Contributory Factors

Question 1

What is the primary etiological factor of periodontal disease

Answer 1

Plaque biofilm, bacteria

Question 2

Name epidemiological evidence of role of plaque as cause of chornic inflammatory perio disease

Answer 2

Sri Lankan and Norwegian study showed that poorer oh associated with poorer periodontal health (≠cause and effect)

Question 3

Name experimental evidence of role of plaque as cause of chornic inflammatory perio disease

Answer 3

Dental students and personnel with healthy gingiva and good oh at baseline abstain from all forms of oral hygiene for 2-3 weeks. Gingivitis develops in 10-21 days, reinstitution of oral hygiene resulted in resolution of gingival inflammation within 7 days

Question 4

Name clinical evidence of role of plaque as cause of chornic inflammatory perio disease

Answer 4

Axelsson and Lindhe 1974
Schoolchildren with 2 weekly professional prophy, intensive oh and fluoride few new caries, negligible gingivitis

School children with half yearly review, necessary treatment, fluoride —> gingivitis, new caries

Question 5

How is plaque biofilm able to have pathogenic potential

Answer 5

Able to colonise
Able to evade host response eg capsule to evade phagocytosis
Able to cause direct tissue damage
Down regulate inflammatory response

Question 6

What are the plaque retention factors

Answer 6

Calculus

Anatomical factors eg furcation, multiple roots, root concavities, enamel projections

Malaligned teeth

Restorations eg overhangs

Appliances eg ortho

Factors related to periodontal disease eg rough, plaque retentive periodontically involved cementum

Question 7

Compare supra and subgingival calculus

Answer 7

Supragingival calculus has minerals derived from saliva while subgingival calculus minerals derived from exudate and gcf

Supra calculus white/yellow while subg calculus brown/black (due to chronic exposure to blood and blood breakdown products)

Supra calculus is hard and claylike while subg calculus is hard and glass like

Supra calculus is easily detached while subg calculus is firmly attached to tooth surface

Question 8

Studies about diabetes being a major risk factor in destructive perio disease

Answer 8

Pima Indians by Nelson et al 1960: diabetics 2.6 times greater prevalence of periodontal disease

European study Ternoben and Knuuttila 1986: diabetics with poor glycemic control have the worst periodontal condition

Question 9

How is diabetes a risk factor for periodontal disease

Answer 9

Diabetes leads to hyperglycemia, causing the accumulation of advanced glycogen end products. This stimulates macrophages, increasing secretion of inflammatory mediators. Increased connective tissue breakdown

Vascular changes, reducing waste elimination

Altered polymorphonuclear function, decreasing host resistance to infection

Question 10

What is the association between cardiovascular disease and periodontal disease

Answer 10

Joshipura et al 1996 showed that men with tooth loss and periodontal disease are 70% more likely to have cardiovascular heart disease

Periodontal disease may affect atherosclerotic lesion formation via different pathways

Question 11

What genetic conditions may be risk factors for periodontal disease

Answer 11

Cyclic neutropenia — low wbc count every 28 days, low immune response, cumulative effect is severe periodontitis

Down’s syndrome —> impaired host immune response hence more prone to advanced periodontitis

Question 12

How is smoking a risk factor for periodontal disease

Answer 12

Smokers have more pathogenic flora. Tobacco smoke and nicotine affect plaque microbiology, affecting gingiva periodontium

Systemic absorption of nicotine can cause pmn leukocytosis, affecting t and b lymphocytes, impairing immune response