risk factors for Periodontitis

Question 1

chain of events

Answer 1

1. mature biofilm present
2. host response & inflammatory mediators
3. damage to periodontium
4. clinical signs of PD

*altered by genetic/environmental/acquired factors

Question 2

why is understanding risk important

Answer 2

• influences the prognosis of PD breakdown
• increased risk = more adjunctive measures

Question 3

define risk factor

what are the most significant risk factors related to the onset/progression/severity of periodontitis

Answer 3

risk factor: attribute or exposure that increases the probability or occurrence of disease and its removal reduces disease occurrence

significant: smoking cigarettes/nicotine increases your risk by 2-3X; cigar and pipe smoking as well

Question 4

difference between modifiable and innate risk factors with examples

Answer 4

modifiable: can be changed/modified.
- smoking, control of systemic diseases, decreasing social determinants of health

innate: unchanging
- age, gender, race, ethnicity, social determinants of health, Presence and severity of existing periodontitis, history of periodontitis (higher risk)

Question 5

what are teh 5 SDOH

Answer 5

• education access and qualtiy
• health and care quality
• neighborhood and built environment
• social/community context
• economic stability

Question 6

how to assess for risk factors, we may be the first to notice something off systemically in a patient

Answer 6

• medical, dental, and medication history
• patient interviewing
• clinical evaluation

Question 7

INNATE RISK FACTORS (UNCHANGING)

Higher incidence rates in _____ and _____ populations

More research needed to determine degree of _____

Higher incidence rates in ____ adults

Higher incidence rates in ____

______ have the highest rates of any ethnicity regardless of age. Prevalence increases with _____ in all races.

Answer 7

Higher incidence rates in AFRICAN AMERICAN and HISPANIC populations

More research needed to determine degree of SUSCEPTIBILITY

Higher incidence rates in OLDER adults

Higher incidence rates in MALES

AFRICAN AMERICANS have the highest rates of any ethnicity regardless of age. Prevalence increases with AGE in all races.

Question 8

CDC STUDY ON INCIDENCE

__% Men and __% Women

__% Non-Hispanic Black and __% Mexican-Americans

Social determinants of health-income as it relates to ____ level, _____ level, _____, and resources

adults below 100% federal poverty levels: __%

adults with less than a high school education: __%

Answer 8

56% Men and 38% Women

58% Non-Hispanic Black and 67% Mexican-Americans

Social determinants of health-income as it relates to poverty level, education level, community, and resources

adults below 100% federal poverty levels: 65%

adults with less than a high school education: 67%

Question 9

unmodifiable genetic disorders

Reduced _______ function

Cyclic neutropenia: rare blood disorder that causes episodes of low levels of _____ (vital to fighting _____)

Chediak-Higashi Syndrome: rare, _____ recessive disorder (recurrent ___________)

Papillon-Lefevre Syndrome: rare autosomal recessive disorder caused by _______ gene mutation leading to the deficiency of __________ enzymatic activity. characterized by _________, loss of deciduous and permanent teeth, and increased susceptibility to infections

Down Syndrome: extra _____ with impacts to many systems in the body, including ______

Answer 9

Reduced NEUTROPHIL function

Cyclic neutropenia: rare blood disorder that causes episodes of low levels of NEUTROPHILS (vital to fighting INFECTIONS)

Chediak-Higashi Syndrome: rare, autosomal recessive disorder (recurrent bacterial infections)

Papillon-Lefevre Syndrome: rare autosomal recessive disorder caused by cathepsin C gene mutation leading to the deficiency of cathepsin C enzymatic activity. characterized by palmoplantarhyperkeratosis, loss of deciduous and permanent teeth and increased susceptibility to infections

Down Syndrome: extra chromosome with impacts to many systems in the body, including immunity

Question 10

all unmodifiable conditions _____ the host response. Anything that impairs the host response impacts our _______. This will always impact the _______ with periodontal disease

Answer 10

all unmodifiable conditions ALTER the host response. Anything that impairs the host response impacts our IMMUNE SYSTEM. This will always impact the PROGNOSIS with periodontal disease

Question 11

PST - GENETIC MARKER TEST

Alter the ability of _____ to perform their function in the immune/inflammatory process. ____ and __; genotype-positive persons produce more

_____ in IL-1A and B strongly associated with generalized/severe disease in ________

Answer 11

Alter ability of cytokines to perform their function in immune/inflammatory process IL-1A and B; genotype positive persons produce more

Increase in IL-1A and B strongly associated with more generalized and severe disease in non-smokers

Question 12

______ also identified for increased risk

Highly associated with increased risk for severe periodontal disease because _______ inflammation and mediators, resulting in increased _____ more rapidly

Prognostic test: predict ____ for someone; do they have these _____?

