Periodontal Treatment 3 Flashcards
What is periodontal disease
it is a group fo diseases effecting the periodontal tissues, representing an immune reaction to adjacent microbial plaque
What is periodontal health the outcome of
balance between bacteria of the dental plaque and host immune system
What are the two situations possible in periodontal disease
a susceptible host with an overactive immune system
a susceptible host with a reduced immune system
How does the immune system reaction lead to periodontal disease
the host immune system launches inflammatory responses to the microbiome resulting in long lasting inflammation without self resolution and without destruction of the biofilm
What can result in an impaired immune system
genetic conditions associated with the impaired immune system e.g down syndrome
diseases leading to impairment of the immune system e.g HIV
How does an impaired immune system result in periodontal disease
the bacteria are not controlled resulting in destruction of the period tonal tissues
What are the factors that can all play into the etiology of periodontal disease
microbial biofilm function of the immune systems genetics additional pathological conditions general health
What are the factors in general health that can lead to periodontal disease
stress fatigue smoking diet medication hygienic habits
What are the additional pathological conditions that play into periodontal disease
viral infections bacterial infections diabetes mellitus hypoxia liver disease
What is a risk factor
something that increases a persons chance of developing a disease
What are the two types of local risk factors
acquired
anatomical
What are acquired local risk factors
plaque calculus overhanging and poorly contoured restorations and prosthetic crowns orthodontic appliances occlusal trauma
What are anatomical risk factors
malpositioned teeth
root grooves
concavities and furcations
enamel pearls
What are the two types of systemic risk factors
non modifable
modifiable
What are non modifiable systemic risk factors
age genetic factors gender genetic disorders down syndrome papillon-lefevre syndrome
What are modifiable systemic risk factors
smoking, poorly controlled diabetes, HIV, leukemia, osteopenia, osteoporosis, stress, medications, hormonal changes, poor nutrition, socioeconomic status
How is occlusal trauma a risk
it is a risk for bone loss not periodontal disease
if has periodontal disease as well then the bone loss will be accelerated
How is smoking a risk factor
it effects the microbiota
it increases activation of the immune system
it decreases healing capacity (reduced blood flow)
How does uncontrolled diabetes result in risk of period tonal disease
hyperglycemia in diabetes may module RANKL: OPG ratio and thus contribute to bone destruction
in hyperglycemia production of AGE there is an increase in inflammation resulting in production of proinflamamtoy cytokines and destructive metalloproteinases
What are important factors of diabetes that contribute to periodontal disease severity
degree of diabetic control
age of onset
duration of the disease
How can obesity and nutrition result in risk for periodontal disease
severe vitamin vitamin C will impact periodontal health
lack of nutrients can decrease the function of the immune system
obesity can result in higher risk as adipocytes secrete immunologically active molecules resulting in a proinflammatory effect
What drugs are high risk for periodontal disease
anti-convulsant: phenytoin
immunosuppressants: cyclosporin
calcium channel blockers (nifedipine and amlodipine)
How do these drugs create risk for periodontal disease
there is an interaction between the drug and host fibroblast resulting in a increased deposition of connective tissue supporting a hyperproliferative epithelium
How are osteoporosis and osteopenia a risk
the quality of bone is reduced meaning when bone resorption occurs it occurs factor so can accelerate the bone loss
How can psychological stress be a risk
they can influence function of the immune system via corticosteroid hormones
if the function of the immune system is impacted then perio health may be in danger
How can periodontal disease be a risk for systemic disease
as the chronic inflammation caused by periodontitis is a risk for systemic diseases
Why is it difficult to document cause-effect association between CV disease and periodontitis
the same risk factors for both diseases (smoking, diabetes, stress)
common path-mechanisms associated with systemic inflammation and activation of the immune system
What are the possible mechanisms of periodontist being a risk factor for CV disease
molecular mimicry
direct action of pathogenic bacteria from pocket traveling with blood stream to the vessels
activation of cells from the immune system which can then play significant role in sites of CV disease
What is the issue with the direct action of bacteria theory
it is hard for bacteria to adhere endothelium so endothelium needs to be inflamed in the first place
Describe the activation of cells of the immune system theory
the inflammatory markers from perio disease cause inflammation elsewhere resulting in inflammation of the vessel’s wall resulting in increase in BP
What are the two mechanisms for periodontitis being a risk for preeclampsia
indirect mechanism (activation of immune system)
direct mechanism
Describe the indirect mechanism for preeclampsia
the immune cells result in dysfunction of the placenta resulting in preeclampsia resulting in adverse pregnancy outcomes
Describe the direct mechanism for preeclampsia
barrier between the mother and the baby exists but the bacteria have adhesions that allow them to escape this barrier and invade into the baby’s blood
Describe how periodontitis is a risk for rheumatoid arthritis
via activation of the immune system
RA is an autoimmune disease and if there is additional activation of the immune system from sites where periodontal bacteria are present then the response towards cartilage will be stronger
another mechanism is that some bacteria such as p. gingival have an enzyme b path which change conformation of host proteins and are perceived by the immune system as foreign creating further activation of the immune system and increasing the magnitude to the response in these joints
Describe how periodontal disease is a risk factor for Alzheimer’s
activation of the immune system results in increased production of plaques and tangles and these plaques and tangles build up between spaces between nerve cells and inside the cells
How is periodontal disease a risk for respiratory disease
the periodontal bacteria debilitate immune protection of the respiratory epithelium making colonization by other respiratory viruses and bacteria easier
