Periodontal Risk Factors and Prevention Flashcards
Name some very common pathogens that are associated with periodontitis
Porphyromonas gingival
Fusobacterium nucleatum
What are the links between sex and risk of periodontitis
there isn’t one but studies show that men show worse periodontal health in general
What are the links between age and risk of periodontitis
Prevalence and severity of disease increases with age likely due to the cumulative effect of prolonged exposure of risk factors
Name as much of the Bradford Hill criteria that is set out to provide epidemiological evidence of a causal relationship between a presumed cause and an observed effect
- Strength - effect size
- Consistency - reproducibility
- Specificity - no other likely explanation
- Temporality - effect occurs after exposure
- Biological gradient - greater exposure - greater effect
- Plausibility
- Coherence - epidemiological and lab studies coherence
- Experimental evidence
- Analogy - similar cause agents has strong evidence
- Reversibility - remove effect - effect disappear
What is the difference between modifiable and non-modifiable risk factors
Modifiable - can be changed or altered by behaviour change e.g. smoking
Non-modifiable - unable to change or influence and so cannot directly control e.g. genetics
Give some examples of local risk factors for periodontitis
- Restorations
- Removable partial dentures
- Orthodontic appliances
- Root fracture/cervical root resorption
- Local trauma
- mouth breathing/lack of lip seal
What are some anatomical local risk factors for periodontitis
- Root grooves
- Furcations
- Residual periodontal pockets
- Enamel pearls
- Tooth position e.g. crowding, rotations, traumatic overbites, open contacts
What about restorations can become a risk factor for periodontitis
- Roughness
- Overhangs
- Marginal discrepancies
- Exposed cement margins
- Supra vs sub gingival margins
- Over-contoured crowns
What are some systemic risk factors for periodontitis
- Diabetes type 1/2
- Genetics/host response
- Race/ethnicity
- Neutrophil function
- Socioeconomic status
- Acquired systemic infection
- Severe malnutrition
How does Diabetes result in an increased risk in periodontitis
- Impairing immune response
- Wound healing responses poor/increased infections
- Inducing a hyper inflammatory state
- Increased periodontal tissue destruction
What are some questions to ask yourself relating to diabetes when treating a patient for periodontitis
- Could my period patient have undiagnosed diabetes?
- How well is my patient controlling their diabetes?
- How can I get an objective assessment? - HbA1c glaciated Hb levels indicates long term diabetic control
- Will treating periodontal disease have an effect on my patients diabetic control
What bidirectional effect is there between diabetes and periodontal disease
- Diabetes increases risk of periodontal disease AND conversely periodontal disease can also affect diabetic control
Is there a link between genetics and periodontal disease
strong link can be due to single gene defects or SNPs or neutrophil/immune cell defects
What are the links between ethnicity and periodontal disease risk
- high prevalence of periodontitis in African Americans
Name some conditions that affect neutrophil function and therefore increase the risk of severe forms of periodontitis
- Papillon lefevre syndrome (PLS)
- Lazy leukocyte syndrome
- Leukocyte adhesion deficiency (LAD)
- Chediak Higashi syndrome
How does occlusal trauma/excessive occlusal forces link to periodontitis
they don’t however when plaque-induced periodontitis and occlusal trauma are present together, occlusal trauma may increase the rate of CT loss
What stress/social factors can be linked to periodontitis
- Increasing age
- Low socio-economic status
- Financial strain
- Occupational stress
- Low job satisfaction
- Impatient and irritable personalities
What is the link between obesity and periodontitis
- Some studies have suggested association between high BMI and periodontitis
- Biological plausibility due to release of cytokines by adipose tissue leading to a hyperinflamatory state and increasing tissue destruction
Which teeth are often the most affected by smoking
Maxillary incisors
If a patient is a non-smoker what questions do you need to ask?
▪ Never?
▪ Ex-smoker -
▪ When quit?
▪ Number smoked/day over the years
If a patient is a smoker what questions do you need to ask?
▪ Date started
▪ Number smoked/day at present
▪ Smoking what – Tobacco/Other, Filters etc
▪ Number /day on average since started
What is the evidence that can link vaping to periodontal disease
Few studies tbh so is difficult to conclude boi
What are the 5As of smoking cessation
- Ask about patient’s smoking status
- Advise the value of quitting
- Assess - how ready is the patient to quit
- Assist - offer support to those wishing to quit
- Arrange - monitor and follow up
What options can be offered to a patient to help them to quit smoking
- Stop smoking services in hospital - make a referral
- GP
- Nicotine replacement therapy e.g. bupropion, varenicline
- Vaping?
