Chapter 6 Flashcards
why are some patients more at risk than others for perio
- bacteria insufficient alone
- require a susceptible host
what are systemic risk determinants/indicators for perio
- genetics
- age
- race
- gender
what are evidence for genetics to be a risk determinants for perio
- perio associated with genetic traits
- separated twins
- genetics perio studies
- 50% advanced perio risk to hereditary
- people are not all at an equal risk
- IL-1 gene - 7x more likely
- carried by 30% of population
what is epidemiological evidence for age, race and gender to be a risk determinant for perio
- difficult to prove causal factors
- age: cumulative effect of bacteria and not decreased host response
- gender (males more incidence and severity): genetics vs values
- race: no firm evidence that race is significant risk factor in destructive perio but may be genetic link with particular families
how is stress a systemic factor for perio (2 reasons)
- may depress immune response to periodontal pathogens
1. change behaviours
2. increase production of glucocorticosteroids (antiinflammatory, reduce resistance to infection)
what is diabetes
- absolute deficiency of insult (type 1) or low insulin levels and insulin resistance (type 2)
- unable to utilize glucose
- effects all organs including the blood vessels or the periodontium
- worse with poor metabolic control
- hyperglycemia (elevated glucose) may suppress the host’s immune system
- blood sugars should be between 4-7
why are patients with diabetes more prone to perio
- poor wound healing
- recurrent infections
- periodontal abscesses
- impaired PMN function: chemotaxis (movement to the inflamed area), phagocytosis (engulfing bacteria)
- smoking + diabetes = increase incidence of destructive periodontitis
what happens during pregnancy
- estrogen/progestin levels elevated
- exaggerated gingival response
what is pregnancy gingivitis
- bacteria prevotella intermedia caused by elevated hormones
- increased tooth mobility (body is changing, body doesn’t know what ligaments need to stretch so they all do)
- reversible
- changes in the PDL
what is puberty gingivitis
- hormonal imbalance
- estrogen and progesterone levels
- reversible
- similar to pregnancy gingivitis
- also caused by prevotella intermedia
what is osteoporosis in relation to perio
- not an established risk factor but a risk indicator
- bone more porous
- greater CAL
- increased tooth loss
- estrogen depletion/menopause increases risk of perio
what are bisphosphonates
- any of a group of drugs used to limit the loss of bone density in conditions such as osteoporosis and bone cancer
- for osteoporosis and bone metastasis
- very long half life, stay int the body
- IV vs oral
what is osteonecrosis of the jaw
- exposed necrotic bone more than 8 weeks
- exo, implants, end, ortho, spontaneous
what are oral bisphosphonates used for
- osteoporosis
- ex: fosamax, actonel, boniva
what are intravenous bisphosphonates used for
- bone metastases
- ex: acedia, zometa
what can we and can’t we do when patients take bisphosphonates for ONJ
- no elective dental procedures with IV
- risk factors – all prior dental tx before
- concerns with dental procedures:
- oral: after 3 years, considered at high risk for ONJ
- If taking longer than 3 years, testing prior to treatment. if levels are too low, drug ‘holiday’ of 3 months and retesting to see if have gone up before INVASIVE tx
what are the periodontal findings for HIV patients
- impaired host response (CD4)
- NUG (necrotizing ulcerative gingivitis or NUP (periodontitis) may be the first sign of HIV infection
- NUP causes rapid destruction, microbiology similar to non-HIV infected
how vitamin deficiencies affect perio
- vitamin C: normal function of fibroblasts, osteoblasts and odontoblasts. impaired wound healing
- vitamin D deficiency: perio risk as well as poor tx outcome
how does smoking affect perio
- an established risk factor
- direct correlation between pack/years smoking and perio
- 2-6 times more
- less BOP
- former smokers is an intermediate between never smokers and current smokers
- modulates subgingival microbiota, promotes colonization
what are the local effects of smoking
- in the oral cavity (heat, dryness, increase plaque and calculus)
- impaires PMN chemotaxis and phagocytosis
how does smokeless tobacco affect perio
- may also contribute to perio
- may lead to cancerous changes
- common to see gingival recession
how does alcohol abuse affect perio
- poor OHI
- nutritional deficiencies
- also affects PMNs, clotting, bone metabolism and healing
what drugs can cause gingival overgrowth
- phenytoin
- cyclosporin (for organ rejection and immune compromised conditions ie chrones)
- calcium channel blockers (antihypertensive)
how does diabetes affect perio
- untreated perio can complicate metabolic control of diabetics
- severe attachment loss increased with decreasing diabetic control
- control periodontal infection; reduce insulin requirements
- pro inflammatory cytokine production: bidirectional, effect perio tissues and insulin receptors
how does cardiovascular disease affect perio
- periodontal pathogens enter the bloodstream
- this increases production of inflammatory substances (cytokines such as IL)
- cytokines may increase fibrinogen levels which may cause clot formation
- C-reactive protein (CRP) is an inflammatory serum marker for cardiovascular disease and possibly periodontitis
- this results in atherosclerosis
- successful periodontal therapy could decrease these serum markers
- if the patient has periodontitis: 50% increased risk for heart disease, 30% increased risk for stroke
- a recent study suggested that there may not be an association between periodontitis and development of coronary artery calcification
- more research is needed
how can perio lead to pre-term delivery and low birthweight babies
- periodontal infection leads to inflammation
- inflammation is initiated through chemical mediators such as prostaglandins
- elevated levels of PGE2 is seen in periodontal inflammation
- PGE2 is responsible for uterine contractions (induce labor)
how does perio affect respiratory conditions
- increase risk to pneumonia, bronchitis, emphysema
- elderly
- long term care facilities
- impact on health care system
how does perio affect alzheimer’s
- early exposure to inflammatory diseases may increase the risk for developing alzheimer’’s disease later in life
- this is a topic of on-going research
