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MODULE 6 > PERIO - systemic disease > Flashcards

PERIO - systemic disease Flashcards

1
Q

what is a periodontal pocket filled with in the presence of periodontal disease?

A

pathogenic anaerobic biofilm

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2
Q

what makes the periodontal pocket ulcerated and leaky?

A

inflammatory reaction between pathogenic anaerobic biofilm and adjacent gingival tissues

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3
Q

what do inflamed periodontal tissues contain?

A

large numbers of invading bacteria and host inflammatory cells (secrete pro-inflammatory mediators IL-1, TNFa, PGE2)

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4
Q

how may periodontal bacteria (bacteraemia) and inflammatory mediators spill over into the systemic bloodstream?

A

periodontal tissues are very vascular
blood vessels within inflamed tissue are very leaky

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5
Q

what accounts for the link between periodontal disease and systemic chronic disease?

A

leaking of pro-inflammatory mediators and/or perio bacteria into the systemic bloodstream:
- raise systemic inflammation
- direct effects of bacteraemia
- or both

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6
Q

what systemic disease has a bi-directional relationship with periodontal disease?

A

diabetes

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7
Q

list some systemic disease that could be linked to perio disease?

A

diabetes
CVD
resp disease
kidney disease
osteoporosis
alzheimers
IBD

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8
Q

why is it difficult to confirm a link between chronic conditions and periodontal disease?

A

they share the same risk factors (smoking, poor diet, genetic factors)

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9
Q

what are ways in which systemic diseases can affect the periodontal tissues?

A

progression of plaque induced periodontitis (negative effect of host response to plaque)
periodontium independently of dental induced inflammation

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10
Q

what can systemic disease be classified into regarding periodontitis?

A
  1. systemic disorders that have a major impact on the loss of periodontal tissues by influencing periodontal inflammation (conditions that make perio worse)
  2. other systemic disorders that influence the pathogenesis of periodontal diseases
  3. systemic disorders that can result in loss of periodontal tissues independent of periodontitis
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11
Q

describe group 1 systemic conditions?

A

have a negative effect on the host response to plaque bacteria - lowering immune response to the invading bacteria promoting periodontal disease progression

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12
Q

what are examples of group 1 systemic conditions (make perio worse)?

A

Down syndrome
Papillon-Lefevre syndrome
Ehlers-Danlos syndrome (type IV and VIII)

HIV

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13
Q

what is the medical name for Down syndrome?

A

Trisomy chromosome 21

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14
Q

how many people with Down syndrome have cardiac abnormalities?

A

40-50%

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15
Q

what immune defect presents with down syndrome?

A

neutrophil (PNM) defects - no chemotaxis to gingival tissues, no phagocytosis

T-cell migration to perio tissues so increase release of matrix metalloproteinases = tissue damage

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16
Q

other than immune defects, what else does down syndrome present with that results in perio problems?

A

abnormal collagen biosynthesis (lots of collagen breakdown)

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17
Q

how rare is papillon-lefevre ?

A

1 in 4 million - typically in ethnic groups from india/ pakistan

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18
Q

what type of disorder is papillon-lefevre?

A

autosomal recessive - defect chromosome 11, reduced function of neutrophils

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19
Q

what are clinical signs of papillon-lefevre disorder in 2-4 year olds?

A

palmar (hand) plantar (feet) hyperkeratosis
severe periodontitis soon after eruption and early loss of primary and secondary teeth

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20
Q

what type of disorder is Chediak-Higashi syndrome?

A

rare autosomal recessive condition - defects in neutrophil and monocyte chemotaxis, phagocytosis and reduced intracellular killing

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21
Q

what effects does Chediak-higashi syndrome have on the periodontium?

A

very little bone
severe perio with high risk of early loss of primary and secondary teeth - responds poorly to perio tx

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22
Q

what type of disorder is cyclic neutropenia?

