Risk factors for periodontal diseases and perio-systemic links

Question 1

what are some genetic conditions associated with the impairment of immune system in relation to periodontitis?

Answer 1

papillon-levre syndrome, chediak-higashi syndrome, LAS syndrome, down’s syndrome, chronic granulomatous disease

Question 2

what are some diseases leading to the impairment of immune system in relation to periodontitis?

Answer 2

leukaemia, agranulocytosis, neutropenia, HIV infection

Question 3

local acquired factors for periodontal diseases?

Answer 3

plaque, calculus, overhanging and poorly contoured restorations and prosthetic crowns, orthodontic appliances, occlusal trauma

Question 4

local anatomical factors for periodontal diseases?

Answer 4

malpositioned teeth, root groves, concavities and furcations, enamel pearls

Question 5

systemic non-modifiable risk factors for periodontal diseases?

Answer 5

aging, genetic factors, gender (males), genetic disorders: Down syndrome, Papillon-Lefevre syndrome.

Question 6

systemic modifiable risk factors for periodontal diseases?

Answer 6

smoking, poorly controlled diabetes, HIV, leukaemia, osteopenia, osteoporosis, stress, medications, hormonal status, poor nutrition, socioeconomic status

Question 7

why is smoking a risk factor to periodontal disease?

Answer 7

 Effect on oral microbiota
 Increase activation of the immune system
 Decreased healing capacity (reduced blood flow)

Question 8

why is sub-optimally controlled diabetes a risk factor to periodontal disease?

Answer 8

 Hyperglycaemia in diabetes may modulate
 RANKL ( the receptor activator of nuclear factor-kappa 𝛃): OPG (osteoprotegerin) ratio and thus contribute to alveolar bone destruction
 In hyperglycaemia production of AGE (advanced glycation end products) increases which leads to exacerbation of inflammation (production of pro-inflammatory cytokines and destructive metalloproteinases)

Question 9

what are important factors contributing to periodontal diseases severity for a patient with diabetes?

Answer 9

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

Question 10

why is obesity and nutrition a risk factor to periodontal disease?

Answer 10

 Severe vit. C deficiency – scorbutic gingivitis - scurvy
 Lack of nutrients - decrease function of the immune system

Question 11

why is drugs a risk factor to periodontal disease?

Answer 11

 Anticonvulsant: phenytoin
 Immunosupresants: cyclosporin (transplant patients)
 Calcium channel blockers (nifedipine,amlodipine)

Question 12

what does interaction between the drug and host fibroblasts result in, in regards to periodontal disease?

Answer 12

an increased deposition of connective tissue supporting a hyperproliferative epithelium>
e.g
- gingival enlargement hyperplasia - more fibroblasts
- gingival sweellign - more intercellular fluid increases permeabilisation of the vessels

Question 13

Why it is difficult to document cause-effect association between cardiovascular diseases and periodontitis?

Answer 13

o The same risk factors for both diseases (smoking, diabetes, stress, obesity)
o Common pathomechanisms associated with systemic inflammation and activation of the immune system

Question 14

what is periodontitis a risk factor for?

Answer 14

• rheumatoid arthritis
• preeclampsia
• Alzheimer’s disease