ICS2/3: Risk Factors in Periodontal Disease 1 Flashcards
in what ways do systemic diseases increase the chance/risk/severity of periodontal disease occuring in an individual?
- directly: the medical condition itself
- indirectly: the disability caused by the medical condition and/or the effects of its treatment e.g. drug therapy
why is medical history important when it comes to periodontal health?
- systemic factors may account for periodontal condition
- systemic factors may require special precautions to protect patient during treatment e.g. steroid cover
- systemic factors may be hazardous to dentist and healthcare workers e.g. Hep B/C
questions to think about while considering medical history?
- does it affect periodontal prognosis?
- does it cause for a modification in management of patient and the disease?
questions to think about while examining the patient?
- any oral manifestations of the disease?
- do the clinical findings correspond with med history and local factors?
- are there potential effects of periodontitis on the systemic disease?
define “risk factor”
a factor which increases the chance that a disease may develop in an individual
risk factors - cause and effect?
risk factor is biologically related to the occurrence of disease. does not imply cause and effect. presence of risk factor does not mean disease will happen. absence of risk factor does not mean disease will not happen
what is the 2 stage model of disease development for a disease to occur?
- individual must possess genetic risk factors for disease i.e. the inherent susceptibility
- must then be exposed to the environmental risk factors
- disease will then develop
risk factors for periodontal disease - what are the 2 broad categories? what is each based on?
- systemic risk factors. subject based
- local risk factors. site based. (oral factors that increase plaque accumulation or occlusal forces)
systemic risk factors for perio disease:
factors that affect _____?
how do these factors lead to disease development?
- systemic risk factors affect a bodily system (e.g. immune system)
- the systemic factor may adversely affect host response to plaque, leading to disease development
examples of local risk factors for perio disease - plaque retentive factors? x8
- deficient restorations: overhangs/overcontoured restorations
- badly designed/constructed bridgework or dentures
- carious cavities
- anatomy of embrasures/contact points: affects food packing, cleansability
- malalignment of teeth
- orthodontic appliances
- anatomy of teeth: development grooves, talon cusps, furcation)
- mouth breathing
what is a “risk marker”?
signs that a disease is present
what are risk markers for periodontal disease?
- BOP
- mobility
- LOA
- suppuration
risk markers - are they linked to the cause of disease? what do they allow?
- not linked to cause of disease
- may allow early detection of a disease
periodontal risk factors - what are the 2 main types
- modifiable risk factors
- non modifiable risk factors
what are modifiable risk factors?
risk factors where if appropriate counselling/treatment given, risk/severity of periodontal disease will be reduced
examples of modifiable risk factors?
- oral hygiene
- smoking
- restorative overhangs/deficiencies
- poor denture/crown/bridge design
- malocclusion
- alcohol
- stress
what are non-modifiable risk factors? which one is the most important?
- periodontal risk factors that cannot be changed
- most important one is susceptibility (genetic risk) to periodontal disease
with what measures can long term periodontal stability be achieved and maintained?
only through the appropriate management of:
1) modifiable periodontal risk factors
2) adequate periodontal treatment
periodontal risk assessment is important in determining what for an individual patient?
- periodontal prognosis
- treatment planning
- informed consent
assessing periodontal risk in a patient - what to look out for in oral examination? x6
- BOP: absence or presence
- pocket depths
- LOA/true recession
- bone levels (radiograph)
- mobility
- furcation involvement
- oral hygiene
- occlusion
- plaque retentive factors
broad categories of systemic risk factors in perio disease?
- genetic factors
- behavioural
- environmental
- endocrine/metabolic
- lifestyle factors
- haematological
genetics: significance in determining susceptibility to CP?
how many disease modifying genes are involved in determining risk for CP?
genetics is an important determinant in individual susceptibility to CP
- no single genetic change can account for determining genetic risk to CP
- 10-20 candidate genes determine risk for CP
what is a single nucleotide polymorphism?
a single nucleotide change in the genetic code
what do genetic changes seem to affect?
affect host response especially with regard to neutrophil function, reducing the host’s ability to fight off periodontal infection by perio-pathogens
highly destructive perio diseases that result in tooth loss are associated with which genetic diseases?
- downs syndrome
- hypophosphatasia
- papillo-lefevre syndrome
- ehlers-danlos syndrome
- chedak-higashi syndrome
genetic factors - downs syndrome:
results in what type of systemic issues?
- cardiac abnormalities (40%)
- immune effects
- abnormal collagen biosynthesis
- learning diffculties - tends to have poor OH
genetic factors - downs syndrome: results in what type of immune defects?
- neutrophil defects - chemotaxis, phagocytosis and killing defects.
- B lymphocyte receptor defects
chediak-higashi syndrome
- what type of condition?
- defects in?
- what type of oral condition?
- what type of tooth loss?
- autosomal recessive, rare
- defects in neutrophil and monocyte chemotaxis, phagocytosis and reduced intracellular killing
- aggressive-like periodontitis
- early loss of primary & secondary teeth
papillon lefevre syndrome
- how rare?
- what type of condition?
- defects in?
- classical signs?
- 1 in 4 million
- autosomal recessive, chromosome 11 defect
- reduced neutrophil function
- signs seen in 2-4 y/o:
palmar & plantar hyperkeratosis, aggressive-like periodontitis
ehlers-danlos syndrome
- genetic defects lead to defects of?
- symptoms?
- how many sub-types? which are the ones to take note of and why
- lead to defects in collagen synthesis
- excssive joint mobility, skin hyperextensibility, cardiac valve defects
- 10 subtypes, look out for 4 and 8
IV: tend to have bleeding
VIII: associated with aggressive-like periodontitis
hypophosphatasia how rare? what type of condition deficiency in? leads to? what is the result of the defect? affects which set of teeth?
- 1/100,000
- autosomal recessive
- deficiency in enzyme alkaline phosphatase
- abnormal mineralization of bones and teeth, abnormal cementum
- premature loss of deciduous teeth
- only deciduous, not permanent teeth
