Modifying Factors for Periodontal Diseases Flashcards
What can gingivitis progress to?
GIngivitis can be controlled and this will prevent complications from taking place by controlling biofilm and bacterial biomass
What is the relationship between dental plaque and periodontitis?
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.
What do risk factors do to periodontium during periodontitis in addition to dental plaque?
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
What are the types of risk factors for periodontal disease?
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
What do predisposing factors do and what are some examples?
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,
What are modifying factors?
Modifying factors ted t act in systemic fashion which will alter nature or course of the disease
Altering nature of immune response.
What are the main systemic modifying factors for periodontal disease?
Diabetes
Puberty
Smoking
Menopause
Pregnancy
How do main systemic modifying factors affect periodontal disease?
They affect physiological response, vascular system
Why is it so important to control periodontal disease?
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
How does pregnancy affect the periodontium?
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.
What hormonal changes can affect the periodontium?
Puberty
Menstruation
Pregnancy
Menopause
What non-physiological hormone changes can affect the periodontium?
Non Physiological Hormone changes:
Hormone Replacement
Contraceptives
What do estrogen and progesterone do in the periodontium?
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
What does puberty do?
Raised testosterone in males
Raised estradiol in females
Increased gingival inflammation
Papillary bleeding, interdental bleeding
Increased prevalence of P intermedia
What happens to gums during menstruation?
Increase of Gingivitis in women
Increased GCF exudate
Increased inflammation
Increased tooth mobility
Fluctuation of levels of estrogen and progesterone
How does pregnancy affect the periodontium?
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
What lesion is more common in pregnancy? How is it treated and what is the recurrence rate like?
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
How do hormonal contraceptives affect the gingiva?
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
How does periodontitis affect pregnancy?
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
How does periodontal treatment affect pregnancy?
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
