Risk factors Flashcards
What process gives rise to periodontitis?
dysbiosis
what factors alter someone’s susceptibility to periodontal disease?
genetics
inflammatory drive
biofilm
what is management dependant upon?
risk factor control
if grade A and B - usually plaque control based
what results in breakdown of the periodontium and bone resorption?
inflammatory response
what is essential to prevent an aberrant host response and dysbiosis?
immune fitness - immune response to plaque
what can alter immune response?
diet
genetics
hyperglycaemia
what is the gut microbiome driven by?
nutrition
what does an increasing carb intake result in?
higher circulating glucose
what is a result of having more adipose tissue?
insulin doesnt work as effectively and inhibits hormones that make you feel full (leptin)
what hormone makes you feel full and can be interrupted by adipose tissue?
leptin
what does adipose tissue do to the inflammatory drive?
increases inflammatory drive
what is the result of increased inflammatory drive?
more oxidative stress - hyperresponsive immune system
what does adipose tissue produce?
cytokines
Tnf alpha IL6
Pro inflammatory mediators
adipokines
why are cytokines bad?
bacteria use as energy source
= increase in anaerobes
= dysbiosis
what risk does poorly controlled diabetes have on periodontitis?
x3
what are found in bad foods that increase oxidative stress?
advanced glycation end products (AGE)
how can we reduce the risk of dysbiosis from obesity?
encourage symbiosis
- weight loss to reset oral microbiome
- reduced refined carbs and AGE products
- prebiotic diet: cruciferous diet to feed gut microbiome
what can obesity lead to?
diabetes
signs of diabetes?
bop
lack of immune fitness - suppuration
what is the determining factor of the association between DM and chronic periodontitis?
degree of blood glucose (glycaemic) control
are all diabetes patients at risk of periodontitis?
no, only ones with poorly controlled glycaemic levels
what should glycated haemoglobin levels be?
48 mmol below/ 6.5% below
what may indicate undiagnosed periodontitis?
recurrent perio abscesses - pus
exaggerated perio inflammation
what are the problems with uncontrolled diabetes?
increased formation of AGE products
altered immune cell function
altered fibroblast function
poor wound healing
what effect has AGE got on collagen?
reduced collagen production
increased collagenase (removes collagen)
impaired collagen turnover
what can chronic hyperglycaemia alter with immune cell function?
reduced neutrophil function = persistent infection
hyperresponsive monocyte and macrophages = oxidative stress
altered fibroblast function = reduced tissue formation and healing
what are the effects of poor glycaemic control on periodontitis?
increase risk
- pockets leak bacteria and exotoxins throughout immune system
= increased insulin resistence
what vitamin is essential for collagen?
c
what is vitamin D essential for?
skeletal development
modulation of immune system
how much vitamin D do we need?
40-60ug a day
what foods may help inflammation?
omega 3
cruciferous vegetables
what are key dietary advice points for perio?
healthy diet
- cruciferous veggies
- vit D and C, fresh fruit and veg
reduce carbs
be aware of AGE foods
what are the oral effects of stress?
reduced salivary flow - plaque formation
increased stress hormones - reduce gingival blood flow
what are the stress hormones?
noradrenaline
adrenaline
how does smoking effect the periodontium?
staining
calculus build up
more keratin
why does smoking cause calculus build up?
increase saliva flow = increase pH = precipitate of calcium phosphate
why do smokers gums look healthy?
less BOP - reduced inflammatory response and vascularity
higher amount of keratin laid down on surface
what is smoking a major risk factor for?
necrotising gingivits
