Periodontology Flashcards
What are the main systemic risk factors for periodontal disease?
Smoking, stress and genetic susceptibility
How would you calculate pack years?
Number of packets per day x years of smoking = pack years
If Mr Atkins has 1 packet of cigarettes each day and has smoked for 30 years, what is his pack years?
30 pack years
What does 1g of pipe Tabacco compare to in number of cigarettes smoked?
1g pipe tobacco = 1 cigarette
What is 1 cigar equivalent to in number of cigarettes?
5 cigarettes
How many cigarettes would a patient smoke per day to be considered as having a high level of nicotine dependancy?
15-20 cigarettes
What is important to notify smokers about in regards to periodontal treatment outcome?
Warn these patients early on about likelihood of having a reduced periodontal treatment outcome
According to the Prochaska 1993 model, what is a pre-contemplator?
A smoking patient who is not interested in smoking cessation
According to the Prochaska 1993 model, what is a contemplator?
A patient who is interested in smoking cessation but is not ready to carry it out
According to the Prochaska 1993 model, what are active quitters ?
Patients who are making an attempt to stop smoking
According to the Prochaska 1993 model, what type of patient is of most interest to dentists in terms of brief intervention?
Contemplators
When giving a brief intervention for smoking cessation, what is the approach that should be used?
The 5 A’s approach
Define the 5 A’s approach
Ask
Advise
Assess
Assist
Arrange
Why does smoking cause an increased salivary flow rate and what is the consequence of this?
Increased parotid flow rate due to irritant particulate matter in smoke. This raises pH, calcium concentration and precipitation of calcium phosphate thus calculus build-up occurs.
What are three key oral diseases that smoking is a risk factor for?
- periodontal disease
- Necrotising gingivitis
- Oral cancer
What effect does smoking have on periodontal tissues?
Reduces vascularity, inflammatory and immune responses
Which key cell type does smoking have direct toxic effects on?
Fibroblasts
What is the rebound effect?
After smoking cessation, there is a rapid recovery of both the inflammatory response and vascularity of the periodontal tissues
What is the result of the rebound effect?
Increased BOP
What is a key periodontal treatment outcome of healing in smokers compared to non-smokers?
Smokers have less pocket depth reduction
What effect does stress have on salivary flow and what are the consequences?
Decreases salivary flow, favouring plaque formation
What is the key study that looks into financial strain and depression found to be associated with increased periodontal breakdown?
Genco, et al 1999
What systemic risk factor of periodontitis is non-modifiable?
Genetic susceptibility
What stage and grade would a periodontal patient have if they were thought to have high genetic susceptibility?
Stage 3/4 Grade C
How would you assess a patient’s genetic susceptibility?
- Extent of previous periodontal disease
- Age
- Level of oral hygiene
How are genes affected to cause genetic susceptibility to periodontitis?
Natural variations within the structure of genes results in altered protein production. If this occurs in a periodontal disease-modifying gene the resultant altered protein production leads to increased susceptibility to periodontitis.
Give some examples of very rare, genetic systemic disease which are associated with very destructive periodontal disease
- Down’s syndrome
- Papillon-lefevre syndrome
- Ehlers-Danlos syndrome
what type of immune system do periodontitis patients tend to have?
A hyper-responsive immune system
For someone to be considered obese, what must there BMI be?
> 30
How can an increase in adipose (fat) tissue cause an increase in anaerobes?
Adipose tissues produce cytokines, which are an energy source for bacteria, increasing proteolytic activity and thus anaerobes
What products are found in almost all ‘bad’ foods and increase oxidative stress?
Advanced glycation end (AGE) products
How more likely is an obese patient with sleep apnoea to develop periodontitis than a solely obese person? And why?
36% higher chance because sleep regulates the immune system and inflammatory processes
What type of diet favours plaque formation?
High carbohydrate diet
What three factors would encourage symbiosis in obese patients?
- weight loss
- reduced intake of refined carbohydrate + AGE products
- pre-biotic diet
What is diabetes mellitus? And how does it present?
Type II diabetes, presents as chronic hyperglycaemia
What are the five major complications of diabetes mellitus?
- atherosclerosis
- retinopathy
- nephropathy
- Neuropathy
- Impaired wound healing
what may be an oral indication of undiagnosed diabetes?
Recurrent periodontal abscesses &/or exaggerated periodontal inflammation
What are the four main issues associated with uncontrolled diabetes?
