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BDS3 - Periodontology > Periodontal Treatment 3 > Flashcards

Periodontal Treatment 3 Flashcards

1
Q

what is periodontal disease

A

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

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2
Q

does gingivitis always develop into periodontitis

A

no

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3
Q

how does periodontitis progress

A

May progress at different rates at different sites in the mouth and in different people

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4
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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5
Q

what are the 2 ways that the immune system can cause periodontal disease

A

Host immune system might start launching inflammatory response towards the biofilm which leads to long lasting inflammation without self-resolution and without successful destruction of the oral biofilm

Or the opposite is when the immune system function is impaired so it is not successfully controlling the oral bacteria which can then destroy the periodontal tissue
○ This can be seen in genetic disorders with impaired immune system function
○ But also in acquired disorders which can then influence function of the immune system

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6
Q

what genetic conditions are associated with the impairment of immune system

A 
○ Papillon-Lefevre Syndrome
○ Chediak-Higashi Syndrome
○ LAS syndrome
○ Down's Syndrome
○ Chronic granulomatous disease
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7
Q

what diseases lead to the imapirment of the immune system

A

○ Leukaemia
○ Agranulocytosis
○ Neutropenia
○ HIV Infection

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8
Q

how can microbial biofilm progress to periodontal disease

A
  • general health
  • additional pathological conditions
  • function of the immune system
  • genetics
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9
Q

how can general health impact how microbial biofilm progresses to periodontal disease

A
  • stress
  • fatigue
  • smoking
  • diet
  • medications
  • hygienic habits
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10
Q

what additional pathological conditions impact how microbial biofilm progresses to periodontal disease

A
  • viral infections
  • bacterial infections
  • diabetes mellitus
  • hypoxia
  • liver diseases
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11
Q

what role does genetics play in the progression of microbial biofilm to periodontal disease

A

genetics can influence how the immune system functions or can play a direct role on microbial biofilm

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12
Q

what is a risk factor

A

= something that increases a person’s chances of developing a disease

It does not determine the development of the disease but just increases chances

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13
Q

how can local risk factors be categorised

A
  • acquired

- anatomical

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14
Q

what are acquired local risk factors

A

○ Plaque
○ Calculus
○ Overhanging and poorly contoured restorations and prosthetic crowns
○ Orthodontic appliances
○ Occlusal trauma [Not a risk factor for the periodontal disease but for the bone loss]

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15
Q

what are anatomical local risk factors

A 
○ Malpositioned teeth
○ Root grooves
○ Concavities and furcation
○ Enamel pearls
○ Crowding
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16
Q

how can systemic risk factors be categorised

A
  • non-modifiable

- modifiable

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17
Q

what are non-modifiable systemic risk factors

A 
○ Aging 
○ Genetic factors
○ Gender (males)
○ Genetic disorders with impairment of the immune system:
	§ Down's Syndrome
	§ Papillon-Lefevre Syndrome
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18
Q

what are modifiable systemic risk factors

A 
○ Smoking
○ Poorly controlled diabetes
○ HIV
○ Leukaemia
○ Osteopenia 
○ Osteoporosis 
○ Stress
○ Medications
○ Hormonal changes
	§ Puberty 
	§ Pregnancy 
○ Poor nutrition
○ Socioeconomic status
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19
Q

how does occlusal trauma affect periodontal disease

A

May cause the bone loss but not the periodontitis
If there is occlusal trauma in a patient suffering from periodontal disease then the bone loss and the clinical attachment loss will be much faster in this region than if occlusal trauma had not occurred
By addressing occlusal trauma we can slow down bone resorption

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20
Q

how can smoking affecting periodontal disease

A

○ Effect on oral microbiota
§ Change the amount of bad bacteria, the bacteria which is usually anaerobic are more traumatic for periodontal tissue
§ Smoking supports the shift towards bad bacteria

○ Increase activation of the immune system
§ Immune system should only control biofilm and not launch inflammation which is harmful for periodontal tissue

