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Role of systemic factors (periodontal disease) Flashcards

1
Q

What is the Primary aetiological factor causing periodontal disease?

A

Plaque

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2
Q

What does gingivitis result from?

A

Accumulation of plaque over a number of days

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3
Q

What appearance do gums have if they have gingivitis?

A
  1. Swollen papilla
  2. Reddened gingiva
  3. Gross plaque deposits around the gingiva
  4. Gums bleeds on probing
  5. More roles gingival margins
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4
Q

What does periodontitis arise from?

A

Plaque accumulation and an appropriate host response

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5
Q

What are the 2 categories that the secondary aetiological factors fall under?

A

Local factors

Systemic factors

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6
Q

Name the 6 systemic aetiological factors

A
  1. Environmental
  2. Metabolic
  3. Genetic/ inherited
  4. Behavioural
  5. Life style
  6. Haematological
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7
Q

What factors fall under environmental aetiology?

A

Dug therapies

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8
Q

What factors fall under metabolic aetiology?

A

Sex hormones

Diabetes

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9
Q

What can gingival over growth (hyperplasia) be caused by in some patients?

A

Drugs and hormones

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10
Q

Describe what happens in gingival overgrowth

A

There is no loss of attachment or alveolar bone loss

This condition only affects gingival tissues and is not permanent

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11
Q

Name some groups of drugs that cause gingival overgrowth

A
  1. Phenytoins
  2. Ciclosporin
  3. Calcium channel blockers
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12
Q

Give examples of Phenytoins

A

Epanutin
Dilatin
Antiepileptics

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13
Q

Give examples of Ciclosporin

A

Immunosuppressants

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14
Q

Give examples of Calcium channel blockers

A

Nifedipine
Verapamil
Amlodipine
Diltiazem

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15
Q

Who is given Ciclosporin?

A

Renal and heart transplant patients as it is an immunosuppressesant

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16
Q

Who is given Phenytoins?

A

Epileptic patients

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17
Q

Who is given Calcium channel blockers ?

A

Renal transplant patients

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18
Q

How can having gingival overgrowth Lead to periodontal disease?

A

It is harder to obtain good plaque control and so bacteria accumulates on the gingival margins leading to periodontal disease

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19
Q

When are sex hormones given?

A

During mensuration and pregnancy

Can also be given in the form of a contraceptive pill

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20
Q

What can patients taking oral contraceptives have higher chance of getting?

A

Hyperplastic, oedematous Gingivitis

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21
Q

What is the degree of inflammation due to in some patients suffering from Hyperplastic, oedematous Gingivitis ?

A

It is plaque related and related to hormone levels

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22
Q

What type of gingivitis is pregnancy gingivitis?

A

Plaque induced gingival hyperplasia

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23
Q

When does pregnancy gingivitis usually occur?

A

After 2 months and it is most severe at 8 months

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24
Q

Is pregnancy gingivitis permanent?

A

No it usually resolves pithing weeks after giving birth

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25
Q

What else can some pregnant women get?

A

Pregnancy epulis which is a more severe type of pregnancy gingivitis

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26
Q

What is an epulis?

A

A swelling in the interdental papilla

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27
Q

What problems arise due to pregnancy epulis?

A

The red swollen tissue will bleed on touching a brushing making it hard for mothers to brush their teeth and maintain good oral hygiene

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28
Q

How do we manage pregnancy epulis?

A

By keeping the area as clean as possible until the baby is born
Then the tissue should regress and we can surgically remove the epulis

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29
Q

What percentage of the uK population is affected by diabetes?

A

2%

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30
Q

Name the 2 types of diabetes

A
  1. Type I (insulting dependant)

2. Type II (Non-insulin dependen)

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31
Q

What are both types of diabetes characterised by?

A

Hyperglycaemia

32
Q

How can diabetes be managed?

A
  1. Diet
  2. Drugs
  3. Insulin injections
33
Q

What do diabetic patients have an increased susceptibility to?

A

Periodontal disease ie attachment loss and alveolar bone loss

34
Q

What is the degree of periodontitis severity in diabetic patients related to?

A

Their level of glucose control

More controlled = less severe periodontitis

35
Q

Why are diabetic patients at a greater risk of developing periodontal diseases?

A

As they have an impaired immune response
They are likely to have:
1. a deceased neutrophil function
2. altered chemotaxis and phagocytosis activity
3. Increased inflammatory response
4. Increased coagulation

36
Q

How can periodontal disease effect diabetic patients?

A

It can effect their diabetic control

So controlling the periodontal disease can help with controlling glucose levels

37
Q

What factors fall under genetic aetiology?

A 
Genetic diseases like:
Down syndrome
Papillon-lefevre syndrome 
Hypophophatasia 
Ehlers-danlos syndrome
38
Q

What do patients with Down syndrome have an increased chance of getting?

A

Severe periodontal disease like necrotising ulcerative gingivitis
Especially on the lower incisors

39
Q

Why are down syndrome patients more susceptible to periodontal disease?

A

They have a defected neutrophil chemotaxis
Have a tendency for mouth breathing
Potentially have poorer oral hygiene

40
Q

What is papillon lefevre syndrome categorised by?

