Periodontal Disease and Systemic Health Flashcards
Common Modifying Factors of periodontal disease
Diabetes
Pregnancy
Puberety
Menopause
Smoking
Obesity
Modifying factors can influence 5
- Susceptibility to gingivitis and perio
- Plaque growth and composition
- Clinical presentation
- Disease progression
- Response to periodontal therapy
4 main oral and periodontal effects of diabetes mellitus
Xerostomia
Candida infections
Periodontitis
Multiple periodontal abcesses
Periodontitis effect on insulin resistance
Increases insulin resistance
Glycemic control improved after periodontal therapy
Diabetes effects on bacteria
- Spirochetes increase in poorly controlled diabetes
- P intermedia C rectus P gingivalis in Type 2
- Capnocytophaga predominance seen in Type 1 diabetes
Diabetes effects on host response
- PMN function, chemotaxis impaired
- PMN enzymes( beta glucoronidase and elastase increase)
- Collagenase increases–>tissue destruction
- Cytokines monocytes and MO
- Increase in PGE, IL-1 beta, TNF alpha
- Advanced glycation end products (AGE) create destructive phenotype of macrophages
- Connective tissue
- Decrease in matrix synthesis by fibroblasts and osteoblasts
- Reactive oxygen species damage cells
- AGE creates thickening of vascular endothelium, synthesis of wound healing steroids
Diabetes effects on healing and treatment response
- Decreased synthesis of collagen by fibroblasts
- Increased degradation by collagenase
- Glycosylation of existing collagen and wound margins
- Defective remodeling and rapid degradation of newly synthesized, poorly cross-linked collagen
When to time periodontal treatment on a diabetic
- Early morning
- Avoid hypoglycemia
- May need to change insulin(consult MD)
- Know what to do in medical emergency
Pregnancy, puberty and menopause effects on
Estrogen 2
vascular/inflammation
gingival inflammation
periods
- Estrogen affects salivary peroxidases
- Estrogen increases collagen metabolism, angiogenesis
- Increases vascular response and inflammatory mediators
- Gingival inflammation increases in puberty & pregnancy
- Increase in bleeding during period in women with gingivitis
- These populations may have exaggerated bleeding, does not indicate disease r infection
Special note about 2nd trimester in pregnant women
2nd trimester (and 3rd) is when gingival inflammation is the highest
2nd trimester is best time to do perio treatment
Avoid antibiotics
Pregnancy effects on microbiota
Increase in P. intermedia
Naphthoquinones from steroids used by P intermedia
Increase in Spirochetes
Pregnancy effects on host 3
- Increase in vascular permeability
- resulting in increase gingival exudate
- Decrease in keratinization
- Decrease in PMN chemotaxis and phagocytosis, Ab, T cell response
Smoking effects on Periodontitis
- Increased
- pocket depth
- atachment loss
- bone loss
- tooth loss
- rate of destruction
- severity
- Generalized Aggressive Perio in young adults
Smoking effects on Micro
- No effect on rate of plaque accumulation
- Increased colonization of shallow periodontal pockets by perio pathogens
- Increased levels of periodontal pathogens in deep periodontal pockets
- Qualitative rather than quantitative alterations- range from no differneces to increased levels of pathogens
Less favorable response to mechanical thrapy in smkers has been associated with
- Increased residual levels of
- T. forsythia
- A a.
- P. gingivalis
