Aetiology of periodontal diseases- systemic factors

Question 1

What are systemic factors?

Answer 1

Systemic factors modify the presentation of periodontal disease but may also determine susceptibility to periodontitis.

Question 2

Give examples of systemic factors?

Answer 2

Systemic factors that increase the susceptibility to periodontitis:

• Smoking
• Diabetes
• Pregnancy
• Medications which cause gingival enlargement
• Genetic factors

Question 3

How can smoking increase the risk of periodontal diseases?

Answer 3

Smoking masks the effects of periodontitis so these patients will experience:
-less bleeding
-Reduces the gingival blood flow hence the masking the signs and symptoms of gingival inflammation.
-Also impairs wound healing and increases inflammation.

Important to explain to the patient the effects of smoking on their oral and general health and direct them to smoking cessation services ultimately encourage patients to quit smoking.

Question 4

How can uncontrolled diabetes increase the risk of periodontal diseases?

Answer 4

• Uncontrolled/ poorly controlled (poor glycaemic control) increases risk of periodontal disease and disease progression
  o Impaired immune response,
  o Impaired wound healing
  o Recurrent / multiple periodontal abscesses

Stress the importance of good glycaemic control in patients with diabetes. Successful periodontal treatment can improve glycaemic control.

Question 5

How can pregnancy increase the risk of periodontal diseases?

Answer 5

• Increases gingival response to plaque
• Increased progesterone results increased gingival blood flow
• Similar effects also seen at puberty and associated with the contraceptive pill

Question 6

How can medication increase the risk of periodontal diseases?

Answer 6

DRUG INDUCED GINGIVAL OVERGROWTH:
* Calcium channel blockers – for hypertension
o E.g. Nifedipine, Amlodipine, Felodipine
* Phenytoin – for epilepsy
* Ciclosporin-
o immunosuppresant,
o prescribed for some autoimmune disorders

Question 7

How can genetics increase the risk of periodontal diseases?

Answer 7

May play an important role in susceptibility to periodontitis evidence from:
* Familial tendency in especially in severe periodontitis
* Racial predilection especially in severe periodontitis
* Twin Studies
* Association with specific genetic polymorphisms

Question 8

What are Genetic polymorphisms?

Answer 8

Genetic polymorphisms are common they occur through normal variations in gene structure. Some people may have a more genetic predisposition to suffering gum disease than others. They way the immune system reacts to plaque may differ from person to person.

Ask patient family history of periodontitis

Question 9

What are Hereditary neutropenic conditions?

Answer 9

Rare condition and these result from single point genetic mutations.

These patient have a single normal gene and the hallmark of this there is periodontal breakdown not just in the adult dentition but also in the deciduous dentition as well.

These are due to defects in the neutrophils.

Question 10

Give examples of Hereditary neutropenic conditions.

Answer 10

• Papillon Lefevre syndrome
• Chediak Higashi Syndrome
• Leukocyte Adhesion syndrome

All of these patients suffer from periodontitis at a young age.