Risk Assessment of Periodontal Disease Flashcards
Name some local risk factors of periodontal disease:
- furcation involvement
- root morphology
- localised gingival recession
- dental anatomy and tooth arch relationships (crowding, retroclined teeth, PE teeth)
- overhanging restorations
- poorly designed partial dentures
- orthodontic appliances
- defective crown/bridge margins
- trauma from occlusion (deep overbite)
Name some systemic risk factors of periodontal disease:
- genetic/inherited/inborn
- environmental
- behavioural
- life-style
- metabolic
- haematological
What is genetic susceptibility testing?
Periodontal Susceptibility Test (PST)
- finger prick blood sample
- tests for periodontitis associated genotype (PAG)
- individuals who are PAG positive produce more IL-1 for a given bacterial challenge - hyperinflammatory response
How is downs syndrome a risk factor for periodontal disease?
- chronic granulomatous disease
- hypophosphatasia
- ehler-danlos syndrome
Down’s syndrome: defects of PMNL chemotaxis and phagocytosis
Chronic granulomatous disease: defect in cell killing ability of phagocytes
Hypophosphatasia: skeletal hypomineralisation, poor mineralisation/formation of cementum - attachment compromised and teeth exfoliate
Ehler-danlos syndrome: defects in collagen synthesis associated with hyperextendible skin, hypermobility and severe periodontal destruction
What are some environmental risk factors?
Drugs: anti-epileptics (phenytoin), calcium channel blockers (nifedipine, amlodipine, felodipine), immunosuppressants (cyclosporin)
Any of these drugs can cause gingival overgrowth –> OH more difficult, false/true pocketing
What are behavioural risk factors?
- poor OH: aim to motivate patient, monitor plaque and bleeding scores
- smoking
What are pack years?
no. of packs per day X no. of years patient has smoked
Calculation of lifetime exposure to tobacco
What do smokers have in terms of the periodontium?
- more sites with deep pockets
- more LOA and bone loss
- higher prevalence of furcation
- accumulate more calculus
What lifestyle risk factors impact periodontal disease?
- stress - definite association with necrotising gingivitis, reduces immune function, affects salivary production favouring plaque formation
- malnutrition
Vit C deficiency: destruction of collagen
Vit E: antioxidant, protects cell membranes
Vit A: healthy epithelium
What are metabolic risk factors?
- diabetes
- pregnancy and oral contraceptive
- crohn’s disease
- sarcoidosis
Which factors contribute to high risk in diabetic patients?
- PMNL function
- collagen metabolism - less collagen synthesised
- wound healing decreased in diabetics
How does pregnancy/oral contraceptive affect gingival health?
Increased response to inflammation due to progesterone, if OH good, no problems, if pre-existing gingivitis, progesterone will exaggerate this
How does crohns affect the mouth?
- oral ulceration and cobblestone appearance of oral mucosa
- diffuse, erythematous, granular enlargement of the attached gingivae - severe periodontitis
How is haematological conditions a risk factor for periodontal problems?
Blood diseases do not cause periodontal disease but alter the tissue response to plaque
- rare and generally require specialist management
