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Clinical Knowledge 2 > Risk Factors of Periodontal Disease > Flashcards

Risk Factors of Periodontal Disease Flashcards

1
Q

What is a risk factor ?

A

a factor that increases the probability of developing a disease in a given individual

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2
Q

What are the main types of risk factors ?

A

Local risk factors
systemic risk factors

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3
Q

What is a local risk factor?

A

these are risk factors which can be confined into the oral cavity

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4
Q

Local risk factors can be divided into…

A
  • acquired
  • anatomical/developmental
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5
Q

List examples of local acquired modifiable risk factors of periodontal disease

A
  • plaque/calculus
  • bleeding on marginal probing
  • PPD
  • iatrogenic causes- partial dentures, open contacts, overhangs of poorly contoured restorations
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6
Q

List examples of local anatomical modifiablerisk factors of periodontal disease

A
  • malpositioned teeth
  • furcations
  • root grooves and concavities
  • enamel pearls
  • dental crowding, bone defects
  • cervical enamel projections
  • canine fossa
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7
Q

List examples of systemic modifiable risk factors of periodontal disease

A
  • smoking
  • diabetes
  • poor diet
  • certain medications
  • stress
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8
Q

List examples of systemic non-modifiable risk factors of periodontal disease

A
  • socioeconomic status
  • genetics
  • adolescence - hormonal changes
  • pregnancy- hormonal changes
  • age
  • leukaemia- immunodeficiency
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9
Q

What depth of pockets increases the risk of attachment loss? (JE detachment)

A

pockets >/= 5mm are at an increased risk of attachment loss

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10
Q

Plaque is the sole cause of periodontal disease. True or false

A

false

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11
Q

Removal of _________ can help with plaque control

A

plaque retentive factors

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12
Q

What iatrogenic factors can cause the development of plaque?

A
  • restoration overhangs and margins
  • partial dentures
  • restorations with bulbous emergence profile
  • restorations which impinge on biological width
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13
Q

What is the cause of overhangs and deficiencies in restorations?

A

poor adaptation of matrix band

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14
Q

What is the cause of inadequate contact points?

A

poor adaptation of matrix band
-failure to assess cervical fit
-difficult adapting matrix band when cervical floor is subgingival

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15
Q

How can inadequate contact points lead to plaque accumulation?

A

increases the risk of food impaction and thus plaque retention

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16
Q

What kind of restoration margins increase the risk of plaque accumulation?

A

subgingival margins

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17
Q

What are the consequences of sub gingival margins if the biological width is reached?

A
  • risk of direct operative trauma
  • risk of plaque accumulationa and marginal soft tissue recession
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18
Q

What is the biological width?

A

junctional epithelium and supra cresal tissue surrounding each tooth

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19
Q

When does the need for sub gingival margins arise?

A
  • if caries, fractures/ previous restorations extend subgingivally
  • if aesthetics are an issue
  • retention purposes
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20
Q

You must treat perio before you fix defective restorations. True or false

A

true

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21
Q

What is the purpose of the restoration of edentulous spaces?

A
  • aesthetics
  • function
  • occlusion
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22
Q

Any prostheses has the potential to become a plaque retentive factor. True or false

A

true

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23
Q

What treatment options can you consider for restoring edentulous spaces to prevent plaque retention

A
  • shortened dental arch as opposed to prosthesis ?
  • resin bonded bridges for a single missing tooth
  • well designed Co-Cr partial denture
  • well designed acrylic partial denture
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24
Q

What is a shortened dental arch?

A

dentition of no more than 20 teeth with an intact anterior design but reduced number of occluding pairs of posterior teeth

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25
Q

Give examples of instances where damage to periodontal tissues can occur

A
  • during cavity prep
  • during impression taking
  • result of faulty restorations
  • creation of occlusal interferene
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26
Q

Dental crowding can lead to …

A

compromised oral hygiene

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27
Q

Give examples of bone defects that can increase the risk of developing periodontal disease

A

fenestration
bone dehiscence

28
Q

What is fenestration?

A

this is when bone coverage of the root is lost and the root surface is only covered by periosteum and gingiva

29
Q

What is bone dehiscence?

A

this is when fenestration defect spreads to marginal bone- marginal bone coverage is lost

30
Q

What mucosal defect can compromise oral hygiene measures?

A

a high frenal attachment

31
Q

Gives examples of root anomalies that can increase the risk of periodontal disease?

A
  • cervico-enamel projection
  • enamel pearl
  • furcation involvment
  • root grooves and concavity
32
Q

What is a cervico-enamel projection?

A

it is a focal apical extension of the coronal enamel beyond the smooth cervical margin into the root of the tooth

33
Q

How can cervico-enamel projections impact periodontitis?

A
  • they can complicate plaque removal (scaling and RSD)
  • they have also been implicated in attachment loss in the furcation area (PDL cells in this area??- can they bind to enamel) - increases risk of periodontitis
34
Q

How can enamel pearls affect periodontitis?

A

the are usually a plaque retentie factor

35
Q

Where are enamel pearls usually found?

A

usually found apical to the CEJ

36
Q

How can enamel pearls complicate periodontal treatment?

A

Care must be taken when removing or sub-scaling enamel pearls as they often contain an extension of the pulp

37
Q

What does furcation involvement often indicate ?