Interleukin Genetics, Inc. is marketing a genetic test to predict _____ risk by testing for genetic _____ predisposing individuals to an enhanced interleukin-1 (IL-1) mediated inflammatory response.

Answer 12

GENETIC MARKERS also identified for increased risk

Highly associated with increased risk for severe periodontal disease because IT OVERPRODUCES inflammation and mediators, resulting in increased DESTRUCTION more rapidly

Prognostic test: predict RISK for someone; do they have these GENES?

Interleukin Genetics, Inc. is marketing a genetic test to predict PERIODONTITIS risk by testing for genetic POLYMORPHISMS predisposing individuals to an enhanced interleukin-1 (IL-1) mediated inflammatory response.

Question 13

GENETIC MARKER TEST

Genotype Negative - even with ____, regardless of ____ type, no severe __

Genotype Positive - increased susceptibility to _____ disease: mid-__’s

__ x more tooth loss

____ times greater risk for perio destruction in ______

YET, ____ not as strong a risk as ____

Better- counsel ____ smoking

Answer 13

Genotype Negative - even with SMOKING, regardless of PLAQUE type, no severe DISEASE

Genotype Positive - increased susceptibility to SEVERE disease: mid-40’s

positive = 3 x more tooth loss

positive = 3-7 times greater risk for perio destruction in NONSMOKERS

YET, GENETICS not as strong a risk as SMOKING

Better- counsel QUIT smoking

Question 14

TREATMENT FOR A POSITIVE GENOTYPE MARKER

Treat _____; Less “wait and watch”

______ re-treatment decisions

Host response therapy, ____ drug delivery

Emphasis on oral hygiene _____

_____ treatment

_______ referral

Answer 14

Treat AGGRESSIVELY; Less “wait and watch”

EARLIER re-treatment decisions

Host response therapy, LOCAL drug delivery

Emphasis on oral hygiene ADJUNCTS

POCKET treatment

PERIODONTAL referral

Question 15

MODIFIABLE SYSTEMIC FACTORS (6)

Answer 15

Tobacco use
Diabetes control
Medications (?)
Poor oral hygiene
HIV disease control
Obesity (?)

Question 16

______ risk factors are conditions or diseases that _____ a persons susceptibility to periodontal disease by ______ or ______ the host reponse to periodontal pathogens

Answer 16

Systemic risk factors are conditions or diseases that increase an individual’s susceptibility to periodontal disease by modifying or amplifying the host response to periodontal pathogens.

Question 17

SMOKING (modifiable)

______ clinical appearance

Greater pocket depths in ____ segment (_____)

Gingiva- thickened, ______, minimal _______, lighter color, ____

Minimal association between ____ and __________

Smoking may be responsible for more than ___ of adult periodontal cases in the US

smokeless tobacco also associated with ______, typically where it is placed

Answer 17

DISTINCT clinical appearance

Greater pocket depths in ANTERIOR segment (MAX LINGUALS) *different from typical molar impaction

Gingiva- thickened, FIBROTIC, minimal REDNESS, lighter color, STAINING

Minimal association between LEVEL OF DISEASE (high) and AMOUNT OF PLAQUE (low)

Smoking may be responsible for more than 1/2 of adult periodontal cases in the US

smokeless tobacco also associated with LOSS OF ATTACHMENT, typically where it is placed

Question 18

what are the 3 mechanisms that smoking may contribute to Periodntal destruction

Answer 18

1. impact on oral microbial biofilms: conflicting research; increase in anaerobic and gram neg bacteria from nicotine, reduction in healthy bacteria, higher rate of red complex
2. impact on immune system: known, nicotine directly alters our immune system and impacts host response. Less clinical signs due to vasoconstriction, less edema and bleeding, but disease is still active! Nicotine also causes decreased functionality of some leukocytes, less antibodies
3. impact on bone metabolism: Nicotine may also suppress osteoblasts—more research needed. It is possible nicotine increases inflammatory mediators that lead to destruction

