s3 perio guidance, questions for exam

Question 1

What is a risk factor

Answer 1

A factor which increases the probability/chance that a disease may develop in an individual

Question 2

How can risk factors be categorised?

Answer 2

Either
- Systemic risk factors (subject based)
- Local risk factors (site based)
Oral factors that increase plaque accumulation &/or occlusal forces

Question 3

What is a local risk factor for periodontal disease?

Answer 3

• Deficient restorations:
  Overhangs or deficiencies on restorations
  Overcontoured restorations
• Badly designed/constructed dentures & bridgework
• carious cavities
• anatomy of embrasures/contact points
  food packing
  cleansability
  (Plaque retentive factors continued)
• Malalignment of teeth (e.g. crowding)
• Orthodontic appliances
• Anatomy of the teeth
  Development grooves
  talon cusps
  furcation involvement
• Mouth breathing

Question 4

What is the definition of a risk marker?

Answer 4

Signs that a disease is present

Question 5

What is an example of a risk marker for periodontal disease?

Answer 5

• Bleeding on probing
• Mobility
• Loss of attachment
• Suppuration

Risk markers are not linked to the cause of the disease
- May allow early detection of a disease

Question 6

What is the difference between an association and causation?

Answer 6

• Research might show an association between smoking and periodontal disease. Smokers may be found to have higher rates of periodontal disease compared to non-smokers. This indicates a relationship but does not prove that smoking directly causes periodontal disease.
• Establishing that smoking causes periodontal disease would require evidence that smoking directly leads to the development or worsening of periodontal disease, beyond merely being associated with it. This could involve demonstrating a biological mechanism whereby smoking influences the health of periodontal tissues.
• while associations in periodontology can highlight important links between factors and periodontal disease, establishing causation is essential for developing effective interventions and understanding the underlying mechanisms of periodontal disease.

Question 7

Currently, is there nay evidence that treating periodontal disease reduces the risk of CVD?

Answer 7

yes

Question 8

Explain the possible links between CVD and periodontitis

Answer 8

• Periodontal disease the periodontal pocket is filled with a pathogenic anaerobic biofilm resulting in an inflammatory reaction in the adjacent gingival tissues resulting in the pocket wall being ulcerated & leaky
• The surface area of the exposed ulcerated periodontal pockets can be extensive & has been estimated to be approximately 20 to 30cm^2 in a subject with generalised deep periodontal pocketing
• The inflamed periodontal tissues next to the periodontal pocket contains large numbers of invading bacteria & host inflammatory cells (secreting pro-inflammatory mediators)
• The periodontal tissues are very vascular & the blood vessels within the inflamed tissue are very leaky allowing periodontal bacteria (bacteraemia) & the inflammatory mediators to spill over into the systemic bloodstream
• It is the leaking of the pro-inflammatory mediators &/or the periodontal bacteria into the systemic bloodstream accounts for the possible link between periodontal disease & systemic chronic disease either through
• raising systemic inflammation:
  making any systemic chronic disease (e.g. diabetes) already present worse
• Direct effects of the periodontal bacteria
• or possibly involving both of the above

Question 9

How is Alzheimer’s thought to be linked to periodontal disease?

Answer 9

• Pathological evidence of alzheimer’s disease:
  neurofibrillary tangles (NFT) within the neurones
  Amyloid plaques containing beta peptides (alpha-beta)
• Alzheimer’s disease thought to be caused by increased levels of toxic forms of alpha-beta peptides within the brain
  (possible mechanisms)
• Probably multi-factorial
• Possible periodontitis-related mechanisms:
• periodontal pathogens
• Primed periodontal macrophages
• periodontal neutrophils

Question 10

A patient asks you whether there is any evidence that Covid is linked to gum disease? How should you respond?

Answer 10

More research required, but possible links between periodontitis & covid-19 complications are:
- Periodontitis causes increased systemic inflammation on top of the severe systemic inflammation associated with covid-19 (“cytokine storm”)
- Inhalation of periodontal pathogens into lungs exacerbates pulmonary infection

Question 11

Examples of modifiable periodontal risk factors

Answer 11

• Oral hygiene
• Smoking
• Glycaemic control/Diabetes
• Restorative overhangs/deficiencies
• Poor denture/crown/bridge design
• Malocclusions
• Alcohol
• Stress