Risk Factors for Periodontal Diseases

Question 1

Explain how health can progress to gingivitis or periodontal disease

Answer 1

In health there is immune cells present at gingival margins

When plaque accumulates on teeth it causes inflammation of the gingiva

Inflammation causes the immune system to increase secretion of neutrophils, B lymphocytes and T lymphocytes

If bacteria persists on teeth they because dysbiosis. This causes normal balance between immune response and bacteria to be disrupted. The immune system reacts to the bacteria causing destruction

Question 2

Define Risk Factor

Answer 2

something that increases a persons chanced of developing a disease

Question 3

What are local risk factors for periodontitis?

Answer 3

• plaque/calculus
• Overhanging or priorly contoured matrix bands
• Orthodontic appliances
• Malpositioned teeth
• Occlusal Trauma

Question 4

What are non modifiable systemic risk factors for periodontitis?

Answer 4

• age
• genetic factors
• genetic disorders (downs syndrome and papillon lefevre syndrome)
• gender (males more at risk)

Question 5

What are modifiable risk factors of periodontitis?

Answer 5

• smoking
• poorly controlled diabetes
• HIV
• stress
• medications
• leukemia

Question 6

Explain why smoking affects periodontal disease

Answer 6

• has an effect on oral microbiota
• increases activation of the immune system
• decreases healing capacity (reduced blood flow to gingiva)
• contributes to shift between symbiotic and dysbiotic biofilm

Question 7

Explain how diabetes can affect periodontal disease

Answer 7

hyperglycaemia causes increased levels of AE (advanced glycation end products) which leads to exacerbation of inflammation as the host recognises extra AE as foreign

immune response up regulates secretion of cytokines which disrupts RANKL:OPG ratio to increase rate of bone resorption

Question 8

What are important considerations of diabetes when assessing risk to periodontal tissues?

Answer 8

• Degree of diabetic control
• Age of onset
• The duration of the disease

Question 9

what is HbA1c and why is it used ?

Answer 9

HbA1c measures glaciated haemoglobin

As red blood cells are renewed ever 8-12 weeks it gives indication of average blood glucose levels over 3 months

Question 10

What are the values of HbA1c used to measure diabetes control?

Answer 10

low blood sugar - <4%
Normal blood sugar - >4 and <6%
pre diabetic - 6-6.4%
diabetes 6/5% or over

Question 11

How does obesity increase risk of periodontitis?

Answer 11

• lack of nutrients - decreases the function of the immune system
• increased fat - adiposites produce more cytokines which increases immune response and inflammation
• impacts collagen production - this affects the gingiva

Question 12

How can medication increase risk of periodontitis?

Answer 12

interaction between the drug and the host fibroblasts increases the deposition of connective tissue and causes hyperproliferative epithelium
- this is harder to clean and control plaque

Question 13

What type of drugs can increase risk of peridontitis? give an example

Answer 13

anticonvulsants - phenytoin

Immunosuppressants - cyclosporin (transplant patients)

Calcium channel blockers - nifedipine and amlodipine

Question 14

How does pregnancy increase risk of periodontitis?

Answer 14

hormones contribute to immune system response and increase risk of inflammation

Question 15

how does osteoporosis increase risk of periodontitis?

Answer 15

osteoporosis causes low bone mineral density which will accelerate alveolar bone resorption

Question 16

how can stress increase the risk of periodontal disease?

Answer 16

stress increases cortisol production - a hormone that stimulates the immune system

Question 17

How does periodontal disease affect diabetic control?

Answer 17

periodontal bacteria enter the circulation and increase systemic inflammation
- this causes impaired insulin signalling and insulin resistance making diabateres worse