Question 19

what 5 things do smokers have an increased incidence with

Answer 19

• pocket depths
• alveolar bone loss
• tooth loss
• clinical attachment loss
• furcations

Question 20

smoking on the immune system

Affects both ______ system and _______ response system

Smokers have decreased signs of _______ and impaired gingival _____ flow

______ function impaired

May decrease _________ production

Answer 20

Affects both immune system and inflammatory response system

Smokers have decreased signs of inflammation and impaired gingival blood flow

Neutrophil function impaired

May decrease antibody production

Question 21

smoking and bone metabolism

Associated with greater amount of _______ destruction than non smokers

nicotine may suppress ______

may alter normal bone _____

Answer 21

Associated with greater amount of alveolar bone destruction than non-smokers

nicotine may suppress osteoblasts

may alter normal bone remodeling

Question 22

____ impacts of smoking exist too and may be seen with____ products as well as products that are associated with smoke and inhaling

Answer 22

DIRECT impacts of smoking exist too and may be seen with NON-NICOTINE products as well as products that are associated with smoke and inhaling

Question 23

Direct ____ damage to tissues

Potential _____ damage

Decrease in ____ volume and salivary _______

More severe disease and more ____ loss

Amount*

Longevity*

all of these direct impacts have been seen with smoking ______, especially a decrease in ______ and _______

Answer 23

Direct local damage to tissues

Potential thermal damage

Decrease in saliva volume and salivary antibodies

More severe disease and more tooth loss

the more you smoke and longer you smoke the more direct impacts you will see, hence why grading matters on smoking 10 or more per day

all of these direct impacts have been seen with smoking marijuana, especially a decrease in salivary volume and antibodies

Question 24

nicotinic stomatitis: associated with ______ use. however can be a _____ damage.

inflamed ______ with increased _____

Answer 24

Nicotinic stomatitis—associated with nicotine use, however can be a thermal damage seen with others too.

What we are seeing are inflamed minor salivary glands with increased keratin (whiteness) around them

Question 25

smoking is associated with treatment ____, especially surgeries. most periodontist's/oral surgeons require _____ prior to surgery. treatment failure examples (4)

Answer 25

Smoking associated with treatment failures for many things, especially surgeries. Most periodontists and oral surgeons require cessation prior to surgery. implants, regenerative therapy, conventional therapy, refractory disease

Question 26

E-cigarettes - introduced in the US in ____ - don't contain ______ - heats up _____, turning into vapor - vapor is _____ and _____ - vapor has significant ____ and _____ side effects

Answer 26

- introduced in the US in 2007 - don't contain tobacco - heats up nicotine, turning into vapor - vapor is inhaled and exhaled - vapor has significant oral and systemic side effects

Question 27

do e-cigs and normal ones have the same effects

Answer 27

yes, same nicotinic impacts apply, same direct effects of thermal heat and inhalation

Question 28

CDC e-cig use most commonly used ______ product among youth since ____ 2020 rates: ___ middle school students ___ high school students 2022 rates __ in every middle school ___ in every high school

Answer 28

most commonly used tobacco product among youth since 2014 2020 rates: 1/20 middle school students 1/5 high school students 2022 rates 1/30 in every middle school 1/7` in every high school

Question 29

2014, the FDA ruled tobacco products because of the nicotine derived from tobacco plants are there any FDA approved electronic nicotine devices Marketed as ___ product than cigarettes; however the ___ have the same negative health effects as research is starting to show ___, ___, ___ all do not recommend this as a tobacco cessation product

Answer 29

2014, the FDA ruled tobacco products because of the nicotine derived from tobacco plants NO Marketed as safer product than cigarettes; however the aerosols have the same negative health effects as research is starting to show ADA, AMA, AHA all do not recommend this as a tobacco cessation product

Question 30

recommendations of the AAP When a tobacco product is smoked, more than ____ toxins are present in the smoke. The American Academy of Periodontology strongly recommends the inclusion of _____ in periodontal therapy. All smokers and chewers of tobacco should be advised about the support of _______ to help with ______.

Answer 30

When a tobacco product is smoked, more than ____ toxins are present in the smoke. The American Academy of Periodontology strongly recommends inclusion of tobacco cessation in periodontal therapy. All smokers and chewers of tobacco should be advised about the support of quit lines to help with cessation.

