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BDS3 Perio > Perio Tx 3 > Flashcards

Perio Tx 3 Flashcards

1
Q

peridontal disease

A

a group of diseases affecting the periodontal tissues, representing an immune reaction (innate and adaptive) to adjacent microbial plaque

  • Gingivitis does not always progress to periodontitis
  • Periodontitis may progress at a different rates at different sites in the mouth in different people
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2
Q

periodontal health

A

outcome of the balance between the bacteria of the dental plaque and the host immune system

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3
Q

2 ways to periodontal disease

A

Host immune response launches inflammatory to microbiome -> localised inflammation without self-resolution

Or

immune system not controlling oral bacteria

  • Genetic conditions associated with the impairment of immune system:
    • Papillon-Lefevre syndrome, Chediak-Higashi syndrome, LAS syndrome, Down’s syndrome, chronic granulomatous disease
  • Diseases leading to impairment of immune system:
    • Leukaemia, agranulocytosis, neutropenia, HIV infection
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4
Q

periodontal disease aetiopathogenesis

A

multifactorial

  • Any factor influencing immune system function or number or diversity of bacteria is a potential risk factor for periodontal disease
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5
Q

general health factors for periodontal disease

A
  • stress
  • smoking
  • fatigue
  • diet
  • medications
  • hygienic habits
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6
Q

risk factor

A

something that increases a person’s chance of developing a disease

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7
Q

local risk factors

A

plaque retentive factors

either

  • acquired
  • anatomical
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8
Q

acquired local risk factors for perio

A

plaque,

calculus,

overhanging and poorly contoured restorations and prosthetic crowns,

orthodontic appliances,

occlusal trauma (bone loss not perio)

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9
Q

anatomical local risk factors for perio

A

malpositioned teeth,

root groves,

concavities and furcations,

enamel pearls

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10
Q

systemic risk factors

A

either

  • modifiable
  • non-modifiable
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11
Q

non-modifiable systemic risk factors for perio

A

(impairment of immune system)

  • aging,
  • genetic factors,
  • gender (males),
  • genetic disorders: Down syndrome, Papillon Lefevre syndrome
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12
Q

modifiable systemic risk factors for perio

A

(impact on immune system)

  • smoking,
  • poorly controlled diabetes,
  • HIV,
  • leukaemia,
  • osteopenia,
  • osteoporosis,
  • stress,
  • medications,
  • hormonal changes,
  • poor nutrition,
  • socioeconomic status
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13
Q

how can occlusal trauma impact perio health

A
  • May cause the bone loss but not periodontitis
  • If suffering from periodontal disease and has occlusal trauma will have faster clinical attachment loss
    • Need to address to help slow down bone resorption
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14
Q

smoking impact on perio

A

Effect on oral microbiota

  • anaerobic inc so more traumatic for periodontal tissue

Increase activation of the immune system

  • activation of immune system, trigger inflammation so no longer just controlling oral microbiome and causing damage

Decreased healing capacity (reduced blood flow)

Vaping? Not enough data currently

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15
Q

how does sub-optimally controlled diabetes contribute to perio

A
  • Hyperglycaemia in diabetes may modulate RANKL (the receptor activator of nuclear factorkappa β): OPG (osteoprotegerin) ratio and thus contribute to alveolar bone destruction
  • In hyperglycemia production of AGE (advanced glycation end products) – increase of inflammation (production of pro-inflammatory cytokines and destructive metalloproteinases)

do not see hyperglyceamia in well controlled diabetes

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16
Q

important factors contributing to periodontal disease severity in diabetics

A
  • degree of diabetic control (hyperglycaemia chance)
  • age of onset
  • duration of disease
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17
Q

what to look at to assess diabetic control

A

glycated haemoglobin (HbA1c)

  • Not glucose level - only short period of time*
  • Whereas HbA1c assesses stores (8-12 weeks)*

Look at diabetes – below 48mmol/mol or below 6.5%

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18
Q

obestiy and nutrition impact on perio health

A

Severe vit. C deficiency

  • scorbutic gingivitis - scurvy

Lack of nutrients

  • decrease function of the immune system

Obesity

  • adipose tissue can become endocrine organ, adipocytes secrete variety of metabolically and immunologically active molecules – produce pro-inflammatory cytokines  contribute development of inflammation

ALL HAVE proinflammatory effect

19
Q

3 drug groups that contribute to gingival enlargement

A
  • Anticonvulsant: phenytoin
  • Immunosupresants: cyclosporin (transplant patients)
  • Calcium channel blockers (nifedipine,amlodipine)
    • (majority of pts seen as age risk factors so many 50+ who are suffering from both perio and hypertension)

Interaction between the drug and host fibroblasts resulting in a increased deposition of connective tissue supporting a hyperproliferative epithelium – accelerated by inflamed tissue due to poor plaque control

20
Q

systemic diseases that has periodontitis as a symptom

A

Defect of function of some cells of immune system – if immune system not working correctly not able to protect periodontal tissue against ubiquitous periodontal bacteria

  • papillon-lefevre syndrome
  • Chediak-Higaski syndrome
  • lazy leucocyte syndrom
  • LAD syndrome
  • chronic granulomatous disease
  • Down’s syndrome
  • Ehlers-danlos syndrome
  • hypophostasia
21
Q

HIV infection effect on perio tissue

A

Increased risk of necrotising conditions, but no evidence of increased progression of periodontitis

22
Q

blood dyscrasias (e.g. neutropenia, agranulocytosis, leukaemia) effect on perio tissues

A

Reduced numbers/function of neutrophils and macrophages, increasing risk of NUG and progressive periodontitis

