BSP Risk Factors Flashcards
What is the major determinant of susceptibility of periodontal disease
patient’s response to the bacterial challenge which is the major determinant of susceptibility
What are risk factors
- Risk factors are those factors that influence the likelihood of periodontitis developing in an individual and how fast the disease progresses
When should local risk factors be identified
in an examination visit and should either be corrected or educate the patient about local oral hygiene measures
What are systemic risk factors
- A number of systemic diseases, states or conditions can affect the periodontium in a generalized manner
What are the modifiable systemic factors
smoking diabetes poor diet certain medications stress
What are the non modifiable risk factors
socioeconomic status genetics adolescence pregnancy age leukemia
What is affected by diabetes
Wound healing is adversely affected by diabetes, especially if poorly controlled and this can make treatment more difficult
How is diabetes control best assessed
assessed using glycates haemoglobin values
How may patients with undiagnosed diabetes present
with multiple, lateral periodontal abscesses in which case contacting the GP to confirm the diabetic status of the patient is advised
How can stress > periodontal disease
Prolonged or intense periods of stress can cause suppression of the immune system which might top the host-bacterial interaction in favour of bacteria increasing the attachment loss
Also effects how patients look after themselves
How can you help manage periodontal disease related to stress
requires recognition of this factor and asking patients about their stress and explaining the importance of stress management and adopting coping strategies due to the effects of stress on general/oral health
What should you do if there is drug related gingival overgrowth
it is prudent to liaise with medical colleagues to determine if alternative drug therapies are available especially if overgrowth is severe or not reducing despite the patient’s best efforts at good plaque control and effective personal debridement
What are other considerations regarding risk factors
Hormonal change can affect the gingivae (pregnancy)
socioeconomic status
Why are smokers more likely to have PD disease
due to a reduction in gingival blood flow (nicotine causes vasoconstriction), impaired white cell function, impaired wound healing and an increased production of inflammatory cytokines enhancing tissue breakdown
What do smokers often display with
o Greater calculus formation
o Higher mean probing pocket depths and more sites
o Greater gingival recession
o Greater alveolar bone loss and furcation involvement
o Less bleeding on probing
What is your responsibility regarding patients expectations and smoking
- It is your responsibility to make your patients fully aware of the effects that smoking will have on their periodontal health, response to treatment, risk of relapse and eventually tooth loss
What does your approach to smoking cessation depend on
o Is the patient a contended smoker
o Contemplating quitting
o Or whether they have tried and failed to quit in the past
What is a specialist for quitting smoking services
NHS smoke free
For those who are unwilling to take up smoking cessation services what should you do
- For people who are unwilling to take up such a service, you should provide brief tobacco cessation advice
If patients quit smoking what should they be warned of
remind them that there is a possible transient increase in bleeding from the gingivae on smoking cessation as the oral vascular supply returns to normal and the masking effects of smoking are removed
What should you report upon every appointment regarding smoking
- You should note down your patient’s current self-reported smoking status at every regular recall appointment and it is also important to make note of the historic burden of smoking for instance in pack-years
How is periodontitis linked to systemic health
- The biological mechanisms by which periodontitis might influence systemic health are linked to the fact that periodontitis causes gingival inflammation which compromises the barrier function of the gingival epithelium leading to an ingress of bacteria or bacterial products or inflammatory products into the systemic circulation
What are established associations for periodontitis
CV disease
diabetes
adverse pregnancy outcomes
