Periodontal Risk Factors

Question 1

What is periodontal health?

Answer 1

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

Question 2

What genetic conditions are associated with impairment of the immune system?

Answer 2

Papillon-Lefevre syndrome
Chediak-Higashi syndrome
LAS syndrome
Down’s syndrome
Chronic granulomatous disease

Question 3

Which diseases lead to impairment of the immune system?

Answer 3

Leukaemia
Agranulocytosis
Neutropenia
HIV

Question 4

What aspects of general health can increase risk of periodontal disease?

Answer 4

Stress
Fatigue
Smoking
Diet
Medications
Hygienic habits

Question 5

What additional pathological conditions can increase periodontal risk?

Answer 5

Viral infections
Bacterial infections
Diabetes mellitus
Hypoxia

Question 6

What is a risk factor?

Answer 6

Something that increases a person’s chances of developing a disease

Question 7

Give examples of acquired local risk factors

Answer 7

Plaque
Calculus
Overhanging and poorly contoured restorations and crowns
Orthodontic appliances
Occlusal trauma

Question 8

Give examples of anatomical local risk factors

Answer 8

Malpositioned teeth
Root grooves
Concavities and furcation
Enamel pearls

Question 9

Give examples of non-modifiable systemic risk factors

Answer 9

Ageing
Gender (males)
Genetic disorders

Question 10

Give examples of modifiable systemic risk factors

Answer 10

Smoking
Poorly controlled diabetes
HIV
Leukaemia
Osteopenia
Osteoporosis
Stress
Medications
Hormonal status
Poor nutrition
Socioeconomic status

Question 11

How does occlusal trauma affect periodontitis risk?

Answer 11

May cause the bone loss but not periodontitis

Question 12

How does smoking increase periodontitis risk?

Answer 12

Has an effect on the oral microbiome
Increases activation of the immune system
Decreases healing capacity, reducing blood flow

Question 13

How does poorly controlled diabetes mellitus increase periodontitis risk?

Answer 13

Hyperglycaemia may modulate RANKL ratio, contributing to alveolar bone destruction
In hyperglycaemia, AGE production increases which leads to exacerbation of inflammation

Question 14

What does AGE stand for?

Answer 14

Advanced glucagon end products

Question 15

What is a normal HbA1c for diabetic control?

Answer 15

Below 42 or below 6%

Question 16

How can poor nutrition increase periodontitis risk?

Answer 16

Severe vitamin C deficiency can lead to scorbutic gingivitis and scurvy
Lack of nutrients decreases function of the immune system

Question 17

Give examples of drugs that can increase periodontitis risk

Answer 17

Anticonvulsant - phenytoin
Immunosuppressants - cyclosporin
Calcium channel blockers - nifedipine, amlodipine

Question 18

How can drugs increase periodontitis risk?

Answer 18

Interaction between the drug and host fibroblasts result in an increased deposition of connective tissue supporting a hyperproliferative epithelium

Question 19

How can osteoporosis and osteopenia increase periodontitis risk?

Answer 19

Low bone density in the maxilla and mandible can accelerate alveolar bone resorption that is initiated by periodontal infection
Factors affecting bone remodelling can increase pro-inflammatory mediators leading to destruction of periodontal tissues

Question 20

How can psychological stress increase periodontitis risk?

Answer 20

In response to stress, cortisol is released, stimulating the immune system
This leads the autonomic system to release substance P which affects bacterial adherence and growth

Question 21

Why is periodontal disease a risk factor for cardiovascular diseases?

Answer 21

It can lead to atherosclerosis and hypertension

Question 22

Give examples of long term clinical complications of cardiovascular disease

Answer 22

Heart failure
Renal failure
Dementia/stroke
Vascular diseases

Question 23

Describe the relationship between periodontal disease and atherosclerotic vascular disease

Answer 23

There is an association but not a causative relationship

Question 24

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

Answer 24

They both have the same risk factors
There are common pathomechanisms associated with systemic inflammation and activation of the immune system

Question 25

Give examples of possible mechanisms of periodontitis being a risk factor for cardiovascular diseases

Answer 25

Molecular mimicry The direct actions of pathogenic bacteria from periodontal pockets travelling with the blood stream to the vessels Activation of calles of the immune system which then can play significant roles in sites of cardiovascular pathologies

Question 26

What effect does non-surgical periodontal therapy have on hypertension

Answer 26

Intensive periodontal therapy is shown to decrease blood pressure

Question 27

Why is periodontitis a risk factor for preeclampsia?

Answer 27

Indirect mechanism - activation of immune system causes increased cytokine production Direct mechanism - specific bacteria can invade the placenta

Question 28

Why does diabetes mellitus increase periodontal risk?

Answer 28

Diabetes contributes to increased inflammation in periodontal tissues There is increased deposition of AGEs and interactions between AGEs and there receptor RAGE leads to activation of local immune and inflammatory responses These upregulated responses result in increased secretion of cytokines which favour bone resorption

Question 29

What impact does periodontitis have on diabetes mellitus?

Answer 29

Periodontal bacteria and their products, together with inflammatory cytokines enter the circulation and contribute to insulin resistance

Question 30

How does periodontal treatment improve diabetes mellitus complications?

Answer 30

Periodontal treatment causes reduced circulating bacteria, antigens and cytokines This causes a reduction in systemic inflammation and improved insulin signalling and resistance This reduces HbA1c, improving diabetic control and leading to less diabetes complications

Question 31

How is periodontitis a risk factor for rheumatoid arthritis?

Answer 31

Activates the immune system P. gingivalis causes cytrulination of the host proteins, changing the proteins conformation destroying the surface of cartilage

Question 32

How is periodontitis a risk factor for Alzheimer’s disease?

Answer 32

Increased activation of the immune system increases production of plaques and tangles Plaques are deposits of a protein fragment that builds up between nerve cells Tangles are twisted fibres of a protein that builds up inside cells

Question 33

How is periodontitis a risk factor for respiratory disease?

Answer 33

Periodontal bacteria debilitate immune protection of the respiratory epithelium making colonisation by other respiratory viruses and bacteria easier