Periodontal Treatment 3 Flashcards
what is periodontal disease
A group of diseases affecting the periodontal tissues, representing an immune reaction (innate and adaptive) to adjacent microbial plaque
does gingivitis always develop into periodontitis
no
how does periodontitis progress
May progress at different rates at different sites in the mouth and in different people
what is periodontal health
= the outcome of the balance between bacteria of the dental plaque and the host immune system
what are the 2 ways that the immune system can cause periodontal disease
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
what genetic conditions are associated with the impairment of immune system
○ Papillon-Lefevre Syndrome ○ Chediak-Higashi Syndrome ○ LAS syndrome ○ Down's Syndrome ○ Chronic granulomatous disease
what diseases lead to the imapirment of the immune system
○ Leukaemia
○ Agranulocytosis
○ Neutropenia
○ HIV Infection
how can microbial biofilm progress to periodontal disease
- general health
- additional pathological conditions
- function of the immune system
- genetics
how can general health impact how microbial biofilm progresses to periodontal disease
- stress
- fatigue
- smoking
- diet
- medications
- hygienic habits
what additional pathological conditions impact how microbial biofilm progresses to periodontal disease
- viral infections
- bacterial infections
- diabetes mellitus
- hypoxia
- liver diseases
what role does genetics play in the progression of microbial biofilm to periodontal disease
genetics can influence how the immune system functions or can play a direct role on microbial biofilm
what is a risk factor
= something that increases a person’s chances of developing a disease
It does not determine the development of the disease but just increases chances
how can local risk factors be categorised
- acquired
- anatomical
what are acquired local risk factors
○ 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]
what are anatomical local risk factors
○ Malpositioned teeth ○ Root grooves ○ Concavities and furcation ○ Enamel pearls ○ Crowding
how can systemic risk factors be categorised
- non-modifiable
- modifiable
what are non-modifiable systemic risk factors
○ Aging ○ Genetic factors ○ Gender (males) ○ Genetic disorders with impairment of the immune system: § Down's Syndrome § Papillon-Lefevre Syndrome
what are modifiable systemic risk factors
○ Smoking ○ Poorly controlled diabetes ○ HIV ○ Leukaemia ○ Osteopenia ○ Osteoporosis ○ Stress ○ Medications ○ Hormonal changes § Puberty § Pregnancy ○ Poor nutrition ○ Socioeconomic status
how does occlusal trauma affect periodontal disease
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
how can smoking affecting periodontal disease
○ 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
how can sub-optimally controlled diabetes mellitus affect periodontal disease
○ 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
what important factors contribute to periodontal disease severity (with regards to type 2 diabetes)
§ 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
what are the ranges for the HbA1c
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
how can nutrition affect periodontal disease
• Severe vitamin C deficiency
○ Scorbutic gingivitis - scurvy
• Lack of nutrients decrease function of the immune system
