Systemic disease

Question 1

What are the 8 systemic diseases under periodontics?

Answer 1

• Smoking
• Diabetes
• Osteoporosis
• Hormonal changes
• HIV
• Stress
• Genetics
• Medications and gingival enlargement

Question 2

Describe smoking as a risk factor

Answer 2

• Major risk factor where there is a distinct relationship between dose and severity
• Smokers respond less favourably to therapy
• It affects gingival fibroblasts, decreases collagen production and deposition. This delays healing
• It reduces blood and gingival crevicular fluid flow
• Microflora: With smokers, periopathogens are greater in number. The colonisation patterns are greater in the maxillary than the mandible
• Host response: Impaired immune response = Neutrophils, T cell function, B cell function are affected

Question 3

What are clinical features of smoking?

Answer 3

· Number and depth of perio pockets is increased - pocketing and re-pocketing
· More loss of attachment (LOA)
· Alveolar bone loss
· Tooth loss
· Reduction in signs of inflammation- especially in colour and consistency
· Furcations
· Extrinsic staining
· Halitosis (bad breathe)
· Pigmentation (on tongue, mucosal tissues)

Question 4

Describe diabetes as a risk factor

Answer 4

· There is no difference between type one or type two diabetes when it comes to risk
· Increased rate of attachment loss and bone loss over time
· Risk of progression/recurrence of periodontal disease is related to diabetic control (metabolic) control
· Exaggerated response to plaque- more bleeding on probing and higher gingival index scores
· Periodontal disease can affect their ability to control their glycaemic index

Question 5

What is the role of AGES in periodontitis?

Answer 5

· Binding of AGE to its receptor(RAGE) results in the upregulated production of inflammatory mediators such as IL-1β, TNF-α and IL-6
· AGEs can increase the permeability of blood vessels, cause arterial stiffness and inhibit vascular dilation

Question 6

What are the clinical features of diabetes?

Answer 6

· Increased risk of acute periodontal infection
· Frequent fungal infections
· Increased periodontal pocketing
· Increased attachment loss
· Increased alveolar bone loss
· Impaired saliva flow
· Burning tongue syndrome

Question 7

Describe osteoporosis as a risk factor

Answer 7

· Loss of bone density. Increases susceptibility and decreases healing rate
· Smoking and decreased calcium uptake= osteoporosis
· Post menopausal osteoporosis disorder= no estrogen

Question 8

Describe hormonal changes as a risk factor

Answer 8

· Puberty, menstrual -Synthetic hormones, pregnancy, menopause and post menopause
· Increased sensitivity to small amounts of plaque: gingival inflammation which is exacerbated by hormones in the second and third trimester of pregnancy = pregnancy gingivitis

Question 9

Describe hiv as a risk factor

Answer 9

· Response to periodontal therapy is also not as favourable especially when combined with smoking habit

Question 10

Describe stress as a risk factor

Answer 10

· Associated with – depressed immune responsiveness, lowered host resistance- impaired cellular defence mechanisim, release of pro-inflammatory cytokines (IL-6)
· Can lead to other risk factor behaviour such as smoking

Question 11

Describe the clinical signs of stress

Answer 11

· Dental neglect
· Changes in diet
· Smoking habit
· Bruxing habit
· Increase in attachment loss
· Bone loss
· Necrotising Ulcerative Gingivitis (NUG) – associated with stress

Question 12

Describe genetics as a risk factor

Answer 12

· Current research indicate that certain individuals have a genetically determined immune response which increases their susceptibility to periodontal disease
· Defective PMN production or function increases susceptibility to recurrent bacterial infections

Question 13

Describe medications as a risk factor

Answer 13

· Alters composition of plaque
· Alteration of salivary flow
· Effects on gingival tissue

Question 14

Discuss how periodontal disease can serve as a risk factor for heart disease

Answer 14

Oral bacteria may directly infect the blood vessel walls causing local inflammation and contributing to the build up of fatty deposits inside the heart arteries. It can also cause small blood clots that contribute to congestion of arteries

Question 15

Discuss how periodontal disease can serve as a risk factor for premature underweight babies

Answer 15

Oral bacterial by-products can enter the bloodstream, cross the placenta and harm the fetus. While prostaglandins play an important role in regulating the onset of labour, uterine contractions and delivery, they also have a role in periodontal disease

Question 16

Discuss how periodontal disease can serve as a risk factor for pneumonia

Answer 16

Adults- bacterial pneumonia associated with aspiration of oral bacteria into the lower respiratory tract