Question 31

It is generally accepted that even ______ individuals are affected by inhaling _______ smoke or “passive smoking.” Unknown if this can also increase _____ disease risk at this time, but it does increase ____ risks.

Answer 31

It is generally accepted that even nonsmoking individuals are affected by inhaling secondhand smoke or “passive smoking.” Unknown if this can also increase periodontal disease risk at this time, but it does increase cancer risks.

Question 32

diabetes control - increased risk for diabetics if ______ controlled - Poor control increases risk of ___ disease - _____ effects of periodontal diseases might make ______ regulation more difficult - Type I (____) and type II (_________) - ____ MAJOR risk factor; _____ relationship CONFIRMED! Meaning, one impacts the other and it is harder to control either disease without controlling all.

Answer 32

- increased risk for diabetics if poorly controlled - Poor control increases risk of oral disease - Systemic effects of periodontal diseases might make insulin regulation more difficult - Type I (autoimmune) and type II (acquired insulin deficiency) - Confirmed MAJOR risk factor; RECIPROCAL relationship CONFIRMED! Meaning, one impacts the other and it is harder to control either disease without controlling all.

Question 33

uncontrolled diabetes ______ risk factor for PD increases ______, ________, and ______ considered a _______ of diabetes __X more likely to develop PD

Answer 33

established risk factor for PD increases prevalence, severity, and progression considered a complication of diabetes 3x more likely to develop PD

Question 34

diabetes ___ consult after diagnosis needed because of the _____ relationship Maintaining a mouth free of _____ should be a goal of all diabetics Impaired _______ is common, even after treatment Reduced _____ flow ______ (Cracking lips) increases

Answer 34

DDS consult after diagnosis is needed because of the reciprocal relationship Maintaining a mouth free of inflammation should be a goal of all diabetics Impaired wound healing common too, even after our treatment Reduced salivary flow Cheilosis (Cracking lips) incidence increases

Question 35

diabetes chain link

Answer 35

periodontal infection increased inflammatory mediators inflammatory mediators disseminated via bloodstream increased insulin resistance and poor glycemic control diabetic complications

Question 36

Periodontal diseases may serve as initiators of ________, thereby aggravating ________.

Answer 36

Periodontal diseases may serve as initiators of insulin resistance, thereby aggravating glycemic control.

Question 37

HbA1C shows control ____ over ____ months, finger-stick shows control in that _____. HbA1C helps us better determine ____, but finger-stick readings may help prevent ________ in the moment. Uncontrolled is at an _____ risk for infection and may require ____

Answer 37

HbA1C shows control average over three months, finger-stick shows control in that moment. HbA1C helps us better determine control, but finger-stick readings may help prevent medical emergencies in the moment. Uncontrolled is at an increased risk for infection and may require pre-med

Question 38

hba1c goal: hba1c susceptible: finger stick goal: finger stick risk of infection: finger stick unacceptable:

Answer 38

hba1c goal: less than 7% hba1c susceptible: above 8% finger stick goal: 80-120 mg/dL finger stick risk of infection: 180-300 mg/dL finger stick unacceptable: greater than 300mg/dL

Question 39

children between ___ with diabetes showed significantly more periodontal disease than those without diabetes. Children with diabetes should be examined for signs of _____ disease and receive _____ intervention and prevention. Kids can also have impacts from diabetes! We don’t typically see ___ besides ______ in children, but with ______ as a risk factor we do.

Answer 39

children between 6-18 with diabetes showed significantly more periodontal disease than those without diabetes. Children with diabetes should be examined for signs of periodontal disease and receive early intervention and prevention. Kids can also have impacts from diabetes! We don’t typically see PD besides gingivitis in children, but with diabetes as a risk factor we do.

Question 40

can we screen chairside for diabetes

Answer 40

Lots of research out there for us to start doing this within our scope of practice. Some states are!