A

Palmar plantar keratosis

41
Q

What is Palmar plantar keratosis

A

An increased layer of keratin on the palms of the hands and soles of the feeth

42
Q

What are people with papillon lefevre syndrome more susceptible to?

A

Rapid periodontal destruction

43
Q

Why are patients suffering from papillon lefevre syndrome more susceptible to periodontal disease?

A

As they have a defect of neutrophil chemotaxis and phagocytosis

44
Q

What is hypophosphatasia characterised by?

A

Low levels of the enzyme alkaline phosphatase which leads to defective mineralisation and formation of cementum
Rickets like skeletal disease

45
Q

How are the teeth affected by hypophosphatasia?

A

As cementum doesn’t form the PDL doesn’t have cementum to insert into so the teeth exfoliate

46
Q

What is Ehlers-danlos syndrome characterised by?

A 
A disorder of collagen formation 
Hyperextensibel skin 
Easily bruised 
Loose jointedness 
Dislocation
47
Q

What is one of the types of Ehlers-danlos syndrome associated with?

A

Only type VIII is associated with Severe periodontal destruction
pulp stones
Floppy heart sounds

48
Q

Which type of Ehlers-danlos syndrome is associated with severe periodontal disease?

49
Q

Type VIII of Ehlers-danlos syndrome is associated with what?

A

Severe periodontal disease

50
Q

What is a consequence of Ehlers-danlos syndrome patients having “loose jointedness”

A

Means they easily loose their teeth and by the age of 30 most of them have lost all their teeth
Dislocation of the TMJ

51
Q

What factors fall under behavioural aetiology?

52
Q

What is tobacco associated with?

A

Periodontal disease

53
Q

What does the severity of periodontal disease depend on in relation to smoking?

A

The duration of the habit and the number of cigarettes smoked per day

54
Q

Describe characteristics of periodontal disease in smokers

A
  1. Fibrotic gingival with rolled margins
  2. Deeper pockets around the anterior teeth and palatal sides
  3. Recession anteriorly
  4. More alveolar bone loss
  5. More calculus
  6. More friction defects
  7. Reduced gingival blessing
55
Q

Why is it harder to detect periodontal disease in smokers?

A

As the gingivae is not red and inflamed and looks fairly normal
Smokers also have reduces gingival bleeding

56
Q

Why does smoking increase your chances of getting periodontal disease?

A
  1. Effects the composition of bacterial flora
  2. Increased cytokine release
  3. Increased destruction of extracellular matrix proteins
57
Q

What are patients who smoke more likely to have?

A

Destructive periodontal disease

Therapy is less effective in smokers

58
Q

What should we recommend to patients what smoke?

A

To quit smoking

We should give them smoking cessation advice

59
Q

What factors fall under life style aetiology?

A

Stress

Malnutrition

60
Q

Why does stress impact your oral health?

A
  1. It modulates the neuroendocrine system
  2. It depresses the immune system
  3. Produces indirect behavioural effects which can lead to decreased oral hygiene
61
Q

Name some connective tissue defects

A

Vitamin C deficiency (Scurvy)

Protein deficiency

62
Q

What can Vitamin C deficiency (Scurvy) lead to?

A

Haemorrhagic gingivitis

63
Q

What can Protein deficiency lead to?

A

Contributes to loss of periodontal supporting tissues

64
Q

What factors fall under haematological aetiology?

A
  1. Chediak-Higashi syndrome
  2. Neutropenia
  3. Leukaemia
65
Q

What is Chediak-Higashi syndrome characterised by?

A

Defects of phagocyte chemotaxis, degranulation and membrane fusion

66
Q

What is Chediak-Higashi syndrome associated with?

A
  1. Severe gingivitis
    Periodontal destruction resembling 2. Localised Aggressive Periodontitis
  2. Eventual loss of adult dentition
67
Q

What are the 2 types of neutropenia?

A
  1. Cyclic neutropenia

2. Familial benign neutropenia

68
Q

What is Cyclic neutropenia characterised by?

A

Period of normal neutrophil functions followed by periods when neutrophil function is very low

69
Q

What is Cyclic neutropenia associated with?

A

Gingivitis with hyperaemic zone
Gingival ulceration
Rapid periodontal breakdown

70
Q

What is Familial benign neutropenia associated with?

A

Gingival oedema or desquamation

But it is often self limiting

71
Q

What are the 2 broad types of Leukaemia

A

Acute Leukaemias

Chronic Leukaemias

72
Q

Acute Leukaemia is seen more in which type of people?

A

Younger people under their 20s especially in young children

73
Q

What is Acute Leukaemia associated with?

A

Gingival swelling
Excessive blessing
Gingival ulcerations

74
Q

Why are patients with Acute Leukaemia more likely to have periodontal disease?

A

As they have a lack of healthy white cells to counter the plaque

75
Q

Why are patients with Acute Leukaemia more likely to swollen gums?

A

Gingiva swell as they are packed with Acute Leukaemic cells

76
Q

Chronic Leukaemia is seen more in which type of people?

A

Older age groups

77
Q

What is less common in Chronic Leukaemia?

A

Gingival swelling is less common

ODDR- e lec (5 decks)

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