PD: Systemic risk factors (session 2 & 3)

Question 1

How many cigarettes are in: 1g of pipe tobacco, 1 small cigar, and cigar?

Answer 1

1g of pipe tobacco = 1
1 small cigar = 3
cigar = 5

Question 2

What are two indicators of high nicotine dependency?

Answer 2

1. Smoking at least 15-20 cigarettes per day.
2. Smoking within 30 minutes of waking.

Question 3

Three types of approaches to smoking cessation

Answer 3

1. Pre-contemplators: not interested.
2. Contemplators: interested unready.
3. Active quitters: making an attempt.

Question 4

Smoking cessation: 5 As

Answer 4

For patients more open to quitting:
1. Ask (about the smoking use status)
2. Advise (about the advantages and value of stopping)
3. Assess (how motivated a patient is to stop)
4. Assist (those who wish to stop)
5. Arrange (monitoring, follow-up and referral).

Question 5

Smoking cessation: 5 Rs

Answer 5

For patients more resistant to quitting:
1. Relevance (of smoking to the individual)
2. Risks (associated with smoking)
3. Rewards (of cessation to be stressed)
4. Road (blocks must be identified)
5. Repetition (repeat at each consultation)

Question 6

What are the important carcinogens in smoke?

Answer 6

Polycyclic aromatic hydrocarbons and N-nitroso compounds.

Question 7

calculus and smoking

Answer 7

1. More calculus than non-smokers.
2. Increased salivary flow rate as a response to the irritant particulate matter in smoke (this causes a raised pH, calcium concentration & raised precipitation of calcium phosphate thus calcium deposition occurs i.e calculus).

Question 8

Smoking key effects on periodontal tissues

Answer 8

1. Reduced vascularity
2. Reduced inflammatory & immune responses
3. More pathogenic plaque biofilm
4. Direct toxic effects on various cell types e.g. fibroblasts.
5. Thermal damage (especially if reverse smoking - put the lit part in your mouth)

Question 9

How does smoking effect vascularity of the periodontal tissues?

Answer 9

Nicotine is a powerful vasoconstrictor & was thought to cause reduced blood flow.
Reality: Change in vascularity due to inflammatory response.

Question 10

How does stress affect saliva?

Answer 10

Salivary flow decreases and the saliva seen is more viscous with a higher glycoprotein content. Salivary acidity also increases.

Question 11

Which study first showed the correlation between stress and periodontal breakdown?

Answer 11

Genco, et al. 1999. “Financial strain & depression found to be associated with increased periodontal breakdown.”

Question 12

Give an example of a non-modifiable risk factor

Answer 12

Genetic susceptibility

Question 13

Three key ways to assess patient’s genetic susceptibility to PD

Answer 13

1. Extent of previous disease
2. Age
3. Level of oral hygiene

Question 14

What genetic factors can put someone at a higher risk of periodontitis?

Answer 14

No single genetic change, there are at least 10-20 disease-modifying genes involved.

Variations within the structure of genes (polymorphisms) result in altered protein production.

Question 15

Key genetic systemic diseases which are associated with very destructive periodontal disease

Answer 15

1. Down’s syndrome
2. Papillon-Lefevre syndrome
3. Chediak-Higashi syndrome
4. Ehlers-Danlos syndrome
5. Hypophosphatasia

Question 16

Cardiovascular disease and PD link: The Common Susceptibility Model.

Answer 16

Possess hyper-inflammatory (over-reactive monocyte phenotype). Leads to cytokine ‘storms’ increases systemic inflammation.

Question 17

Cardiovascular disease and PD link: Invasion/uptake of bacteria into endothelial cells & macrophages.

Answer 17

Perio pathogens can invade blood vessel walls and contribute to atherosclerotic plaque formation.