- Increased formation of AGE products
- Altered immune cell function
- Altered fibroblast function
- Poor wound healing
What do AGE products alter?
The structure and function of proteins, specifically of interest is collagen.
what does altered fibroblast function due to diabetes result in?
Reduced tissue formation and reduced healing potential
What dental conditions can short term alcohol intake result in?
-dental trauma
-facial injury
What dental conditions can long term alcohol intake result in?
- oral cancer
- periodontal disease
- non-carious tooth surface loss
What vitamin is essential for collagen production?
Vitamin C
What vitamin is essential for skeletal development?
Vitamin D
What vitamin defends against oxidative stress and free radicals, promoting chemotaxis?
Vitamin C
what vitamin is essential for iron absorption?
Vitamin C
What vitamin deficiency is associated with autoimmunity?
Deficiency in vitamin D
Plant fibre critical as a food source for gut’s healthy bacteria
Pre-biotics
Live bacteria and yeasts promoted as having various health benefits
Probiotics
What are examples of cruciferous vegetables?
Cabbage, cauliflower and broccoli
Why are cruciferous vegetables beneficial as part of a balanced diet?
- anti-inflammatory
- support symbiosis
- antioxidant
What type of cell are the best defence for periodontitis, when they are not subjected to oxidative stress?
Neutrophils
What are the 6 most common chronic systemic diseases associated with periodontitis?
- Cardiovascular disease
- Diabetes
- Pulmonary disease
- Kidney disease
- Rheumatoid arthritis
- Adverse pregnancy outcomes
Explain how presence of generalised inflammation can interfere with uptake of blood glucose into cells, resulting in elevated blood glucose levels.
Generalised inflammation causes inhibition of insulin binding and therefore reduces glucose uptake in cell
What is the concern over blood glucose levels remaining high in regards to periodontitis?
If levels remain high, other proteins will bind to excess sugar on red blood cells resulting in AGE products which promote inflammatory complications
How do AGE products make tissue remodelling more difficult and thus interfere with wound healing?
By cross linking fibres of connective tissue
Why is the periodontal pocket wall ulcerated and leaky?
Because periodontal pocket is filled with pathogenic anaerobic biofilm resulting in an inflammatory reaction in the adjacent gingival tissues making the pocket wall ulcerated and leaky
What is the key factor accounting for the possible link between periodontal disease and systemic chronic disease?
The leaking of pro-inflammatory mediators &/or the periodontal bacteria into the systemic bloodstream, raising systemic inflammation.
What study model does not guarantee that treated periodontitis will result in improved CVD?
The common susceptibility model
Explain ‘the direct bacterial effects on platelets’ mechanism of linking periodontitis and CVD
Certain Surface proteins on some oral bacteria mimic the host receptors that trigger thrombus (clot) formation within the vascular system
Explain ‘ the autoimmune responses’ mechanism of linking periodontitis and CVD
Some perio pathogens can cause a cross reaction ( molecular mimicry) which causes the host to produce antibodies against itself leading to damage to the host cells
Explain ‘ the invasion/uptake of bacteria into endothelial cells and macrophages’ mechanism of linking periodontitis and CVD
Perio pathogens access bloodstream, attach to endothelial cells lining blood vessels and contribute to atherosclerotic plaque formation
Explain ‘the systemic inflammation’ mechanism of linking periodontitis and CVD
Periodontal inflammation leads to the systemic release of pro-inflammatory mediators which cause damage to the vascular tissues leading to atherosclerosis
What does systemic release of pro-inflammatory mediators trigger?
The release of C-reactive protein (CRP) from the liver
What does CRP do?
Further raises the systemic level of inflammation which worsens the CVD
What is a pregnancy epulis?
Specific localised lesion on gingivae
In what trimester should periodontal treatment be avoided and why?
First trimester, because of possible stress to foetus
In the presence of pregnancy epulis, when should surgical excision occur?
Delayed until postpartum
Which weeks does the first trimester cover?
Week 1 to end of week 12
Which weeks does the second trimester cover?
Week 13 to end of week 26
Which weeks does the third trimester cover?
Week 27 to end of pregnancy
Why does pregnancy gingivitis occur?
Hormonal changes make gums more susceptible to plaque, leading to inflammation and bleeding
What are the benefits of breastfeeding?
Can help protect baby against some short and long term illnesses