○ Decreased healing capacity (reduce blood flow)
§ Smoking reduces blood flow

○ Is vaping the alternative?
§ Not enough data for now
§ But preliminary data is not showing vaping as a good alternative and can actually have a negative effect on the oral cavity and the oral mucosa

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21
Q

how can sub-optimally controlled diabetes mellitus affect periodontal disease

A

○ Hyperglycaemia in diabetes may modulate RANKL (the receptor activator of nuclear factor-kappa β): OPG (osteoprotegerin) ratio and thus contribute to alveolar bone destruction

○ In hyperglycaemia production of AGE (advanced glycation end products) - increase of inflammation (production of pro-inflammatory cytokines and destructive metalloproteinases)

○ If diabetes is well controlled and the blood sugar levels remain normal then we don’t see the side effects of hyperglycaemia

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22
Q

what important factors contribute to periodontal disease severity (with regards to type 2 diabetes)

A

§ Degree of diabetic control
□ Because red blood cells in the human body can survive for 8-12 weeks before renewal, measuring glycated haemoglobin (or HbA1c) can be used to reflect average blood glucose levels over that duration
□ Glucose level only reflects hyperglycaemia over a short period of time

§ Age of onset

§ The duration of the disease

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23
Q

what are the ranges for the HbA1c

A

normal = below 42mmol/mol = below 6%

prediabetes = 42 to 47 mmol/mol = 6% to 6.4%

diabetes = 48mmol/mol or over = 6.5% or over

24
Q

how can nutrition affect periodontal disease

A

• Severe vitamin C deficiency
○ Scorbutic gingivitis - scurvy

• Lack of nutrients decrease function of the immune system

25
Q

how can obesity affect periodontal disease

A

the function of the adipose tissue as essentially an endocrine organ is central to its role in the association between obesity and periodontitis
adipocytes secrete a variety of metabolically and immmunologically active molecules, termed adipokines, among which leptin, adiponectin, and resistin have been studied the most
= proinflammatory effect

26
Q

what 3 drug groups can result in gingival enlargement / periodontal disease

A
  • anticonvulsant eg phenytoin
  • immunosuppressants eg cyclosporin
  • calcium channel blockers eg nifedipine, amlodipine
27
Q

how can drug interactions cause periodontal disease

A

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

Won’t see gingival enlargement on every patient taking one of these drugs because usually the gingival enlargement will be associated with poor oral hygiene

The inflammatory process is increased with the plaque control is not ideal

28
Q

what is the difference between gingival enlargement and gingival swelling

A

gingival enlargement = more fibroblasts

gingival swelling = more intercellular fluid, increased permeabilisation of the vessels

29
Q

how can periodontitis be a symptom of a geneitc disease

A

Systemic Diseases - Genetic Conditions
Periodontitis one of the Symptoms of the Disease

next qs are specific conditions and disorders

30
Q

what disorder does papillon-lefevre syndrome cause

A

Defects in neutrophil adhesion

Increased cathepsin production

31
Q

what disorder does chediak-higashi syndrome cause

A

Abnormal phagocyte chemotaxis

32
Q

what disorder does lazy leucocyte syndrome cause

A

Reduced leucocyte chemotaxis

33
Q

what disorder does LAD syndrome cause

A

Reduced leucocyte adhesion / phagocytosis

34
Q

what disorder does chronic granlumoatous disease

A

Abnormal leucocyte intracellular killing

35
Q

what disorder does down’s syndrome cause

A

Abnormal leucocyte chemotaxis and phagocytosia

36
Q

what disorder does ehlers-danlos syndrome cause

A

collagen defect

37
Q

what disorder does hypophostasia cause

A

collagen defect

38
Q

what effect on periodontal tissues does HIV infection cause

A

Increased risk of necrotising conditions

But no evidence of increased progression of periodontitis

39
Q

what effect on periodontal tissues does blood dyscrasias cause

A

reduced numbers / functions of neutrophils and macrophages

Increasing risk of NUG and progressive periodontitis

40
Q

what effect on periodontal tissues does scurvy cause

A

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

41
Q

what effect on periodontal tissues does pregnancy cause

A

Increased risk of gingival inflammation (pregnancy gingivitis)

