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3 Perio > Periodontal Risk Factors > Flashcards

Periodontal Risk Factors Flashcards

1
Q

What is periodontal health?

A

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

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2
Q

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

A

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

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3
Q

Which diseases lead to impairment of the immune system?

A

Leukaemia
Agranulocytosis
Neutropenia
HIV

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4
Q

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

A

Stress
Fatigue
Smoking
Diet
Medications
Hygienic habits

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5
Q

What additional pathological conditions can increase periodontal risk?

A

Viral infections
Bacterial infections
Diabetes mellitus
Hypoxia

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6
Q

What is a risk factor?

A

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

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7
Q

Give examples of acquired local risk factors

A

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

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8
Q

Give examples of anatomical local risk factors

A

Malpositioned teeth
Root grooves
Concavities and furcation
Enamel pearls

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9
Q

Give examples of non-modifiable systemic risk factors

A

Ageing
Gender (males)
Genetic disorders

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10
Q

Give examples of modifiable systemic risk factors

A

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

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11
Q

How does occlusal trauma affect periodontitis risk?

A

May cause the bone loss but not periodontitis

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12
Q

How does smoking increase periodontitis risk?

A

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

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13
Q

How does poorly controlled diabetes mellitus increase periodontitis risk?

A

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

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14
Q

What does AGE stand for?

A

Advanced glucagon end products

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15
Q

What is a normal HbA1c for diabetic control?

A

Below 42 or below 6%

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16
Q

How can poor nutrition increase periodontitis risk?

A

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

17
Q

Give examples of drugs that can increase periodontitis risk

A

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

18
Q

How can drugs increase periodontitis risk?

A

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

19
Q

How can osteoporosis and osteopenia increase periodontitis risk?

A

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

20
Q

How can psychological stress increase periodontitis risk?

A

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

21
Q

Why is periodontal disease a risk factor for cardiovascular diseases?

A

It can lead to atherosclerosis and hypertension

22
Q

Give examples of long term clinical complications of cardiovascular disease

A

Heart failure
Renal failure
Dementia/stroke
Vascular diseases

23
Q

Describe the relationship between periodontal disease and atherosclerotic vascular disease

A

There is an association but not a causative relationship

24
Q

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

A

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

25
Q

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

A

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

26
Q

What effect does non-surgical periodontal therapy have on hypertension

A

Intensive periodontal therapy is shown to decrease blood pressure

27
Q

Why is periodontitis a risk factor for preeclampsia?

A

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

28
Q

Why does diabetes mellitus increase periodontal risk?

A

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

29
Q

What impact does periodontitis have on diabetes mellitus?

A

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

30
Q

How does periodontal treatment improve diabetes mellitus complications?

A

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

31
Q

How is periodontitis a risk factor for rheumatoid arthritis?

A

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

32
Q

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

A

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

33
Q

How is periodontitis a risk factor for respiratory disease?

A

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

3 Perio (5 decks)

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