Risk Factors of Periodontal Disease Flashcards
What is a risk factor ?
a factor that increases the probability of developing a disease in a given individual
What are the main types of risk factors ?
Local risk factors
systemic risk factors
What is a local risk factor?
these are risk factors which can be confined into the oral cavity
Local risk factors can be divided into…
- acquired
- anatomical/developmental
List examples of local acquired modifiable risk factors of periodontal disease
- plaque/calculus
- bleeding on marginal probing
- PPD
- iatrogenic causes- partial dentures, open contacts, overhangs of poorly contoured restorations
List examples of local anatomical modifiablerisk factors of periodontal disease
- malpositioned teeth
- furcations
- root grooves and concavities
- enamel pearls
- dental crowding, bone defects
- cervical enamel projections
- canine fossa
List examples of systemic modifiable risk factors of periodontal disease
- smoking
- diabetes
- poor diet
- certain medications
- stress
List examples of systemic non-modifiable risk factors of periodontal disease
- socioeconomic status
- genetics
- adolescence - hormonal changes
- pregnancy- hormonal changes
- age
- leukaemia- immunodeficiency
What depth of pockets increases the risk of attachment loss? (JE detachment)
pockets >/= 5mm are at an increased risk of attachment loss
Plaque is the sole cause of periodontal disease. True or false
false
Removal of _________ can help with plaque control
plaque retentive factors
What iatrogenic factors can cause the development of plaque?
- restoration overhangs and margins
- partial dentures
- restorations with bulbous emergence profile
- restorations which impinge on biological width
What is the cause of overhangs and deficiencies in restorations?
poor adaptation of matrix band
What is the cause of inadequate contact points?
poor adaptation of matrix band
-failure to assess cervical fit
-difficult adapting matrix band when cervical floor is subgingival
How can inadequate contact points lead to plaque accumulation?
increases the risk of food impaction and thus plaque retention
What kind of restoration margins increase the risk of plaque accumulation?
subgingival margins
What are the consequences of sub gingival margins if the biological width is reached?
- risk of direct operative trauma
- risk of plaque accumulationa and marginal soft tissue recession
What is the biological width?
junctional epithelium and supra cresal tissue surrounding each tooth
When does the need for sub gingival margins arise?
- if caries, fractures/ previous restorations extend subgingivally
- if aesthetics are an issue
- retention purposes
You must treat perio before you fix defective restorations. True or false
true
What is the purpose of the restoration of edentulous spaces?
- aesthetics
- function
- occlusion
Any prostheses has the potential to become a plaque retentive factor. True or false
true
What treatment options can you consider for restoring edentulous spaces to prevent plaque retention
- 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
What is a shortened dental arch?
dentition of no more than 20 teeth with an intact anterior design but reduced number of occluding pairs of posterior teeth
Give examples of instances where damage to periodontal tissues can occur
- during cavity prep
- during impression taking
- result of faulty restorations
- creation of occlusal interferene
Dental crowding can lead to …
compromised oral hygiene
Give examples of bone defects that can increase the risk of developing periodontal disease
fenestration
bone dehiscence
What is fenestration?
this is when bone coverage of the root is lost and the root surface is only covered by periosteum and gingiva
What is bone dehiscence?
this is when fenestration defect spreads to marginal bone- marginal bone coverage is lost
What mucosal defect can compromise oral hygiene measures?
a high frenal attachment
Gives examples of root anomalies that can increase the risk of periodontal disease?
- cervico-enamel projection
- enamel pearl
- furcation involvment
- root grooves and concavity
What is a cervico-enamel projection?
it is a focal apical extension of the coronal enamel beyond the smooth cervical margin into the root of the tooth
How can cervico-enamel projections impact periodontitis?
- 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
How can enamel pearls affect periodontitis?
the are usually a plaque retentie factor
Where are enamel pearls usually found?
usually found apical to the CEJ
How can enamel pearls complicate periodontal treatment?