Question 41

STRESS Acute = ______ Chronic = _______ - Anxiety, depression, impaired cognition, reduced self-esteem - High ______ stress and ______ are significant risk factors

Answer 41

Acute = immuno enhancing Chronic = immunosuppressant - Anxiety, depression, impaired cognition, reduced self-esteem - High financial stress and depression are significant risk factors

Question 42

what drugs might cause xerostomia

Answer 42

- over 1800 - antihypertensives, antihistamines, antidepressants, and anticholinergics - tricyclic antidepressants, antipsychotics, benzodiazepines, atropines, beta blockers, decongestants, diuretics, bronchodilators, appetite suppressants, protease inhibitors, didanosine, serotonin reuptake inhibitors Some also cause increase biofilm Some are acidic and alter the pH of the mouth which also can have direct impacts to periodontium and hard tissue

Question 43

what are the increased risks and side effects (besides xerostomia) cause by medications

Answer 43

gingival hyperplasia - calcium channel blockers (nifedipine) - anticonvulsive (dilantin) - immunosuppressants (cyclosporine) - hormones

Question 44

are there medications to help with PD

Answer 44

limited evidence to support systemic antibiotic use (control risk factors via medications) NSAIDS help with inflammation and have been shown to decrease bone resorption tetracycline known to increase formation of connective tissue

Question 45

HIV positive/disease control __% - severe destruction type of periodontitis complete cause and effect is ____ HIV is a known systemic condition for _______ so of course we see severe destruction at different _____ of HIV. ___________ is almost exclusively associated with HIV, however we can see it with other immunosuppressing conditions (more rarely) Impacts ____ system; leukocytes do not function as well, _____ is limited, decreased _______ Many oral ________ of uncontrolled HIV

Answer 45

17% - severe destruction type of periodontitis complete cause and effect is unknown HIV is a known systemic condition for immunosuppression so of course we see severe destruction at different phases of HIV. Necrotizing ulcerative periodontitis is almost exclusively associated with HIV, however we can see it with other immunosuppressing conditions (more rarely) Impacts immune system; leukocytes do not function as well, chemotaxis is limited, decreased phagocytosis Many oral manifestations of uncontrolled HIV

Question 46

HEMATOLOGIC DISORDERS Neutropenia: low ______ counts, increased susceptibility to infection. ______, _______, leukemia, _____-induced, ____-induced Leukemia: _____ of the _____ cells; can be any blood cells, but most common _______

Answer 46

Neutropenia: low neutrophil counts (PMNs!!); increased susceptibility to infection. Congenital, idiopathic, leukemia, radiation-induced, drug-induced Leukemia: cancer of the blood cells; can be any blood cells, but most common leukocytes

Question 47

hormonal impacts on periodontium Puberty ___ genders Increased ____ and ___ flow due to ___ hormones Pregnancy Pregnancy ____ p____ g_____ Menopause Lack of ____ also cause disruption ______ increase

Answer 47

Puberty both genders Increased inflammation and blood flow due to sex hormones Pregnancy Pregnancy gingivitis pyogenic granuloma (scar tissue from trauma) Menopause Lack of hormones also cause disruption (xerostomia) osteoporosis increase

Question 48

puberty: raging hormones make gums overreact and increase ______ monthly menstruation: _____ levels decrease causing swollen gums, inflamed salivary glands, ______ gums, _____ sores pregnancy: _____ and _____ increase causing _____. birth control pills: provoke ___ diseases and _________ disorder menopause: decreased _____ causes _____, off taste, ______ sensation

Answer 48

puberty: raging hormones make gums overreact and increase gingivitis monthly menstruation: progesterone levels decrease causing swollen gums, inflamed salivary glands, bleeding gums, canker sores pregnancy: estrogen and progesteron increase causing gingivitis (common). birth control pills: provoke gum diseases and Temporomandiublar joint disorder menopause: decreased estrogen causes xerostomia, off taste, burning sensation

Question 49

osteoporosis = ______ bone loss of bone ____ occurs most frequently in (4) disease characterized by low bone ___ and structural _______ of bone tissue Leads to bone ____ and an increased susceptibility to fractures of the ___, ___, and _____. ___ women ___ men over 50 will have a related fracture in their life More seen in the _____

Answer 49

porous bone mineral postmenopausal women, sedentary individuals, bedridden individuals, individuals on long term steroid therapy disease characterized by low bone mass and structural deterioration of bone tissue Leads to bone fragility and an increased susceptibility to fractures of the hip, spine, and wrist. 1:2 women 1:8 men over 50 will have a related fracture in their life More seen in the mandible

Question 50

osteoporosis and periodontal disease Does not _____ disease Loss of bone density may ______ existing periodontal disease condition _____ status is a strong predictor More resorption in the _____ = more resorption in the _______

