Q

is gingivitis caused by vitamin c deficiency

A

no

51
Q

what medication cause periodontitis

A

bisphosphonates

52
Q

what bisphosphonates for osteoporosis/osteopenia

A

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

53
Q

what are IV bisphosphonates for bone cancer

A

Zometa ® (Zoledronate)
Aredia ® (Pamidronate injection)

54
Q

how does medication-related osteonecrosis of jaw occur

A

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.

55
Q

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

A

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.

56
Q

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

A

3 or more years

57
Q

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

A

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

58
Q

osteoprotegarin and denosumab prevent binding of what

A

RANKL to RANK

59
Q

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

A

increase RANKL
decrease OPG

60
Q

what systemic disease causing perio is associated with menopause

A

osteopenia/osteoperosis

61
Q

Estrogen Deficiency and Osteopenia/Osteoporosis associated with what

A

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

62
Q

what have links to periodontitis for systemic diseases

A

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

63
Q

is diabetes and important contributing factors to perio

A

yes

64
Q

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

A

leukemia

65
Q

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

A

TRUE

23 Periodontology (13 decks)

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