23
Q

scury effect on perio tissues

A

Vitamin C deficiency causing abnormal collagen turnover resulting in increased risk of periodontal attachment loss

24
Q

pregnancy effect on perio tissues

A

Increased risk of gingival inflammation (pregnancy gingivitis)

25
Q

acquired systemic diseases and syndromes that have negative affect on perio health

A
  • HIV infection
  • blood dyscrasias e.g. neutropenia, agranulocytosis, leukaemia
  • scurvy
  • pregnancy

impairs immune system function

26
Q

osteoporosis and osteopenia affect on perio tissues

A

Complex

  • Not direct risk factor

If quality of bone is poor, then bone resorption progresses quicker – accelerate bone loss once pt has both conditions simultaneously

27
Q

psychological stress effect on perio tissues

A

Influencing function of immune system through corticosteroid hormones

  • Hypothalamus-pituitary-adrenal axis stimulated release corticosteroids (cortisol)

Inhibiting function of immune system

  • Once function of immune system is impacted so is periodontal health impacted

Several stress markers reported in blood, saliva, GCF of perio pts

28
Q

most common chronic inflammation in world

A

periodontal disease

estmated 70% have some form

29
Q

periodontal disease a risk factor for other systemic diseases?

A

Systemic activation of the immune system

  • Significant risk factor (70% of world)
    • early symptoms not problematic so delay medical help
  • surface of inflammation is large – folded in gingival crevice (gingiva and root) but approx. size of palm

goes untreated for years - chronic inflammation with little symptoms

30
Q

most common mortality in world population in 21st century (pre-covid)

A

hypertension

31
Q

Why is it difficult to document the cause-effect association between cardiovascular diseases and periodontitis?

A
  • The same risk factors for both diseases (smoking, diabetes, stress
  • Common pathomechanisms associated with systemic inflammation and activation of the immune system
32
Q

3 mechanisms as periodontitis as risk factor for CVD

which is the main theory currently

A
  • molecular mimicry
  • direct action of pathogenic bacteria from periodontal pocket travelling within the blood stream to vessel
  • indirect activation of immune cells that play significant role in sites of CVD pathologies (heart, kidney, vessels etc)
33
Q

evidence for and against molecular mimicry as mechanism of periodontitis and CVD linke

A

for

  • Evidence of cross reactivity between oral pathogens and both inflammatory and endothelial cell components

against

  • might be the case in all bacterial infections
34
Q

evidence for and against direct action of pathogenic bacteria from perio pocket travelling to vessels

A

for

  • Transient bacteremia – after brushing, chewing etc
    • immediately contained by competent immune system
  • but perio bacteria can get to vessels and attach to wall surfaces – inflammation and plaque
  • Periodontal bacteria detected in atherosclerotic plaque

against

  • But, hard for bacteria to adhere to healthy endothelium – needs to be already inflamed and expressing adhesins - thus rare occurrence
35
Q

evidence for and against indirect activation of immunce cells in perio link to CVD

A

for

  • Systemic inflammation, with chronically elevated inflammatory markers, is common in both diseases processes

against

  • To what extent anatomically remote sources of inflammation interact in causative fashion is unclear
36
Q

atherosclerosis

A

inflammation of the vessel’s wall

  • Activation of immune system needs to occur
37
Q

increase of blood pressure link to immune system

A

depends on activation of lymphocytes T (hypertension)

  • need source of activation of T cells - chronic inflammaiton - periodontal disease?
38
Q

to investigate cause-effect need

A

interventional studies

39
Q

indirect link of preeclampsia and periodontal disease

A

indirect mechanism activation of immune system

  • trophoblast invasion depends on production of cytokines and relies on activation of immune system – help in invasion
  • if imbalance of cells and cytokines – invasion of trophoblast incorrect (too little or too deep)
  • translates as dysfunctional placenta and ischaemia -> adverse pregnancy outcomes
40
Q

direct link between periodontal disease and preeclampsia

A

direct mechanisms

  • barrier between mother and foetus
  • periodontal bacteria have adhesins that can go through endothelial cells and traverse barrier and invade foetus circulation
41
Q

periodontal risk factor for rheumatoid arthritis

A

autoimmune disease – action of immune system towards self-tissue of cartilage of joints

if there is additional activation of immune system from site of periodontal bacteria

  • response towards cartilage is stronger

some periodontal (P.gingivalis) has PPAD enzyme

  • cause proteins change conformation –
    • detected as foreign so increasing activation of immune system

increasing activation of immune system increases magnitude of response towards self-tissue in cartilaginous joints

42
Q

periodontal risk factor for Alzeheimer’s disease

A

activation of immune system causes increases production of plaques and tangles

  • Plaques are deposits of a protein fragment called beta-amyloid that build up in the spaces between nerve cells.
  • Tangles are twisted fibres of another protein called tau that build up inside cells

Contributes to impairment of memory and function of pt

In experimental models oral P. gingivalis infection in mice resulted in brain colonization and increased production of Aβ1-42 (amyloid), a component of amyloid plaques

43
Q

peridontal risk factor for respiratory pathologies

A

Periodontal bacteria debilitate immune protection (damage surfactant) of the reparatory epithelium making colonisation by other respiratory viruses and bacteria easier

  • Impair immune protection of respiratory epithelium

Periodontal bacteria can also cooperate with resp viruses and bacteria aiding their colonisation

  • Facilitate colonisation of respiratory epithelium of respiratory viruses and bacteria
44
Q

prevention and treatment of periodontal disease can

A

help prevent development of systemic diseases

but only one of many risk factors

BDS3 Perio (7 decks)

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