Answer 50

Does not initiate disease Loss of bone density may exacerbate existing periodontal disease condition mandible status is a strong predictor More resorption in the mandible = more resorption in the body

Question 51

obesity defined: what is the link between obesity and periodontal disease (4)

Answer 51

obesity: excess body fat in proportion to lean mass (orange-red is at risk) link: not cause/effect; adipose tissue secretes immunomodulatory factors; elevated levels of TNF and interleukins seen in obesity; similar inflammatory pathways

Question 52

ADA states: “___ are encouraged to promote awareness of the adverse health conditions associated with ____, including ______ disease and _______ as well as risk for ____”

Answer 52

ADA states: “Oral hygiene personnel are encouraged to promote awareness of the adverse health conditions associated with obesity, including cardiovascular disease and diabetes as well as risk for perio”

Question 53

nutritional deficiences as a risk factor Not _____, just exacerbates the disease sometimes described as ________ origin causes issues with the ___ response Depresses the _____ system Vitamin _______: (most common in 3rd world countries)

Answer 53

Not cause/effect, just exacerbates the disease sometimes described as nonbiofilm induced origin causes issues with the host response Depresses the immune system Vitamin C-Scurvy: (most common in 3rd world countries)

Question 54

social determinants of health _______ status predictor of periodontal disease ______ level predictor of periodontal disease Access to ___? Information? Resources and tools?

Answer 54

socioeconomic status predictor of periodontal disease education level predictor of periodontal disease ACCESS to care? Information? Resources and tools?

Question 55

Published evidence supports a _____ ______ between periodontitis and some systemic conditions Only one risk factor has a direct causal link to PD: It is possible that the association is the result of ________ and not causality.

Answer 55

Published evidence supports a modest association between periodontitis and some systemic conditions Only one risk factor has a direct causal link to PD: diabetes It is possible that the association is the result of common risk factors and not causality.

Question 56

bacteria and the systemic link Periodontal bacteria can enter the bloodstream via the ______ and travel to ______ Cause ____ and ____ infection Contribute to _______ diseases Infective Endocarditis: ______ get infected and inflamed due to ______ in the blood

Answer 56

Periodontal bacteria can enter the bloodstream via the gingival sulcus and travel to major organs Cause further and new infection Contribute to respiratory diseases Infective Endocarditis > heart valves get infected and inflamed due to bacteria in the blood

Question 57

Pose a serious threat to people whose health is compromised by _____, ______ diseases, or ______ (joint replacement, ___ dialysis/transplants, ___, _____, immunosuppressed) Increase a ______ risk of having a pre-term, low birthweight baby

Answer 57

Pose a serious threat to people whose health is compromised by diabetes, respiratory diseases, or osteoporosis (joint replacement, renal dialysis/transplants, HIV, chemo, immunosuppressed) Increase a woman's risk of having a pre-term, low birthweight baby

Question 58

the key: _______ oral inflammation leads to ________ _______ and ______ enter the bloodstream and circulation source of _______ inflammatory mediators ________ (CRP): ____ produces this in response to inflammation Interleukins (1 and 6) ________ (TNF)

Answer 58

the key: inflammatory mediators oral inflammation leads to systemic inflammation endotoxins and mediators enter the bloodstream and circulation source of systemic inflammatory mediators C-reactive protein (CRP): tells us where inflammation is present Interleukins (1 and 6) tumor necrosis factor (TNF)

Question 59

we must explain inflammatory mediators to people who need a medical consult, how?

Answer 59

lets them know the "markers" in the mouth for inflammation impact systemic inflammation as well whole body wellness is the goal inflammation is the link multifactorial part of a greater disease process in the body

Question 60

what is ACVD what is atherosclerosis what is atheroma

Answer 60

ACVD: group of heart/vascular diseases Atherosclerosis: thickening of artery walls/narrowing of the opening/ creation of plaques) a major component of CVD atheroma: fatty deposit in the inner lining of an artery

Question 61

cardiovascular disease Heart disease - most _____ condition found in periodontal patients (______) Severe perio - __x greater stroke risk Heart attack - __x greater stroke risk Severity of oral infections correlates with the extent of _______

Answer 61

Heart disease - most common condition found in periodontal patients (hypertension) Severe perio - 3x greater stroke risk Heart attack - 3.6x greater stroke risk Severity oral infections correlates with the extent of coronary atherosclerosis

