Periodontal Treatment 3

Question 1

What is periodontal disease

Answer 1

it is a group fo diseases effecting the periodontal tissues, representing an immune reaction to adjacent microbial plaque

Question 2

What is periodontal health the outcome of

Answer 2

balance between bacteria of the dental plaque and host immune system

Question 3

What are the two situations possible in periodontal disease

Answer 3

a susceptible host with an overactive immune system

a susceptible host with a reduced immune system

Question 4

How does the immune system reaction lead to periodontal disease

Answer 4

the host immune system launches inflammatory responses to the microbiome resulting in long lasting inflammation without self resolution and without destruction of the biofilm

Question 5

What can result in an impaired immune system

Answer 5

genetic conditions associated with the impaired immune system e.g down syndrome

diseases leading to impairment of the immune system e.g HIV

Question 6

How does an impaired immune system result in periodontal disease

Answer 6

the bacteria are not controlled resulting in destruction of the period tonal tissues

Question 7

What are the factors that can all play into the etiology of periodontal disease

Answer 7

microbial biofilm
function of the immune systems
genetics
additional pathological conditions
general health

Question 8

What are the factors in general health that can lead to periodontal disease

Answer 8

stress
fatigue 
smoking
diet
medication
hygienic habits

Question 9

What are the additional pathological conditions that play into periodontal disease

Answer 9

viral infections
bacterial infections
diabetes mellitus
hypoxia
liver disease

Question 10

What is a risk factor

Answer 10

something that increases a persons chance of developing a disease

Question 11

What are the two types of local risk factors

Answer 11

acquired

anatomical

Question 12

What are acquired local risk factors

Answer 12

plaque
calculus 
overhanging and poorly contoured restorations and prosthetic crowns
orthodontic appliances 
occlusal trauma

Question 13

What are anatomical risk factors

Answer 13

malpositioned teeth
root grooves
concavities and furcations
enamel pearls

Question 14

What are the two types of systemic risk factors

Answer 14

non modifable

modifiable

Question 15

What are non modifiable systemic risk factors

Answer 15

age
genetic factors
gender
genetic disorders 
down syndrome
papillon-lefevre syndrome

Question 16

What are modifiable systemic risk factors

Answer 16

smoking, poorly controlled diabetes, HIV, leukemia, osteopenia, osteoporosis, stress, medications, hormonal changes, poor nutrition, socioeconomic status

Question 17

How is occlusal trauma a risk

Answer 17

it is a risk for bone loss not periodontal disease

if has periodontal disease as well then the bone loss will be accelerated

Question 18

How is smoking a risk factor

Answer 18

it effects the microbiota
it increases activation of the immune system
it decreases healing capacity (reduced blood flow)

Question 19

How does uncontrolled diabetes result in risk of period tonal disease

Answer 19

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

Question 20

What are important factors of diabetes that contribute to periodontal disease severity

Answer 20

degree of diabetic control
age of onset
duration of the disease

Question 21

How can obesity and nutrition result in risk for periodontal disease

Answer 21

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

Question 22

What drugs are high risk for periodontal disease

Answer 22

anti-convulsant: phenytoin
immunosuppressants: cyclosporin
calcium channel blockers (nifedipine and amlodipine)

Question 23

How do these drugs create risk for periodontal disease

Answer 23

there is an interaction between the drug and host fibroblast resulting in a increased deposition of connective tissue supporting a hyperproliferative epithelium

Question 24

How are osteoporosis and osteopenia a risk

Answer 24

the quality of bone is reduced meaning when bone resorption occurs it occurs factor so can accelerate the bone loss

Question 25

How can psychological stress be a risk

Answer 25

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

Question 26

How can periodontal disease be a risk for systemic disease

Answer 26

as the chronic inflammation caused by periodontitis is a risk for systemic diseases

Question 27

Why is it difficult to document cause-effect association between CV disease and periodontitis

Answer 27

the same risk factors for both diseases (smoking, diabetes, stress)
common path-mechanisms associated with systemic inflammation and activation of the immune system

Question 28

What are the possible mechanisms of periodontist being a risk factor for CV disease

Answer 28

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

Question 29

What is the issue with the direct action of bacteria theory

Answer 29

it is hard for bacteria to adhere endothelium so endothelium needs to be inflamed in the first place

Question 30

Describe the activation of cells of the immune system theory

Answer 30

the inflammatory markers from perio disease cause inflammation elsewhere resulting in inflammation of the vessel’s wall resulting in increase in BP

Question 31

What are the two mechanisms for periodontitis being a risk for preeclampsia

Answer 31

indirect mechanism (activation of immune system)

direct mechanism

Question 32

Describe the indirect mechanism for preeclampsia

Answer 32

the immune cells result in dysfunction of the placenta resulting in preeclampsia resulting in adverse pregnancy outcomes

Question 33

Describe the direct mechanism for preeclampsia

Answer 33

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

Question 34

Describe how periodontitis is a risk for rheumatoid arthritis

Answer 34

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

Question 35

Describe how periodontal disease is a risk factor for Alzheimer’s

Answer 35

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

Question 36

How is periodontal disease a risk for respiratory disease

Answer 36

the periodontal bacteria debilitate immune protection of the respiratory epithelium making colonization by other respiratory viruses and bacteria easier