Epidemiology and Etiology Flashcards
What is the difference between a risk factor and a risk indicator
A risk factor has been confirmed by longitudinal study, and a risk indicator has been shown in cross-sectional study but not confirmed
Risk for gingivitis and periodontitis
Poor Oral Hygiene
Risk Factor
Listgarten showed increased plaque mass or reeduced host defense causes periods of periodontal destruction
Loe et al found 8% of population had rapid progression, 11% had no progression, and 81% had moderate progression
Risks of gingivitis and periodontitis
Dental plaque and biofilm retention factors
Risk Factor
a direct or indirect restoration with overhanging margin can be associated with localized gingivitis, increase in PD and BL
tooth position (crossbite/crowding etc)
Risks of gingivitis and periodontitis
Oral Dryness
Risk Factor
reduced cleansing which can lead to increased dental plaque and increased inflammation
Risks of gingivitis and periodontitis
Smoking
Risk Factor
strongest modifiable risk factor and predictor of future disease
Grossi, smokers are 2.7 times more likely to have periodontal disease than nonsmokers
smokers have 18 times more periodontal pathogens compared with nonsmokers
Risks of gingivitis and periodontitis
Diabetes
Risk Factor
3X more bone loss and attachment loss
after treatment of periodontal disease there is a 10% drop in blood sugar levels
Risks of gingivitis and periodontitis
Genetics
Risk Factor
Kornman et al 86% of severe periodontitis patients were either smokers or had the interkeukin-1 genotype
Michalowicz et al 50% enhanced risk for periodontitis can be accounted for by genetics alone
Risk indicators of periodontitis
Age - increased age associated with increased severity
Sex - Male have poorer OH
Socioeconomic status - lower SES have less access to care
Race - greater incidence in Black and Hispanic, with Blacks showing a much greater risk of aggressive periodontitis
Obesity - adipose tissue can produce cytokines. Gorman et al found increased prevalence in men
Alcohol - Shepherd found evidence that alcohol was a risk indicator. Gay et al found overall increased likelihood
Stress - Genco found association with financial stress and the patient coping mechanisms
Contraceptives - a plausible association between injectable contraceptives and poor OH
Recreationally cannibs - recurrent cannibis use may be linked
What is an odds ratio
The probability that a person with an adverse outcome was exposed to risk. A ratio greater than 1 has a positive assocaition.
What is the difference between sensitivity and specificity
Sensitivity is the proportion of subjects with a disease who test positive
Specificity is the proportion of subjects without disease who test negative.
What is the difference between prevalence and incidence
Prevalence is defined as the total number of cases in the population at a given time, divided by the number of individuals in the population
Incidence is a measure of the risk of developing a new condition within a specified period of time.
prevalence is better for chronic conditions (periodontitis) vs incidence is better for acute conditions (toothache)
What is gingival index
Loe - incorporates BOP and colour change
0: Normal gingiva
1: Mild inflammation, no BOP
2: moderate inflammation and BOP
3: severe inflammation, spontaneous bleeding
Average GI in US population is 1.055. 93.9% greater than 0.5, and 55.7% greater than 1
What factors can increase/decrease BOP scores
increase BOP score
Anticoagulant
Medications
Probing force over 25N
Decrease BOP
Smoking
What is the prevalence of gingivitis
Albandar and Kingman found a prevalence of 32.3% (21.8% limited and 10.5% extensive)
mild localized clinical inflammation is found in 95% of the population
What percentage of tooth extractions are caused by periodontitis
Brown et al less than 20% of all missing teeth
Overall mean anual attachment loss is 0.1mm per year, and mean tooth loss is 0.2 teeth per year. Periodontitis patients lose 0.6mm per year
Worldwide incidence of periodontitis
Severe periodontitis is 11% of the world population
Localized aggressive periodontitis is 0.53%
Generalized aggressive periodontitis is 0.13%
2009-2014 NHANES US prevalence of periodontitis
- 2% of dentate adults over 30 have periodontitis. 7.8% severe periodontitis and 34.4% non-severe
- 3% of all periodontally probed sites or 9.1% of all teeth had probing depth 4mm or greater.
what percentage of adults have gingival recession
88% of people over 65 and 50% 18-65 have one or more sites
Association of periodontitis and preterm births and low birth weight
Offenbacher et al found 11.2% preterm birth with no periodontal disease and 28.6% with moderate to severe periodontitis.
Treatment was safe but did not alter the rates of preterm birth.
Lopez et all found an assocation with periodontal disease and preterm birth
Does food impaction contribute to periodontal pathosis
Open contacts are correlated with food impaction which is correlated with increased probing depth, however no direct relationship
Jernberg found less plaque but increased probing depth and attachment loss for open contacts.
How does smoking affect periodontitis
increases expression of cytokines involved in periodontal destruction.