Question 62

CHD and periodontitis Periodontal disease provides a biological burden of endotoxins (____) and inflammatory cytokines/mediators These _____ and exacerbate the growth of _____ in arterial walls Contribute to vessel ______ and ___

Answer 62

Periodontal disease provides a biological burden of endotoxins (LPS) and inflammatory cytokines/mediators These initiate and exacerbate the growth of atheroma in arterial walls Contribute to vessel blockage and CHD

Question 63

simplified dyslipidemia: Periodontal infection may elevate serum ______ and low-density _______ (LDLs) _____ may also be elevated Dyslipidemia refers to abnormal amounts of ____ (____) in the blood how to manage (3) increased risk for:

Answer 63

dyslipidemia: high cholesterol Periodontal infection may elevate serum cholesterol and low-density lipoproteins (LDLs) Triglycerides and very low-density lipoproteins may also be elevated Dyslipidemia refers to abnormal amounts of lipids (fats) in the blood how to manage: diet, exercise, medications increased risk for: plaques and narrow arteries

Question 64

DYSLIPIDEMIA Increase _______ in vessels Thrombus: Embolism: _______ formation

Answer 64

Increase build-up in vessels Thrombus formation: attached to the BV wall Embolism: thrombus that breaks off and travels in blood Atheroma formation

Question 65

PRE-TERM LOW BIRTH WEIGHT (PTLB) Women with severe periodontal disease are __ times risk for preterm low birth weight baby Cause under investigation- probably linked to the release of biochemical mediators associated with periodontitis (___) prostaglandins cause ___, severe perio stimulates ______, causing PTLB

Answer 65

Women with severe periodontal disease are 7.5 times risk for preterm low birth weight baby Cause under investigation- probably linked to the release of biochemical mediators associated with periodontitis (PGE2) prostaglandins cause contractions, severe perio stimulates prostaglandins, causing PTLB

Question 66

PTLB deliveries Bacteria ____, ____, and ____ are detected at higher levels in PTLB mothers compared to normal controls Theory- Periodontitis creates _____ and ______ abnormalities: increased amniotic prostaglandin production Levels of ____ increased Circulating inflammatory mediators ___ and ___ travel from the gingival sulcus and enter the placenta placenta stimulated to produce ___ Raise the _______ level earlier to precipitate early uterine ____ and ____ Dental hygienists have a critical _______ role

Answer 66

Bacteria AA, PG, and TD are detected at higher levels in PTLB mothers compared to normal controls Theory- Periodontitis creates hormonal and cytokine abnormalities- increased amniotic prostaglandin production Levels of PGE2 (prostaglandins) increased Circulating inflammatory mediators Il-1 and LPS travel from gingival sulcus and enter placenta; placenta stimulated to produce PGE2 Raise threshold level earlier to precipitate early uterine contractions and labor Dental hygienists have a critical educational role

Question 67

what are the shared risk factors between periodontal disease and PTLB deliveries (3)

Answer 67

- smoking - diabetes - increased prostaglandins

Question 68

RESPIRATORY DISEASES Periodontal disease may increase risk for ______ disease Oral bacteria from biofilm may serve as a ______ for respiratory pathogen colonization and subsequent _____ _________ oral secretions with elevated levels of inflammatory mediators Travel from oral cavity to the ____, increases respiratory ________

Answer 68

Periodontal disease may increase risk for respiratory disease Oral bacteria from biofilm may serve as a reservoir for respiratory pathogen colonization and subsequent infection Aspirating oral secretions with elevated levels of inflammatory mediators Travel from oral cavity to the lungs, increases respiratory inflammation

Question 69

Aspiration Pneumonia _______ patients ____ homes and _____ care facilities RDHs: we must _____ for these populations Medical professionals need to be trained on how to advocate

Answer 69

immunocompromised patients nursing homes and long term care facilities RDHs: we must advocate for these populations Medical professionals need to be trained on how to advocate

Question 70

Alzheimer's disease Periodontal disease may increase risk of _________ associated with AD in _____ individuals and in those who already are ______ impaired. Research: people whose blood shows signs of ______ are more likely to later develop ___ than people with no signs of inflammation Potential link between ______ and ___? Researchers analyzed ___ tissue, ___ fluid, and ___ from AD patients: both living and deceased, and found evidence of ____ in most Encourage older adults and other at-risk individuals to maintain diligent ______ and promptly treat periodontal disease to help mitigate Alzheimer’s risk.

