risk factors for Periodontitis Flashcards
chain of events
- mature biofilm present
- host response & inflammatory mediators
- damage to periodontium
- clinical signs of PD
*altered by genetic/environmental/acquired factors
why is understanding risk important
- influences the prognosis of PD breakdown
- increased risk = more adjunctive measures
define risk factor
what are the most significant risk factors related to the onset/progression/severity of periodontitis
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
difference between modifiable and innate risk factors with examples
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)
what are teh 5 SDOH
- education access and qualtiy
- health and care quality
- neighborhood and built environment
- social/community context
- economic stability
how to assess for risk factors, we may be the first to notice something off systemically in a patient
- medical, dental, and medication history
- patient interviewing
- clinical evaluation
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.
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.
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: __%
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%
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 ______
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
all unmodifiable conditions _____ the host response. Anything that impairs the host response impacts our _______. This will always impact the _______ with periodontal disease
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
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 ________
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
______ 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.
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.
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
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
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
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
MODIFIABLE SYSTEMIC FACTORS (6)
Tobacco use
Diabetes control
Medications (?)
Poor oral hygiene
HIV disease control
Obesity (?)
______ risk factors are conditions or diseases that _____ a persons susceptibility to periodontal disease by ______ or ______ the host reponse to periodontal pathogens
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.
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
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
what are the 3 mechanisms that smoking may contribute to Periodntal destruction
- 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
- 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
- impact on bone metabolism: Nicotine may also suppress osteoblasts—more research needed. It is possible nicotine increases inflammatory mediators that lead to destruction
what 5 things do smokers have an increased incidence with
- pocket depths
- alveolar bone loss
- tooth loss
- clinical attachment loss
- furcations
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
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
smoking and bone metabolism
Associated with greater amount of _______ destruction than non smokers
nicotine may suppress ______
may alter normal bone _____
Associated with greater amount of alveolar bone destruction than non-smokers
nicotine may suppress osteoblasts
may alter normal bone remodeling
____ impacts of smoking exist too and may be seen with____ products as well as products that are associated with smoke and inhaling
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
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 _______
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
nicotinic stomatitis: associated with ______ use. however can be a _____ damage.
inflamed ______ with increased _____
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
smoking is associated with treatment ____, especially surgeries. most periodontist’s/oral surgeons require _____ prior to surgery.
treatment failure examples (4)
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
E-cigarettes
- introduced in the US in ____
- don’t contain ______
- heats up _____, turning into vapor
- vapor is _____ and _____
- vapor has significant ____ and _____ side effects
- 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
do e-cigs and normal ones have the same effects
yes, same nicotinic impacts apply, same direct effects of thermal heat and inhalation
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
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
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
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
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 ______.
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.
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.
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.
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.
- 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.
uncontrolled diabetes
______ risk factor for PD
increases ______, ________, and ______
considered a _______ of diabetes
__X more likely to develop PD
established risk factor for PD
increases prevalence, severity, and progression
considered a complication of diabetes
3x more likely to develop PD
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
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
diabetes chain link
periodontal infection
increased inflammatory mediators
inflammatory mediators disseminated via bloodstream
increased insulin resistance and poor glycemic control
diabetic complications
Periodontal diseases may serve as initiators of ________, thereby aggravating ________.
Periodontal diseases may serve as initiators of insulin resistance, thereby aggravating glycemic control.
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 ____
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
hba1c goal:
hba1c susceptible:
finger stick goal:
finger stick risk of infection:
finger stick unacceptable:
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
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.
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.
can we screen chairside for diabetes
Lots of research out there for us to start doing this within our scope of practice. Some states are!
STRESS
Acute = ______
Chronic = _______
- Anxiety, depression, impaired cognition, reduced self-esteem
- High ______ stress and ______ are significant risk factors
Acute = immuno enhancing
Chronic = immunosuppressant
- Anxiety, depression, impaired cognition, reduced self-esteem
- High financial stress and depression are significant risk factors
what drugs might cause xerostomia
- 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
what are the increased risks and side effects (besides xerostomia) cause by medications
gingival hyperplasia
- calcium channel blockers (nifedipine)
- anticonvulsive (dilantin)
- immunosuppressants (cyclosporine)
- hormones
are there medications to help with PD
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
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
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
HEMATOLOGIC DISORDERS
Neutropenia: low ______ counts, increased susceptibility to infection. ______, _______, leukemia, _____-induced, ____-induced
Leukemia: _____ of the _____ cells; can be any blood cells, but most common _______
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
hormonal impacts on periodontium
Puberty
___ genders
Increased ____ and ___ flow due to ___ hormones
Pregnancy
Pregnancy ____
p____ g_____
Menopause
Lack of ____ also cause disruption
______ increase
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
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
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
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 _____
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
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 _______
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
obesity defined:
what is the link between obesity and periodontal disease (4)
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
ADA states: “___ are encouraged to promote awareness of the adverse health conditions associated with ____, including ______ disease and _______ as well as risk for ____”
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”
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)
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)
social determinants of health
_______ status predictor of periodontal disease
______ level predictor of periodontal disease
Access to ___? Information? Resources and tools?
socioeconomic status predictor of periodontal disease
education level predictor of periodontal disease
ACCESS to care? Information? Resources and tools?
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.
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.
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
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
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
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
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)
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)
we must explain inflammatory mediators to people who need a medical consult, how?
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
what is ACVD
what is atherosclerosis
what is atheroma
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
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 _______
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
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 ___
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
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:
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
DYSLIPIDEMIA
Increase _______ in vessels
Thrombus:
Embolism:
_______ formation
Increase build-up in vessels
Thrombus formation: attached to the BV wall
Embolism: thrombus that breaks off and travels in blood
Atheroma formation
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
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
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
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
what are the shared risk factors between periodontal disease and PTLB deliveries (3)
- smoking
- diabetes
- increased prostaglandins
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 ________
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
Aspiration Pneumonia
_______ patients
____ homes and _____ care facilities
RDHs: we must _____ for these populations
Medical professionals need to be trained on how to advocate
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
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.
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 betweenP. gingivalis and AD?
Researchers analyzed brain tissue, spinal fluid, and saliva from AD patients—both living and deceased—and found evidence ofP. 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.
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.
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.
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
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
difference between rheumatoid and osteoarthritis
rheumatoid: autoimmune, any age, impacted host response
osteoarthritis: comes as you age
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.
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.
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
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
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
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
