Modifying Factors for Periodontal Diseases

Question 1

What can gingivitis progress to?

Answer 1

GIngivitis can be controlled and this will prevent complications from taking place by controlling biofilm and bacterial biomass

Question 2

What is the relationship between dental plaque and periodontitis?

Answer 2

Dental plaque is the main aetiological agent for periodontitis. However, it is not enough as some people have lots of plaque and very little periodontal disease.

Question 3

What do risk factors do to periodontium during periodontitis in addition to dental plaque?

Answer 3

The developmentt of the disease (who)

The progression of the disease

The response to therapy

The rate of progression of the disease

And recurrence rate

Question 4

What are the types of risk factors for periodontal disease?

Answer 4

Local factors: Such as overhanging restorations and root caries that tend to allow for plaque accumulation. Eg pocket depth, intrabony projections, and root canal infections.

Systemic factors: Such as cigarette smoking, diabetes mellitus and genetic factors

Question 5

What do predisposing factors do and what are some examples?

Answer 5

Predisposing factors might increase probability of disease occurence and usualyl have localized effects.

These factors include anthing which retains or ginders the removal of dental plaque: Calculus,, overhangs,

Question 6

What are modifying factors?

Answer 6

Modifying factors ted t act in systemic fashion which will alter nature or course of the disease

Altering nature of immune response.

Question 7

What are the main systemic modifying factors for periodontal disease?

Answer 7

Diabetes

Puberty

Smoking

Menopause

Pregnancy

Question 8

How do main systemic modifying factors affect periodontal disease?

Answer 8

They affect physiological response, vascular system

Question 9

Why is it so important to control periodontal disease?

Answer 9

Periodontal disease seems to have a big effect on the rest of the body and so it should be controlled.

More than 100 systemic disease/conditions and 500 medications have oral manifestations.

Periodontitis is a risk factor for many systemic diseases including adverse pregnancy outcomes. Stroke, osteoporosis, rheumatoid arthritis, etc

Question 10

How does pregnancy affect the periodontium?

Answer 10

Hormonal variations can result in significant changes in the periodontium. Especially if there is previous plaque and gingivitis. This means women can be more prone to exacerbated gingivitis as a result.

Question 11

What hormonal changes can affect the periodontium?

Answer 11

Puberty

Menstruation

Pregnancy

Menopause

Question 12

What non-physiological hormone changes can affect the periodontium?

Answer 12

Non Physiological Hormone changes:

Hormone Replacement

Contraceptives

Question 13

What do estrogen and progesterone do in the periodontium?

Answer 13

Affects salivary peroxidases active against microorganisms

Stimulation on collagen metabolism and angiogenesis

Trigger paracrine polypeptide growth factors

Modulation of vascular responses and connective tissue turnover in the periodontium

Question 14

What does puberty do?

Answer 14

Raised testosterone in males

Raised estradiol in females

Increased gingival inflammation

Papillary bleeding, interdental bleeding

Increased prevalence of P intermedia

Question 15

What happens to gums during menstruation?

Answer 15

Increase of Gingivitis in women

Increased GCF exudate

Increased inflammation

Increased tooth mobility

Fluctuation of levels of estrogen and progesterone

Question 16

How does pregnancy affect the periodontium?

Answer 16

Increased levels of steroid hormones

Estradiol, Estriol and Progesterone

Pregnancy gingivitis

Increased BOP GCF and probing depth

Prevalence 35-100%

More gingivitis pregnancy - than postpartum

Exaggerated response to bacteria

Progesterone estrogen oral contraceptives suppress immune response to plaque

PMN chemotaxis, phagocytosis, antibody T cell response depressed

Increase blood levels
progesterone
• Enhance capillary
permeability
• Increased Gin Exhudate
• Stimulation of Prostaglandin
synthesis
• Estrogens and progesterone
decreased keratinization gin
epithelium and connective
tissue
• Decreased epithelial barrier 

Selective increase P Intermedia
• Hormones as GF for P intermedia
• 55 fold increase in P Intermedia
in pregnancy
• Change in microbial ecology pocket

Question 17

What lesion is more common in pregnancy? How is it treated and what is the recurrence rate like?

Answer 17

Pedunculated fibro granulomatous lesion

Vascular and matrix effect estradiol in previous gingivitis sites

Anterior papilla maxillary teeth 2 cm

Recurrence poor plaque control and hormones

OHI and debridement

Question 18

How do hormonal contraceptives affect the gingiva?

Answer 18

Synthetic hormones estrogen progesterone:

Increased gingival inflammation and exudate

Systemic risk Cardiovascular disease Thromboembolic
episodes Clothing factors

Ischemic heart disease

Estrogen-progesterone

Progesterone

Progesterone implants

Progestin injection

Question 19

How does periodontitis affect pregnancy?

Answer 19

Inflammatory mediators TNF-alpha and PGE2

Increase in fetal death

Decreased fetal birth weight

P. gingivalis LPS in animal induced LBW

Offenbacher (1996) women with LBW greater Periodontitis

Periodontitis five fold risk for birth before week 35

Periodontitis seven fold risk for birth before week 32

Question 20

How does periodontal treatment affect pregnancy?

Answer 20

EFFECT OF PERIODONTAL TREATMENT

LOPEZ (2002)
INTERVENTION BEFORE WEEK 28 LBW 1.8%
COMPARED TO CONTROLS 10.1%

PERIODONTAL DISEASE IS ASSOCIATED WITH
ADVERSE PREGNANCY OUTCOME

CAUSAL ROLE IS UNCLEAR