Risk Factors

Question 1

Define periodontal disease

Answer 1

A group of diseases affecting the periodontal tissues, representing an immune reaction to adjacent microbial plaque

Question 2

What general health and general behaviours can affect periodontal disease

Answer 2

Stress,
fatigue,
smoking,
diet,
medications
and hygiene habits

Question 3

What pathological conditions can increase risk of periodontal disease

Answer 3

Viral infections

Bacterial infections

Diabetes

Hypoxia

Question 4

Define risk factor

Answer 4

Something that increases a persons chances of developing a disease

Question 5

Give some local risk factors for periodontal disease - acquired and anatomical

Answer 5

Acquired
- plaque
- calculus
- overhanging restorations, ortho etc

Anatomical
- malpositioned teeth
- furcations
- enamel pearls

Question 6

Give some non-modifiable systemic risk factors

Answer 6

Non-modifiable
- aging
- genetic s
- gender (males)
- genetic disorders such as Down syndrome

Question 7

Give some modifiable systemic risk factors

Answer 7

Modifiable
- smoking
- poorly controlled diabetes, HIV, osteoporosis
- poor nutrition
- socioeconomic status

Question 8

How does occlusal trauma affect the dentition

Answer 8

It does not cause periodontal disease, however it leads to remodelling of alveolar bone due to a RANKL > OPG imbalance

Question 9

How does smoking increase risk of periodontal disease?

Answer 9

Negative defect on oral microbiome

Increased activation of the host immune system

Decreased healing capacity due to vasoconstriction

Question 10

How does sub optimally controlled diabetes affect periodontal risk

Answer 10

Hyperglycaemia may modulate RANKL > OPG ratio contributing ton resorption

In hyperglycaemia, production of AGE (advanced glycation end products) increases…. which leads to an increase of inflamamtion (production of pro-inflammatory cytokines and destructive metalloproteinases)

Question 11

How does obesity and poor nutrition contribute to periodontal disease?

Answer 11

Severe vit C deficiency - leads to scurvy (scorbutic gingivitis)

Lack of nutrients - decreased function of the immune system

Obesity - adipose tissue secretes adipokines leading to a pro-inflammatory effect

Question 12

How can pharmaceuticals affect periodontal disease

Answer 12

Interaction between drugs and fibroblasts results in deposition of more connective tissue, leading to large proliferating gingival tissues e.g. gingival hyperplasia (more fibroblasts) or swelling (more ICF)

Question 13

What drugs can affect gingival tissues?

Answer 13

Anticonvulsants - phenytoin
Immunosuppressants - cyclosporin (transplant patients)
CCBs - nifedipine, amlodipine

Question 14

How can stress affect periodontal health?

Answer 14

In response to stressful events, cortisol is released. Cortisol can stimulate the immune response and aggregate periodontal disease

Question 15

How does periodontal disease act as a risk factor for systemic illness?

Answer 15

PDD is the most common chronic inflammation int he world

Systemic chronic inflammation is a large risk factors for many other systemic diseases

Question 16

What possible mechanism can periodontitis be a risk factor for cardiovascular sites?

Answer 16

Periodontitis results in increased production and activation of inflammatory cells which can play a role in sites of cardiovascular pathology

Question 17

How does periodontal disease worsen diabetes?

Answer 17

Periodontal bacteria and their products up-regulate the host immune system leading to impaired insulin signalling and insulin resistance

This causes an increase in the Hb1Ac levels and the exacerbation of diabetic symptoms