PD: Systemic risk factors (session 1)

Question 1

Inflammatory response key players

Answer 1

PMNs, Cytokines, IL1, PGE2, Osteoclast activation.

Question 2

Linea alba

Answer 2

Streak white line on buccal mucosa typically from cheeky bitting etc.

Question 3

Rothman’s causality pies

Answer 3

An individual factor that contributes to cause disease is shown as a piece of a pie, like the triangles in the game Trivial Pursuit. After all the pieces of a pie fall into place, the pie is complete, and disease occurs. The individual factors are called component causes.

Question 4

Obesity (BMI)

Answer 4

> 30 (25 = overweight)

Question 5

How does being fatter encourage greater desire to eat?

Answer 5

High adipose tissue (fat) means the insulin will not work correctly, encouraging patients to continue to eat.

Question 6

How does adipose tissue cause greater inflammation in patients?

Answer 6

Adipose tissue produces cytokines, TnF alpha IL6, Pro inflammatory mediators, Adipokines (leptin etc. which are proinflammatory).

Question 7

How could adipose tissue increase bacterial activity?

Answer 7

Bacteria can use cytokines (a product of adipose tissue) as an energy source, increase proteolytic activity and increase anaerobes.

Dysbiosis results as aerobic pathways become fermentation.

Question 8

Poorly controlled diabetes are ___ more at risk of periodontitis.

Answer 8

three times

Question 9

HbA1c

Answer 9

Average blood glucose (sugar) levels for the last two to three months.

Question 10

Foods the associated with advanced glycation end products.

Answer 10

Fried food, processed food, meat, cheese.

Vascular aging and damage.

Question 10

Foods the associated with advanced glycation end products.

Answer 10

Fried food, processed food, meat, cheese.

Vascular aging and damage.

Question 11

Sleep apnoea

Answer 11

When your breathing stops and starts while you sleep.

Question 11

Sleep apnoea

Answer 11

When your breathing stops and starts while you sleep.

Question 12

How can sleep apnoea affect periodontitis?

Answer 12

36% higher chance of developing severe periodontitis over control patients.

Sleep regulates immune and inflammatory processes.

Question 13

Prebiotic foods

Answer 13

Fibres, cruciferous vegetables ( 🥦 )

Question 14

Five major complications of Diabetes Mellitus

Answer 14

1. Atherosclerosis (the buildup of fats, cholesterol and other substances in and on the artery walls).
2. Retinopathy (a complication of diabetes, caused by high blood sugar levels damaging the back of the eye (retina)).
3. Nephropathy (the deterioration of kidney function)
4. Neuropathy (a result of damage to the nerves located outside of the brain and spinal cord)
5. Impaired wound healing

Question 15

What is the 6th complication of diabetes mellitus as described by Loe (1993)?

Answer 15

Periodontal disease

Question 16

Target levels for HbA1C

Answer 16

Less than 48 mol/mol (6.5%) - Diabetes UK.

Question 17

How often should you ask a diabetic patient about their HbA1c level?

Answer 17

At each visit, compare this with the clinical findings to see how it compares.

Question 18

What features of the papillae may indicate diabetes?

Answer 18

Purpling or pus discharging (multiple sites - systemic indicatior)

Question 19

Four major biochemical effects of uncontrolled diabetes

Answer 19

1. Increased formation of advanced glycation end-products (AGE).
2. Altered Immune Cell Function.
3. Altered Fibroblast Function.
4. Poor wound healing.

Question 20

How might AGE negatively affect the cellular function of various cell types throughout the body?

Answer 20

Many cells within the body have specific cell surface receptors for AGE. Therefore these cells (endothelial cells, fibroblasts, neurones, monocytes/macrophages) can be negatively affected. AGE products also lead to oxidative stress.

Question 21

How is the reduced neutrophil (PMN) function be illustrated in the mouth?

Answer 21

Persistent bacterial infection and tissue damage found (multiple pus producing sites).

Question 22

Hyper-responsive monocytes and macrophages result in…

Answer 22

Increased secretion of pro-inflammatory mediators such as cytokines (IL-1 & TNF α) & prostaglandins (PGE₂).

Results in increased tissue damage and impaired wound healing.

Question 23

How do pro-inflammatory mediators result in systemic inflammation?

Answer 23

They leak into the bloodstream resulting in increased systemic inflammation (this can cause the liver to release proteins which further amplifies this inflammation).

Question 24

How might you discuss excess alcohol consumption with patients?

Answer 24

Question 25

Biochemical affects of excess alcohol

Answer 25

• Defective neutrophil function
• Altered clotting mechanism (defective prothrombin and vitamin K activity)
• Increased bone resorption and decreased bone formation.
• Reduced healing (deficiency of Vitamin B-complex and protein)
• Direct toxic effect on periodontal tissues.

Question 26

Alcohol vs smoking impact on clinical attachment loss

Answer 26

Similar influence.

Question 27

Role of Vitamin C

Answer 27

1. Essential for collagen
2. Additionally important immune functions.
3. Defends against oxidative stress and free radicals.
4. Promotes chemotaxis
5. Also essential for iron absorption.

Question 28

Role of vitamin D

Answer 28

1. Skeletal development
2. Modulation of immune system
3. Deficiency of vitamin D associated with reduced immunity and increased autoimmunity.

Question 29

How much Vitamin D is needed per ml serum

Answer 29

At least: 30mg per ml serum
Optimal is 40-60mg per ml serum

Question 30

How much vitamin D is needed in mg daily

Answer 30

100-125mg per day

Question 31

What is the recommendation to ensure people are getting enough vitamin D?

Answer 31

Supplementing with 50 mg per day.

Question 32

What does the current evidence suggest with vitamin D and periodontal disease?

Answer 32

There is insufficient evidence, however due to the effect on the immune system it is likely that there is a link. More evidence in the coming decade should reveal more on this.

Question 33

Why might eating a whole piece of fruit as opposed to taking supplements be better?

Answer 33

Eating the whole fruit means consumption go fibres and other nutrients that feed the gut/microbiome which aids its ability for absorption.

Question 34

Prebiotics

Answer 34

Think of as the “soil” - feeds the gut.

Mannan, oligosaccharides, lignin.

Question 35

Probiotics

Answer 35

Think of as the “seeds” - good bacteria consumed through foods (they need the prebiotics to be present in order to nourish them).

Question 36

Benefits of cruciferous vegetables

Answer 36

Anti-inflammatory
Support the symbiotic bacteria
Antioxidant, phytochemical, complex fibres

Question 37

Examples of cruciferous vegetables

Answer 37

Cabbage, cauliflower, broccoli, watercress.

Question 38

How can neutrophils start to have a negative effect on tissues?

Answer 38

High glucose puts neutrophils under oxidative stress and causes them to go rogue and begin destroying tissues.

Question 39

How can antioxidants be beneficial to the body (and what are some examples of these)?

Answer 39

Antioxidants mop up free radicals and reduce the effect of oxidative stress.

Red wine and dark chocolate.