L3 Periodontal medicine Flashcards
What is meant by the term periodontal medicine?
A collective term to describe how periodontal infection/inflammation can affect extraoral health.
Association between periodontal disease and systemic disease.
Why is periodontitis believed to have systemic effects?
Inflammation is the primary pathological feature of periodontal disease.
Presence of other chronic inflammatory disease has been shown to have implications in systemic conditions such as:
- Glycaemic control (diabetes)
- Cardiovascular disease
- Respiratory disease
- Pregnancy outcomes
Important to bear in mind that a risk factor may be associated with increased probability of occurrence of a particular disease without it being a causal factor.
Explain the pathogenesis of periodontal disease.
Periodontitis:
- Increased cytokines, MMPs and oxidative stress
- Bone resorption through action of osteocalsts
- Gingival tissue degradation through action of MMPs and lysosomal enzymes
What are the 3 theories of how oral infection is linked to systemic disease?
- Oral tissues acting as a bacterial reservoir: bacteria and their inflammatory mediators may enter blood and spread systemically
- Bacteria entering circulation via sulcular epithelium (through ulcerated gingival tissues)
- Immuno-inflammatory reponse: if acute perio lesion persists, bacterial antigens are processed and presented to the adaptive immune system which is co-ordinately involved in tissue destruction
Briefly outline the systemic diseases that are associated with periodontal diseases.
- Cardiovascular: MI, atherosclerosis, stroke
- Endocrine: diabetes
- Reproductive: preterm low birth weight, adverse pregancy e.g. pre-eclampsia
- Respiratory: COPD, pneumonia
- Autoimmune: rheumatoid arthritis
Describe the associations between diabetes and periodontitis.
- 2018 report found that people with periodontitis have a higher HbA1C (glycated haemoglobin)
- Aka. higher average plasma glucose concentration, more glucose bound to Hb in blood
- Found that perio patients with type 2 diabetes had poorer glycemic control
- Perio patients had more diabetes complications (retinopathy, chronic kidney disease, neuropathic foot, CV disease)
- Higher overall morrality in perio patients with type 2 diabetes
- Patients with periodontitis have a higher chance of developing pre-diabetes and diabetes
What did the 2018 consensus report discover regarding the mechanistic links between diabetes and periodontal disease?
- People with diabetes and people with periodontitis both had elevated IL-1-β, TNF-α, IL-6, CRP and mediators of oxidative stress
- These pro-inflammatory mediators may affect the control of diabetes
- Successful perio treatment reduces circulating levels of CRP and TNF-α in diabetic patients
What did the 2018 consensus report discover regarding periorontal intervention and diabetes?
- Periodontal therapy is safe and effective in diabetics, and is associated with reductions in HbA1C of 0.27-0.48% after 3 months, although studies involving longer-term follow ups are inconclusive
- No evidence that antibiotics enhance HbA1C reduction over non-surgical management in type 2 diabetics
What recommendations are there for dentists in the treatment of diabetic patients?
- Advise diabetic patients of their increased risk of periodontal disease
- Inform them if they have perio they are higher risk for complications
- Thorough history, ask about their HbA1C (below 6.5%)
- If infection presents, treat promptly
- Provide non-surgical management regardless of glycaemic control
- Avoid surgical treatment and implants in uncontrolled diabetes
- Be aware of other oral complications of diabetes
- Closely monitor young type 1 diabetics, annual oral screening for early signs of periodontal involvement starting age 6
- Be aware of undiagnosed patients which present with risk factors e.g. obesity, poor diet, middle age/older
What should a diabetics patient’s HbA1C be below?
Ideally HbA1C below 6.5%
What conditions has maternal periodontitis been associated with?
- Low birth weight
- Pre-term birth
- Pre-eclampsia
What is the association between PTLBW (pre term low birth weight) and periodontal disease?
- Mothers who have had PTLBW babies have worse periodontal conditions than babies born healthy weights full term
- Periodontal disease is an independent risk factor for PTLBW
- Mothers with PTLBW have been found to have higher levels of Bacterioides forsythus and Campylobacter rectus
How does pregnancy worsen periodontal condition?
Pregnancy increases the inflammatory gingival response to plaque
What are the effects of successful periodontal treatment on pregnancy outcome?
Some research has found a strong and significant relationship between successful periodontal treatment and full term birth.
Patients with unsuccessful perio treatment were significantly more likely to have PTB.
What did the EFP and BSP report regaring pregnancy and periodontal disease?
- Possible mechanisms that link periodontitis and adverse pregnancy outcomes involve commensal and pathogenic bacteria colonising the foeto-placental unit via the blood
- Based on our current understanding, it is likely that periodontal therapy would be more effective in reducing the risk of adverse pregnancy outcomes if it took place prior to conception
What recommendations did these guidelines outline?
- For pregnant women with a healthy periodontium: inform women of the periodontal events that usually occur during pregnancy- increased vascularity, higher incidence of bleeding and gingival enlargement, and of the general adverse outcomes that may occur during pregnancy- hypertension, gestational diabetes etc. Provide OHI and review pt later in pregnancy.
- Gingivitis: as above + PMPR
- Periodontitis: as above + non-surgical management, this is safe and effective in the second trimester
