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Periodontics > Chapter 6 > Flashcards

Chapter 6 Flashcards

1
Q

why are some patients more at risk than others for perio

A
  • bacteria insufficient alone

- require a susceptible host

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2
Q

what are systemic risk determinants/indicators for perio

A
  • genetics
  • age
  • race
  • gender
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3
Q

what are evidence for genetics to be a risk determinants for perio

A
  • 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
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4
Q

what is epidemiological evidence for age, race and gender to be a risk determinant for perio

A
  • 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
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5
Q

how is stress a systemic factor for perio (2 reasons)

A
  • may depress immune response to periodontal pathogens
    1. change behaviours
    2. increase production of glucocorticosteroids (antiinflammatory, reduce resistance to infection)
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6
Q

what is diabetes

A
  • 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
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7
Q

why are patients with diabetes more prone to perio

A
  • 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
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8
Q

what happens during pregnancy

A
  • estrogen/progestin levels elevated

- exaggerated gingival response

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9
Q

what is pregnancy gingivitis

A
  • 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
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10
Q

what is puberty gingivitis

A
  • hormonal imbalance
  • estrogen and progesterone levels
  • reversible
  • similar to pregnancy gingivitis
  • also caused by prevotella intermedia
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11
Q

what is osteoporosis in relation to perio

A
  • not an established risk factor but a risk indicator
  • bone more porous
  • greater CAL
  • increased tooth loss
  • estrogen depletion/menopause increases risk of perio
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12
Q

what are bisphosphonates

A
  • 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
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13
Q

what is osteonecrosis of the jaw

A
  • exposed necrotic bone more than 8 weeks

- exo, implants, end, ortho, spontaneous

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14
Q

what are oral bisphosphonates used for

A
  • osteoporosis

- ex: fosamax, actonel, boniva

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15
Q

what are intravenous bisphosphonates used for

A
  • bone metastases

- ex: acedia, zometa

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16
Q

what can we and can’t we do when patients take bisphosphonates for ONJ

A
  • 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
17
Q

what are the periodontal findings for HIV patients

A
  • 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
18
Q

how vitamin deficiencies affect perio

A
  • vitamin C: normal function of fibroblasts, osteoblasts and odontoblasts. impaired wound healing
  • vitamin D deficiency: perio risk as well as poor tx outcome
19
Q

how does smoking affect perio

A
  • 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
20
Q

what are the local effects of smoking

A
  • in the oral cavity (heat, dryness, increase plaque and calculus)
  • impaires PMN chemotaxis and phagocytosis
21
Q

how does smokeless tobacco affect perio

A
  • may also contribute to perio
  • may lead to cancerous changes
  • common to see gingival recession
22
Q

how does alcohol abuse affect perio

A
  • poor OHI
  • nutritional deficiencies
  • also affects PMNs, clotting, bone metabolism and healing
23
Q

what drugs can cause gingival overgrowth

A
  • phenytoin
  • cyclosporin (for organ rejection and immune compromised conditions ie chrones)
  • calcium channel blockers (antihypertensive)
24
Q

how does diabetes affect perio

A
  • 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
25
Q

how does cardiovascular disease affect perio

A
  • 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
26
Q

how can perio lead to pre-term delivery and low birthweight babies

A
  • 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)
27
Q

how does perio affect respiratory conditions

A
  • increase risk to pneumonia, bronchitis, emphysema
  • elderly
  • long term care facilities
  • impact on health care system
28
Q

how does perio affect alzheimer’s

A
  • 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

Periodontics (9 decks)

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