Grossi et al found heavy smokers have 6-7X more alveolar bone loss
90% of persons with refractory periodontitis are smokers
Attachment loss severity increased by 0.5% by smoking 1 cigarette per day, while 10 increased attachment loss by 5% and 20 by 10%.
How does smoking affect healing after surgery
Root coverage following FGG is diminished by heavy smoking, especially for root coverage
Near 100% failure to obtain root coverage
less clinical attachment improvement in smokers
Implant success is reduced in smokers
How should a dentist manage a patient who smokes
5 A’s
- Ask about smoking at each appointment
- Advise and educate patients on the benefits of quitting
- Assess the patient’s willingness to quit
- Assist the patient with developing a plan to quit
- Arrange for follow-up visits, and ask them again
Does smoking cessation affect periodontal therapy
Kaldahl et al found a history of smoking did not adversely affect the outcome of therapy, but current light and heavy smoking did
Hyman and Reid found odds ratio for LOA was greatest for current smokers, and decreased for former smokers as the number of years since smoking increased.
Is there a difference between smoking a pipe or cigars vs cigarettes
Krall et al found similar rates of alveolar bone loss and tooth loss for both cigar or pipes and cigarettes
How does vaping affect the periodontal tissues
Sundar et al found vaping produces increased oxidative carbonyl stress and cytokine release in PDL
Wadia et al found that vaping had an increase in BOP compared to smoking
What are the characteristics of biofilms
dynamic, optimally organized to make use of nutrients
They have more stability, cohesiveness, antibiotic resistance compared to free-living organisms
What are plaque and calculus
Plaque consists of bacterial byproducts such as enzymes, food debris, calcium, phosphate, with polysaccharides and proteins, and calcium and phosphorus
Calculus is calcium phosphate salts
What are the specific and nonspecific plaque hypothesis
Loesche and Giordano
Specific plaque - only certain microorganisms cause disease
non-specific plaque - periodontitis and caries are the result of noxious agents from the entire bacterial population
Aa description
Aggregatibacter actinomycetemcomitans facultative anaerobe nonmotile, gram negative rod Leukotoxin, kills PMNs and macrophages LPS collagenase induces bone resorption
Pg description
Porphyromonas gingivalis
Obligate anaerobe
Nonmotile, gram negative, non spore forming
Gingipains cleave host progeins between arginine and lysine
LPS produces collagenase, induces bone resorption
inhibits interleukin 8
Pi description
Prevotella intermedia Anaerobe Nonmotile, gram negative Common in pregnancy, common in NUG MMP to descroy the connective tissue Actin polymerixation of the cytoskeleton
Fn description
Fusobacterium nucleatum Anaerobe Nonmotile, gram negative, non spore forming Butyric acid inhibits fibroblasts Supports growth of P gingivalis
Tf description
Tannerella forsythia Anaerobe Non motile, gram negative filament shape Associated with refractory/advanced periodontitis Associated with early implant failure
Td description
Treponema denticola Anaerobe Highly motile, spiral shaped Found in necrotozing gingivalis Spore forming surface protein
Describe red complex bacteria
P gingivalis
T forsythia
T denticola
red complex increase in prevalence and numbers with increasing pocket depth
Describe orange complex bacteria
F nucleatum P intermedia Pepsotostreptococcus micros Campylobacter rectus Campylobacter gracilis Show an association with increasing pocket depth
Yellow complex bacteria
Streptococcus mitis
Streptococcus sanguinis
Streptococcus oralis
no association with pocket depth
Green complex bacteria
Capnocytophaga species
Eikenella corrodens
A actinymycetemcomitans
no assosiation with pocket depth
What bacterial changes occur from health to disease
Gram positive to gram negative
Cocci to rods
Non-motile to motile
facultative to obligate anaerobes
What percentage of gram positive and gram negative are found in gingivitis
about 50/50
Which bacteria are associated with health/gingivitis/aggressive periodontitis/chronic periodontitis
Health - Sgreptococcus sanguis, Streptococcus mitis, Actinomyces viscosus, Actinomyces naeslundii
Gingivitis - Actinomyces naeslundii, Campylobacter gracilis, Tanerella forsythia
Aggressive periodontitis - A actinomycetemcomitans
Chronic periodontitis - P gingivalis T forsythia, F nucleatum, P intermedia
Bacteria assocaited with refractory periodontal disease, HIV, necrotizing periodontal disease
Refractory perio - T forsythia, P intermedia, and P gingivalis
HIV - A actinomycetemcomitans, P gingivalis
Necrotizing perio - Spirochetes (T denticola) and P intermedia
Which bacteria are assocaited with implant failure, diabetes, preterm birth
implant failure - T forsythia, spirochetes, P gingivalis
Diabetes - Capnocytophaga species, P gingivalis, P intermedia
Preterm birth and low birth weight - A actinymocetemcomitans, P gingivalis, T forsythia, and T denticola