42
Q

how can osteoporosis and osteopenia affect periodontal disease

A
  • This is quite complex because it is not direct risk factor for periodontal disease
  • But if the quality of bone is not good then the bone loss and bone resorption progresses much faster

So it is a factor which will accelerate bone loss once patient has periodontal disease and osteoporosis at the same time

43
Q

what are examples of blood dyscrasias

A

Eg neutropenia, agranulocytosis, leukaemia

44
Q

explain how osteoporosis can affect periodontal disease (in detail)

A

it has been proposed that low bone mineral density in the maxilla and mandible as a result of osteoporosis may contribute to periodontal pathology by accelerating alveolar bone resorption that is initiated by the periodontal infection
in addition factors affecting systemic bone remodelling (eg hereditary, oestrogen, vitamin D, RANKL and OPG) may also modify the local tissue response to periodontal infection, increase the release of pro-inflammtory mediators and lead to enhanced destruction of the periodontal tissues
studies exploring the potenittial underlying mechanisms are extremely scarce and although these hypothetical pathways are biologically possible they are only speculative at persent

45
Q

how does psychological stress affect periodontal disease

A

Stress is influencing function of the immune system through cortico-steroid hormones

in response to stressful events, the hypothalamus-pituitary-adrenal axis is stimlated leading eventually to increased production and secretion of cortisol, a hormone that can stimulate the immune system
further the autonomic nervous system is stimulated, leading to secretion of atecholamine and substance P that can also regulate the immune / inflammatory response and affect bacterial adherence and growth
indeed several stress markers have been reported in the blood saliva and GCF of periodonititis patients, and may mediate the potential detrimental effects of stress on the periodontal tissues

46
Q

what is the most common chronic inflammation among world population

A

Periodontal disease is the most common chronic inflammation among world population
Estimated that 70% of the world population has some form of periodontal disease

47
Q

What is a significant risk factor for many systemic diseases

A

Research showed that systemic chronic inflammation is significant risk factor for many systemic diseases

48
Q

Why is it Difficult to Document Cause-Effect Association between Cardiovascular Diseases and Periodontitis?

A 
• The same risk factors for both diseases:
○ Smoking 
○ Diabetes
○ Stress
○ Obesity

• Common pathomechanisms associated with systemic inflammation and activation of the immune system

49
Q

What are the Possible Mechanisms of Periodontitis being Risk Factor for Cardiovascular Diseases?

A

3 mechanisms

  1. molecular mimicry
  2. the direct action of pathogenic bacteria from periodontal pocket travelling with the blood stream to the vessels
  3. activation of cells of the immune system which then can play significant role in sites of cardiovascular pathologies
50
Q

explain molecular mimicry

A

evidence for: evidence of cross reactivity between oral pathogens and both inflammatory and endothelial cell components

evidence against: it might be the casein all bacterial infections

51
Q

explain the direct action of pathogenic bacteria from periodontal pocket travelling with the blood stream to the vessels

A

evidence for: periodontal bacteria detected in atherosclerotic plaque

evidence against: challenges to proof causal association and in undertaking clinical outcome studies

52
Q

explain activation of cells of the immune system which then can play significant role in sites of cardiovascular pathologies

A

evidence for: systemic inflammation with chronically elevated inflammatory markers is common to both disease processes

evidence against: to what extent anatomically remote sources of inflammation interact in causative fashion is unclear

53
Q

how is periodontitis a risk factor for pre-eclampsia

A
  • indirect mechanism activation of immune system

- direct mechanism

54
Q

how is periodontitis a risk factor for rheumatoid arthritis

A

activation of immune system

55
Q

how is periodontitis a risk factor for alzhemer’s disease

A

activation of the immune system

increased production of plaques and tangles

56
Q

what are plaques and tangles

A

plaques are deposits of a protein 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

57
Q

what important role do dentists play

A

By prevention and treatment of periodontal disease you can prevent development of many dangerous, systemic diseases in your patients

BDS3 - Periodontology (8 decks)

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