Answer 70

Periodontal disease may increase risk of cognitive dysfunction associated with AD in healthy individuals and in those who already are cognitively impaired. Research-people whose blood shows signs of inflammation more likely to later develop AD than people with no signs of inflammation Potential link between P. gingivalis and AD? Researchers analyzed brain tissue, spinal fluid, and saliva from AD patients—both living and deceased—and found evidence of P. gingivalis in most Encourage older adults and other at-risk individuals to maintain diligent oral care and promptly treat periodontal disease to help mitigate Alzheimer’s risk.

Question 71

Alzheimer’s disease study: 109 pairs of identical ___ to find any lifestyle factors associated with developing ______. Twins who had _______ disease earlier in life were _____ times more likely to develop ______. Perio disease inflammation may play a role in the destruction of _____ cells.

Answer 71

109 pairs of identical twins to find any lifestyle factors associated with developing dementia. Twins who had periodontal disease earlier in life were four times more likely to develop Alzheimer’s. Perio disease inflammation may play a role in the destruction of brain cells.

Question 72

RHEUMATOID ARTHRITIS _________- common, often severe, and present at ___ stages of RA, including early disease. Inflammatory periodontal microenvironment may play a role in the development of ___ ________ presence can lead to earlier onset, faster progression, and greater severity of RA Increased damage to ___ and _____ Concentration of _____ against ______ is increased before the ____ of rheumatoid arthritis symptoms

Answer 72

Periodontal disease- common, often severe, and present at all stages of RA, including early disease. Inflammatory periodontal microenvironment may play a role in the development of RA P. gingivalis presence can lead to earlier onset, faster progression and greater severity of RA Increased damage to bone and cartilage Concentration of antibodies against P. gingivalis is increased before the onset of rheumatoid arthritis symptoms

Question 73

difference between rheumatoid and osteoarthritis

Answer 73

rheumatoid: autoimmune, any age, impacted host response osteoarthritis: comes as you age

Question 74

rheumatoid arthritis link ______ RA- more likely to experience ________ periodontitis compared to non-rheumatoid arthritis individuals RA had more ______teeth and ____ as likely to have moderate to severe ______ than non-RA subjects Systemic manifestations of RA are mediated primarily by pro-inflammatory cytokines such as ____, _____, ______, and ___ which can induce the production of ___ leading to further tissue destruction. Encourage older adults and other at-risk individuals to maintain diligent oral care and promptly treat periodontal disease to help mitigate RA.

Answer 74

advanced RA- more likely to experience moderate to severe periodontitis compared to non-rheumatoid arthritis individuals RA had more missing teeth and twice as likely to have moderate to severe bone loss than non-RA subjects Systemic manifestations of RA are mediated primarily by pro-inflammatory cytokines such as IL-1, IL-6, IL-18, and TNF-α which can induce the production of MMPs leading to further tissue destruction. Encourage older adults and other at-risk individuals to maintain diligent oral care and promptly treat periodontal disease to help mitigate RA.

Question 75

what cancers may be associated with PD New research is underway to investigate if there is an association between periodontal diseases and ____ or ______ cancer. This research is based on the model that ______ cancer is preceded by ________, so perhaps ______ cancer has an infectious connection. There are also studies looking into the possible associations with _____ cancer

Answer 75

New research is underway to investigate if there is an association between periodontal diseases and oral or pancreatic cancer. This research is based on the model that stomach cancer is preceded by Helicobacter pylori, so perhaps pancreatic cancer has an infectious connection. There are also studies looking into the possible associations with breast cancer

Question 76

Risk factors = increased _____ for periodontal destruction Most significant risk factors? _____, genotype ______, _____, and specific ______ present Periodontitis is also a risk factor for MANY _____ diseases ____ oral infection: _____ risk factor for CVD, diabetes, respiratory conditions Adversely affects _______ outcomes

Answer 76

Risk factors = increased susceptibility for periodontal destruction Most significant risk factors? SMOKING, genotype positive, diabetes, and specific pathogens present Periodontitis is also a risk factor for MANY systemic diseases—and more to be found yet. Chronic oral infection  modifiable risk factor for CVD, diabetes, respiratory conditions, and more? Adversely affects pregnancy outcomes