Practice Mgmt_HTN & Diabetes; Soft tissue procedures; smoking Flashcards
What types of drugs are used for HTN treatment? And what are the most common name endings of these drugs
- ACE inhibitors - “pril” –> Lisinopril
- Angiotensin receptor blockers - “sartan” –> Losartan
- Alpha blockers - “osin” –>
- Beta blockers - “lol” –> Metoprolol
- Calcium channel blockers - “dipine” –> Amlodipine
- Diuretics - “ide” –> Hydrochlorothiazide
Describe the angiotensin pathway.
The liver produces angiotensinogen. The kidneys then produce the enzyme renin, which activates angiotensinogen into angiotensin I. The lungs produce ACE (angiotensin converting enzyme) to turn it into angiotensin II. The molecule raises blood pressure by increasing sodium reabsorption from the kidneys, which brings more water into the bloodstream.
How do alpha-1 receptors affect blood pressure?
Epinephrine and norepinephrine bind to alpha-1 receptors on blood vessels, causing contraction. This increases blood pressure.
What are the beta-1 and beta-2 receptor functions?
Beta-1: Increases heart rate and contraction force
Beta-2: Bronchodilator and vasodilator
What study examined the drugs causing gingival enlargements?
Seymour ‘96 and ‘00:
Anticonvulsants-phenytoin: 50%
Immunosuppressant cyclosporins: 20%
Ca-channel blockers: 10%
What is the gold standard procedure for root coverage? How about for increasing KTW?
Barootchi -
FGG - gold standard for KTW augmentation
CTG: gold standard for best esthetics and root coverage for recession treatments
What is the current consensus regarding KTW ≤2mm around implants?
Sanz ‘22:
Reduced KTW has increased peri-implantitis, biofilm accumulation, soft tissue inflammation, mucosal recession, and greater patient discomfort.
Why include an FGG with an APF around an implant, instead of only an APF?
Bassetti ‘16 - Systematic review. The APF only groups had greater relapse (less stability) at 1 year, compared to the APF + FGG group.
10 included studies
*Parameters assessed:
*Shrinkage
*KT width
*Soft tissue thickness
*PD
*Proximal bone levels
What are the critical probing depths?
Heitz-Mayfield & Lang ‘13:
2.9, 4.2, 5.4
The 2.9 mm: critical depth for SRP
4.2 : Mod Widman
5.4 : Pocket elimination
How does smoking affect the periodontium?
MacFarlane et al. 1992: Neutrophil and phagocytosis functions, and in consequences the immunity, are all affected by smoking and nicotine exposure.
Zambon et al. 1996: T.forsythia OR: 2.3 times more prevalent in smokers
Haffajee et al. 2001 Smokers have a higher prevalence of periodontal pathogens
Hill 2004: Nicotine binds to root surface, potentially altering fibroblast attachment
How does smoking affect periodontal treatments? (SRP, flap, regeneration?)
Grossi et al. 1996
PD reduction after SRP:
Smokers: 1.29 mm
Non-smokers: 1.76 mm
Kaldahl et al. 1996
For flap surgeries, past smokers and nonsmokers had greater CAL gain and PD reduction than the heavy and light smokers.
Preber et al.1990:
PD reduction after flap surgery:
Smokers: 0.76 mm
Non-smokers: 1.27 mm
Tonetti ‘95:
For regenerative procedures, smokers had less than half the CAL gain:
Smokers: 2.1 mm
Non-smokers: 5.2 mm
Is e-Cigarette use better than real cigarette use? (with regards to periodontal disease)
Jeong ‘19:
Large epidemiological study from the Korean NHANES database. (Over 13,500 smokers were included).
Result: Both smoking and vaping are associated with periodontal disease.
Does marijuana cause periodontal disease?
Chisini ‘19:
Systematic review & meta-analysis of 5 articles - Yes, there is an association between marijuana and periodontitis.
Shariff ‘17:
Looked at 2011-2012 of the United States NHANES data. Found that frequent marijuana use was associated with deeper PD, CAL loss, and severe periodontitis.