A

increases risk of disease progression as furcations are hard to clean

38
Q

What is the effect of root grooves and concavities?

A

altered anatomy may retain plaque and make it harder to scale calculus in these areas

39
Q

What is the effect of root grooves and concavities?

A

altered anatomy may retain plaque and make it harder to scale calculus in these areas

40
Q

Systemic factors of periodontal disease can be divided into?

A

modifiable and non-modifiable factors

41
Q

The genetic difference in periodontal disease are likely to be ___________ that contribute to the inflammatory response. Give an example of this

A

polymorphisms

42
Q

When can genetics become a modifiable risk factor?

A

when gene therapy becomes available

43
Q

Patients with bad oral hygiene and no periodontitis may have _________.

A

genetic resistance

44
Q

Outline the underlying defect and periodontal relevance of down syndrome

A
  • defect in PMNL chemotaxis
  • depressed T cell antigen induced killing
45
Q

Outline the underlying defect and periodontal relevance of chronic granulomatous disease

A

failure of respiratory burst in phagocytes
oxygen radicals are not produced and therefore bacteria survive

46
Q

Outline the underlying defect and periodontal relevance of insulin dependent diabetes

A
  • hyperglycaemic state reduced PMNL function
  • monocytes are hyper-reactive, excess IL1, PGE2 and O2 radicals- bone resorption
  • effects on collagen solubility and vascularity reduced healing
47
Q

Outline the underlying defects and periodontal relevance of hypophosphatasia

A
  • low levels of alkaline phosphatase enzyme (produced in the liver) leads to poor mineralisation of cementum, teeth are more likely to exfoliate
48
Q

Outline the underlying defects and periodontal relevance of Papillin-Lefevre Syndrome

A
  • defects in PMNL chemotaxis and phagocytosis
  • gene mapped on PMNL enzyme (cathespin-c) gene locus on chromosome 11
49
Q

Outline the underlying defects and periodontal relevance of Ehlers Danlos Syndrome

A
  • defects in collagen synthesis
  • type VIII ehlers danlos syndrome is associated with severe periodontal destruction
50
Q

Outline the underlying defects and periodontal relevance of Chediak- Higashi Syndrome

A
  • defects in phagocyte chemotaxis, degranulation and membrane fusion leads to loss of adult dentition
51
Q

Outline the underlying defects and periodontal relevance of Jobs Syndrome

A

excessive IgE and histamine release by mast cell and IgE immune complex formation

52
Q

What should the full history of smoking include?

A
  • type of tobacco
  • how many years
  • how many cigarettes a day
  • time of first cigarette (dependence)
  • interested in quitting? why?
  • previous attempsts to quit
53
Q

What are the effects of smoking on the periodontum?

A
  • more sites with deeper pockets
    *greater attachment loss
  • greater levels of bone loss
  • more teeth with furcation involvment
  • increased tooth loss
  • accumulation of calculus and plaque
  • reduced gingival vessels
  • poorer healing response
54
Q

Smoking is a modifiable risk factor of periodontal disease. The effects of smoking on the periodontum comes about due to local exposure. True or false.

A

false
the effects of smoking on the periodontum come about due to systemic exposure

55
Q

Briefly describe the rate of formation of plaque in smokers and non-smokers

A

rate of plaque formation is similar in smokers and non smokers

56
Q

What is the effect of smoking on gingival bleeding?

A

reduced gingival bleeding due to vasoconstriction

57
Q

What clinical/biological sign is evidence of a decreased inflammatory response to plaque in smoking?

A

decreased gingival redness
decreased GCF volume in moles

58
Q

What is the effect of smoking on neutrophils?

A
  • increased number of neutrophils in circulation
  • impaired neutrophil function (kinetics and chemotaxis)
  • increased proteolytic activity
  • smoking affects respiratory burst of neutriphils
59
Q

What is the effect of smoking on fibroblasts?

A
  • nicotine inhibits fibroblats proliferation
  • decreased production of type I collagen and fibronectin
  • increased collagenase activity
  • PDL fibroblast attachment is significantly reduced on root surface of smokers
  • poor wound healing
60
Q

Outline other effects of smoking on the inflammatory response

A
  • increased TNFa in GCF of smokers
  • decreased IL-1a in smoker GCF
  • decreased GCF elastase (conflicting data)
  • decrease alpha-macroglobulin and alpha-1 antitrypsin
61
Q

What medications are known to cause gingival overgrowth (DIGO)?

A

Phenytoin- anticonvulsant
Nifedipine (CCB)
cyclosporin (immunosuppressant)

62
Q

What region of the gingival is usually affected with gingiva overgrowth?

A

anterior region

63
Q

What should you do in the case of non resolving DIGO despite the patients best efforts at good plaque control and effective professional debridement?

A

liaise with medical colleagues

64
Q

Outline the mechanisms for the impact of stress on periodontal health

A

prolonged and intense period of stress can cause depression of the immune system

stress can also affect personal behaviour and habits (brushing, flossing)

65
Q

What kind of risk factor is stress with regards to periodontal health ? What is the implication of this

A

Putative risk factor

has been associated with periodontal disease in cross-sectional studies

66
Q

Why does stress not satisfy the criteria to be a true risk factor for developing periodontal disease?

A

lack of evidence from longitudinal studies that the removal of the risk factor improves the disease

Clinical Knowledge 2 (40 decks)

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