Risk Factors For Periodontal Disease

Question 1

Characteristics that increase the probability that disease will occur

Answer 1

Risk Factors

Question 2

Categories of Risk Factors

Answer 2

Unchanging risk factors/risk indicators: Race, gender

Changing risk factors: Poor oral hygiene, tobacco use

Question 3

Contribute to periodontal problems. Risk factors do not change, even if
periodontal health is restored ž Example: conditions in which there is a
reduction of PMN numbers or function

Answer 3

Unchanging Risk Factors

Question 4

Unchanging Risk Factors

Answer 4

• Sex
• Genetic Factors
• Congenital immunodeficiencies
• Past history of periodontal disease
• Past Hx of periodontal disease
• Congenital systemic diseases

Question 5

Changing Risk Factors

Answer 5

• Poor OH
• Alcohol use
• Tobacco use
• Stress
• Nutritional Status
• Side effects of meds
• Dental restorations
• Some local contributory factors (ex. calculus)

Question 6

Tobacco Use

Answer 6

• Users exhibit greater bone loss, increased
  pocket depths, and calculus ž
  -Nicotine and toxic substances reduce
  neutrophil (PMN) effectiveness
• Alters vasculature of periodontium
  (reduces immunoglobulin levels and
  antibody responses) ž
• May exhibit less inflammation (Why?)
  Vasoconstriction

Question 7

Nutritional Status: Deficiencies of nutrients are associated with

Answer 7

wound healing may contribute to disease progression
Nutrients are important for wound healing such as
- Protein
- Vitamin C
- Folic Acid
- Vitamin B12
- Vitamin A
- Vitamin K 
- Iron
- Zinc

Question 8

Repairs tissue and increases resistance to infection

Answer 8

Protein

Question 9

Promotes collagen formation, tissue synthesis, and wound

healing

Answer 9

Vitamin C

Question 10

Enhances red blood cell maturation, tissue synthesis, and cell proliferation

Answer 10

Vitamin B12

Question 11

Increases resistance to infection and promotes tissue

synthesis; deficiency affects integrity of epithelium

Answer 11

Vitamin A

Question 12

Affects prothrombin formation

Answer 12

Vitamin K

Question 13

Promotes red blood cell formation

Answer 13

Iron

Question 14

Enhances connective tissue formation, wound healing, and protein synthesis

Answer 14

Zinc

Question 15

Side Effects of Medications

Answer 15

severity of periodontal reaction to medication varies among patients
examples:
- gingival enlargement (hyperplasia)
- Xerostomia
- Altered host resistance
- Abnormal bleeding

Question 16

4 LOCAL CONTRIBUTORY FACTORS

Answer 16

1. Calculus
2. Anatomic Factors
3. Iatrogenic Factors- something done in dentistry
4. Traumatic Factors

Question 17

Calculus is considered the most important __ ____ factor!
___ the cause of disease.
Always covered by plaque and retains toxic bacterial products -> contributes

Answer 17

local contributing

not

Question 18

• Calculus is mineralized plaque. Precipitated salts that originate in saliva and GCF.
  ***- Inorganic content of calc. is mainly ____ ____, with lesser amts. of calcium carbonate and other organics
• Minerals deposited within 24-72 hours of
  plaque formation
• Deposits are classified by location

Answer 18

calcium phosphate

Question 19

Why is calculus tenacious at times

Answer 19

because it forms in layers

Question 20

Supra gingival calculus

Answer 20

• Attaches coronally to gingival margin ž
• Chalky, creamy white or yellow
  appearance ž
• Mineralized by saliva ž
• Relatively easy to remove (about 30%
  mineralized) ž
• Common on max. molar buccal surfaces
  and mand. Anterior linguals (why?) salviary glands

Question 21

Sub gingival calculus

Answer 21

• Attaches apically to gingival margin ž
• Gray, brown, or black in color ž
• More difficult to remove than supra G
  (about 60% mineralized) ž
• Mineralized by sulcular fluid

Question 22

Inflammatory periodontal diseases are

infections caused by ____

Answer 22

bacteria

Question 23

Dental calculus is not a cause for
periodontal diseases, but an important
____ contributing factor

Answer 23

LOCAL

Question 24

As a Clinician

Answer 24

Tx Plan
OHI-> Individualized for patient
Recall intervals

Question 25

As a Clinician what is important for us to evaluate?

Answer 25

- Medical Hx - Social Hx - Habits - OH self care - Intraoral exam-> restorations , malpositioning - periodontal exam-> any inconsistences

Question 26

Traumatic Factors

Answer 26

``` - Trauma can result in loss of attachment apparatus, changes in local anatomy, and increased plaque accumulation ž - Toothbrush trauma ž -Factitious disease (scratching) ž - Food impaction ž - Chemical injury (aspirin or cocaine burn) ž - Occlusion ž - Oral piercings ```

Question 27

Examples of tooth position that encourages plaque retentions!

Answer 27

Crowding Tilting Rotation Open contacts->food impaction

Question 28

Procedures, techniques, and materials used in dentistry that directly or indirectly contribute to initiation or progression of periodontitis

Answer 28

Iatrogenic Factors

Question 29

Iatrogenic Factors

Answer 29

ž Rough surfaced or over-contoured amalgams, composites, crowns, bridges, inlays, and onlays ž Overhanging margins ž Sub-gingival margins that invade the biologic width ž Injuries to gingiva during procedure à wedges, retraction cord ž Fixed crowns and bridges à pt must be able to clean all surfaces ž Extractions can affect adjacent teeth (if their attachment app. is damaged or if calculus remains) ž Patients stop chewing on ext. side and stop brushing for a while ž Orthodontics: plaque retention!!!!

Question 30

Traumatic Factors

Answer 30

-Trauma can result in loss of attachment apparatus, changes in local anatomy, and increased plaque accumulation ž - Toothbrush trauma ž - Factitious disease (scratching) - Food impaction ž - Chemical injury (aspirin or cocaine burn) ž - Occlusion ž - Oral piercings

Question 31

As a clinician what is imprortant for us to evaluate

Answer 31

- Medical Hx ž - Social Hx ž - Habits ž - OH self care ž - Intraoral exam à restorations, malpositioning ž - Periodontal exam à any inconsistencies? -Tx Plan - OHI- indiviualized for patient - recall intervals

Question 32

Key Points - Inflammatory periodontal diseases are infections caused by bacteria ž - Certain secondary local and systemic risk factors can influence the initiation and progression of the disease ž - Dental calculus is not a cause for periodontal diseases, but an important ___ contributing factor

Answer 32

LOCAL