A

rare autosomal dominant condition - reduced leukocyte numbers and cyclic depression of neutrophils (PNMs)

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23
Q

what is a cyclic depression?

A

levels fluctuate in cycles

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24
Q

describe cyclic neutropenia?

A

when neutrophils levels drop, gingival inflammation increases (lots of ulcers, severe perio)

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25
what are symptoms of Ehlers danlos syndrome?
stretchy skin and mobile joints cardiac valve defects
26
how does ehlers danlos syndrome affect the periodontium?
type IV - bleeding tendency type VIII - grade C perio
27
what is hypophosphatasia?
rare autosomal recessive condition (1:100000)
28
what causes hypophosphatasia?
deficiency in enzyme alkaline phosphatase
29
how does hypophosphatase affect the periodontium?
abnormal mineralisation of bones and teeth - abnormal cementum premature loss of deciduous teeth *permanent teeth appear not to be affected
30
what 2 periodontal conditions are associated with HIV infection?
necrotizing gingivitis (NG) necrotizing periodontitis (NP) - necrotizing stomatitis (NS) NOTE: usual types of perio also seen
31
are NG and NP associated?
yes, thought to be different ends of the spectrum of the same disease (NS being most severe)
32
what drug therapy may reduce incidence of HIV related perio disease?
anti-viral drug therapy (HAART - highly active antiretroviral therapy)
33
how does HIV-associated NPD compare to non-HIV associated NPD?
CLINICALLY IDENTICAL HIV-associated has higher risk of progression to more severe lesions, recurrence and poorer response to tx
34
what type of HIV pts are at more risk of NPD?
low CD4 levels (<200 cells mm-3) and detectable viral load
35
what does a detectable viral load in an HIV pt present with?
failing immune system AIDS
36
what pathogens are present in HIV-related perio which could explain it's resistance to perio tx?
isolated candida
37
list features of NG
painful red swollen gingivae yellowish-greyish marginal necrosis with loss of interdental papillae gingival bleeding halitosis no LOA anterior gingivae mostly affected
38
what are severe symptoms of NP?
ulceration/ necrosis leading to soft tissue loss destruction or sequestration of bone severe deep pain localised to jaw bone
39
why may HIV-associated NP not always have deep pockets?
rapid hard and soft tissue loss (rapid increase in mobility)
40
how would you class widespread BOP?
50% bleed spontaneously nocturnal gingival bleeding
41
what is the prevalence of NP in HIV + pts?
under 5%
42
treatment for necrotic tissue/bone sequestra?
removal under LA lush with povidone-iodine (blunt syringe) gives pain relief
43
what antimicrobial tx can you give for NP?
oral metronidazole 200-400mg 3xday for 7 days
44
why may you give antimicrobial tx for NP?
improves healing and gives pain relief NEVER give HIV pt antibiotic
45
why would you not give broad-spectrum antibiotic for NP?
risk of untreatable fungal infection
46
what is useful in both active tx and maintenance of NP?
chlorhexidine mouthwash twice daily
47
what are group 2 systemic conditions?
systemic conditions which are risk factors for perio
48
give examples of group 2 systemic diseases?
DM obesity osteoporosis arthritis (osteoarthritis and rheumatoid) emotional stress and depression
49
what are group 3 systemic diseases?
disorders that can result in loss of perio tissues independent of periodontitis
50
give example of group 3 disorders?
neoplasms - oral SCC, odontogenic tumours giant cell granulomas systemic sclerosis
51
another word for systemic sclerosis?
scleroderma
52
what are features of systemic sclerosis?
tight inflexible skin due to fibrosis - masklike face, restricted oral opening (microstomia)
53
what is systemic sclerosis?
autoimmune disease affecting the connective tissues
54
how does systemic sclerosis affect periodontium?
gingival recession common increased prevalence of periodontitis increased width of PDL gradual obliteration of the lamina dura (increased tooth mobility)
55
what is the definition of a risk factor?
Something that increases the chance of developing a disease
56
give 2 examples of evidence-based periodontal risk factors for periodontitis?