Care must be taken when removing or sub-scaling enamel pearls as they often contain an extension of the pulp
What does furcation involvement often indicate ?
increases risk of disease progression as furcations are hard to clean
What is the effect of root grooves and concavities?
altered anatomy may retain plaque and make it harder to scale calculus in these areas
What is the effect of root grooves and concavities?
altered anatomy may retain plaque and make it harder to scale calculus in these areas
Systemic factors of periodontal disease can be divided into?
modifiable and non-modifiable factors
The genetic difference in periodontal disease are likely to be ___________ that contribute to the inflammatory response. Give an example of this
polymorphisms
When can genetics become a modifiable risk factor?
when gene therapy becomes available
Patients with bad oral hygiene and no periodontitis may have _________.
genetic resistance
Outline the underlying defect and periodontal relevance of down syndrome
- defect in PMNL chemotaxis
- depressed T cell antigen induced killing
Outline the underlying defect and periodontal relevance of chronic granulomatous disease
failure of respiratory burst in phagocytes
oxygen radicals are not produced and therefore bacteria survive
Outline the underlying defect and periodontal relevance of insulin dependent diabetes
- 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
Outline the underlying defects and periodontal relevance of hypophosphatasia
- low levels of alkaline phosphatase enzyme (produced in the liver) leads to poor mineralisation of cementum, teeth are more likely to exfoliate
Outline the underlying defects and periodontal relevance of Papillin-Lefevre Syndrome
- defects in PMNL chemotaxis and phagocytosis
- gene mapped on PMNL enzyme (cathespin-c) gene locus on chromosome 11
Outline the underlying defects and periodontal relevance of Ehlers Danlos Syndrome
- defects in collagen synthesis
- type VIII ehlers danlos syndrome is associated with severe periodontal destruction
Outline the underlying defects and periodontal relevance of Chediak- Higashi Syndrome
- defects in phagocyte chemotaxis, degranulation and membrane fusion leads to loss of adult dentition
Outline the underlying defects and periodontal relevance of Jobs Syndrome
excessive IgE and histamine release by mast cell and IgE immune complex formation
What should the full history of smoking include?
- type of tobacco
- how many years
- how many cigarettes a day
- time of first cigarette (dependence)
- interested in quitting? why?
- previous attempsts to quit
What are the effects of smoking on the periodontum?
- 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
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.
false
the effects of smoking on the periodontum come about due to systemic exposure
Briefly describe the rate of formation of plaque in smokers and non-smokers
rate of plaque formation is similar in smokers and non smokers
What is the effect of smoking on gingival bleeding?
reduced gingival bleeding due to vasoconstriction
What clinical/biological sign is evidence of a decreased inflammatory response to plaque in smoking?
decreased gingival redness
decreased GCF volume in moles
What is the effect of smoking on neutrophils?
- increased number of neutrophils in circulation
- impaired neutrophil function (kinetics and chemotaxis)
- increased proteolytic activity
- smoking affects respiratory burst of neutriphils
What is the effect of smoking on fibroblasts?
- 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
Outline other effects of smoking on the inflammatory response
- increased TNFa in GCF of smokers
- decreased IL-1a in smoker GCF
- decreased GCF elastase (conflicting data)
- decrease alpha-macroglobulin and alpha-1 antitrypsin
What medications are known to cause gingival overgrowth (DIGO)?
Phenytoin- anticonvulsant
Nifedipine (CCB)
cyclosporin (immunosuppressant)
What region of the gingival is usually affected with gingiva overgrowth?
anterior region
What should you do in the case of non resolving DIGO despite the patients best efforts at good plaque control and effective professional debridement?
liaise with medical colleagues
Outline the mechanisms for the impact of stress on periodontal health
prolonged and intense period of stress can cause depression of the immune system
stress can also affect personal behaviour and habits (brushing, flossing)
What kind of risk factor is stress with regards to periodontal health ? What is the implication of this
Putative risk factor
has been associated with periodontal disease in cross-sectional studies
Why does stress not satisfy the criteria to be a true risk factor for developing periodontal disease?
lack of evidence from longitudinal studies that the removal of the risk factor improves the disease