smoking stress
57
diabetes is categorised in the 2017 periodontal classification under "periodontitis as a manifestation of systemic disease". true or false?
true
58
a squamous cell carcinoma on the gingiva is categorised in the 2017 periodontal classification under "systemic diseases or conditions affecting the periodontal supporting tissues". true or false?
true
59
clinically, NP diseases associated with HIV infection have identical clinical features to NP in non-HIV Pts. true or flase?
true
60
HIV-associated periodontal diseases have a common clinical feature, which is it?
pain
61
Ehlers-danlos syndrome is categorised in the 2017 periodontal classification under "periodontitis as a manifestation of systemic disease" true or false?
true
62
what is the old-fashioned oral med term for a description of the gingivae when it is red, very inflamed, ulcerated and glossy, which is non-plaque induced?
desquamative gingivitis
63
list the diseases that can present as desquamative gingivitis?
lichen planus benign mucous membrane pemphigoid pemphigus vulgaris plasma cell gingivitis erythema multiforme
64
in the 2017 classification, what are the diseases that cause desquamative gingivitis classified under?
gingival diseases: non-dental biofilm-induced- section 3 inflammatory conditions and lesions
65
why are patients with desquamative gingivitis referred for perio tx?
poor OH will often exacerbate/ worsen the desquamative gingivitis
66
what is DIGE?
drug-influences gingival enlargements results from abnormal effects not expected from the known pharmacological actions of the drug when given in normal therapeutic dose
67
what section in the 2017 classification does DIGE fall under?
gingivits: dental biofilm induced -C: drug influenced gingival enlargements
68
what does DIGE present as?
variable in extend of enlargement from being very minor to covering entire teeth creates difficulties for patient to maintain OH, increasing risk of periodontitis
69
what are the 3 main groups of drugs associated with gingival enlargements?
1. antiepileptics: phenytoin and sodium valproate 2. calcium channel blockers: nifedipine, amlodipine, verapamil, diltiazem and felodipine 3. immune regulators: cyclosporine
70
what is cyclosporine commonly used for?
organ transplant pts - kidney transplant
71
what is needed in conjunction with the drug to cause DIGE?
plaque biofilm
72
describe the understood cellular mechanism that causes DIGE?
increased production of fibroblasts for the ECM reduced tissue turnover = build up of ECM
73
what age group has the highest prevalence of DIGE?
younger
74
where in the mouth is most commonly affected by DIGE?
anterior regions affects papilla first within 3 months of starting medication
75
what types of enlargements is phenytoin associated with?
more fibrotic enlargements
76
what type of enlargements is cyclosporine associated with?
high level of inflammation with little fibrosis
77
what is the incidence of DIGE with the associated drugs?
phenytoin - 50% ciclosporin - 30% CCB - 10-15%
78
what is the most common cause of gingival overgrowth?
plaque
79
what is prevention of DIGE?
good plaque control folic acid supplement (for phenytoin as levels of folate low)
80
what was the traditional prevention of DIGE?
surgical - open wound gingivectomy
81
list other causes of gingival enlargement that is not DIGE or plaque?
hormonal; pregnancy epulis. puberty neoplasia; leukaemia hereditary granulomatosis with polyangiitis (Wegener's granulomatosis
82
what is Wegener's granulomatosis?
rare autoimmune disease resulting in disseminated granulomatous vasculitis of small vessels "strawberry gums"
83
what is factitious injury?
self-harm previously called gingivitis artefacta
84
how may factitious injury present?
localised lesions on gingiva of young people may be ulcerated or have marginal keratosis from chronic trauma notched recession defects caused by finger nails, pencils, knives etc
85
in the 2017 dental classification what is factitious injury classified under?
gingival diseases: non dental biofilm induced - section G traumatic lesions
86
which connective tissue cell is thought to be directly involved in the development of DIGE?
collagenase

MODULE 6 (69 decks)

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