Systemic Factors

Question 1

Risk Determinants

Answer 1

Factors that cannot be modified

genetics, age, sex, ethnicity

Question 2

Risk Factors

Answer 2

Factors that increase the likelihood of developing disease, identified through longitudintal studies and confirmed to be present before disease onset

smoking, diabetes, pathogenic bacteria

Question 3

Risk Indicators

Answer 3

Factors that are identified in cross - sectional studies
retrospective study but not confirmed via longitudinal study

Alcohol, stress, obesity

Question 4

Risk Predictor

Answer 4

Come as a consequence of disease and can be responsible for future disease progression

furcation

Question 5

Risk Markers

Answer 5

BOP

Question 6

RISK FACTOR - Diabetes

Diagnosis of diabetes

Answer 6

> 126 mg/dL fasting, >6.5% HbA1c

Question 7

Taylor (1996)

Answer 7

Diabetes is a major risk factor for periodontitis. Periodontal disease negatively affects glycemic control.

Question 8

Mealey & Ocampo (2007)

Answer 8

Diabetes increased risk of periodontitis by 3x

Question 9

Caused by diabetes

Biological basis of impaired wound healing and decreased immune response

Answer 9

• Neutraphil, monocyte and macrophage fxn altered (chemotaxis and phagocytosis altered)
• High glucose in GCF inhibits fibroblast attachment to tooth
• Less fibroblasts and less CT, increased MMPs
• AGE binds to RAGE; increased proinflammatory cytokines (IL1B, TNFa)
• AGEs increase thickness of microvasculature
• Altered CT metabolism, reduced bone turnover

Question 10

HbA1C, Fasting plasma glucose, Oral glucose tolerance test

Answer 10

HbA1c: <5.7 normal, >6.5 diabetic
FPG (8 hours): >126 mg/dL diabetic, <100 healthy
OGTT (8 hr fast +75 g glucose): >200 mg/dL diabetic, <140 healthy
Random glucose test: >200 mg/dL diabetic, <160 mg/dL healthy

Question 11

Kumar et al 2020

Cohort study

Answer 11

20 healthy, 17 perio, 17 perio +T2DM
SRP given, then GCF tested and sequenced

breakdown of host-bacteria mutualism; mutualism breakdown worse with hyperglycemia

Question 12

Emrich et al 1991

x sectional study of Pima indians (arizona)

Answer 12

T2DM increased risk of perio by 2.81 when CAL used, 3.43 when bone loss used

Question 13

Nelson et al 1990

Pima Indians and T2DM

Answer 13

similar in men and women

rate of perio was 2.6 times higher in T2DM

Question 14

Saremi et al 2005

Prospective study, Pima indians

Answer 14

Sever perio disease increased risk of diabetic related cardiorenal mortality by 3.2x

Question 15

Grossi et al 1997

Answer 15

5 groups, SRP + either:
1. systemic doxy
2. CHX + sys. doxy
3. iodine + sys doxy
4. CHX
5. water

Greatest reduction in PD and subG P.Gingivalis in systemic doxy groups

Reduction of HbA1c by 10% at 3 months in doxy groups

Question 16

Smoking biological basis for perio

Answer 16

1. Reduced perfusion (decrease in gingival vessels, not vasoconstriction) and impaired healing (Grossi 1996)
2. Neutrophil funtion alteration
3. Nictoine reduces fibroblast function (increased MMP8)

Question 17

Tomar & Asma 2000

NHANES-III survery - smoking and perio

Answer 17

smokers have a 4x higher risk for periodontitis than non-smokers

Washout period is 11 years

Former smoker had 1.6x more likely to have periodontitis

Dose-dependent relationship

Question 18

Ravida et al 2020

4 group 258pts non surgical perio therapy

Answer 18

Never smoker: 0.03 TLP
Former smoker: 0.05 TLP
Light smoker (<10 cig/day): 0.08 TLP
Heavy smoker: 0.11 TLP

TLP = Tooth lost from periodontitis

Question 19

Scabbia et al 2001

RCT to evaluate flap surgery in smokers

Answer 19

Evaluated at >7mm sites
PD reduction smoker vs non-smoker: 3mm and 4mm

CAL gain 1.8 (smoker) vs 2.8mm

NSSD in <7mm

Question 20

Tonetti et al 1995

Restrospective study; smoking and GTR

Answer 20

CAL gain

Smokers: 2.1 mm
Non-smokers: 5.2mm

Recurrence rate 2x higher in smokers

Question 21

Ganesan et al 2017

microbiome; smoking and diabetes

Answer 21

Smokers, healthy and periodontitis, had similar microbiome (86%), only 29% similarity to healthy non-smokers

Higher anaerobes in smokers

Diabetetic healthy vs non-diabetic healthy had distinct microflora

Question 22

Rhaumatoid arthritis and perio?

Answer 22

1. both have increase pro-inflammatory cytokines
2. Pg and AA may promote factors that initiate RA
3. Epigentic changes in bone marrow caused by chronic inflammation

Question 23

Ortiz et al 2009

Rheumatoid arthritis and periodontitis

Answer 23

4 group study, pt with severe perio and RA received:

1. SRP + anti-TNFa
2. SRP
3. anti-TNFa
4. Neither

Anti-TNFa alone did not affect perio condition

TNFa levels reduced after SRP

Signs and symtpoms of RA were reduced after perio therapy

Question 24

Mercado et al 2001

Rheumatoid arthritis, missing teeth and bone loss

Answer 24

RA group had 2x more missing teeth (11.6 vs 6.7)

RA group had 2x more bone loss (70% vs 34%)

Almost 2x more PD>6mm

Question 25

BMI

Answer 25

Question 26

waste to hip ratio

Answer 26

Question 27

Saito et al 2001 ## Footnote Obesity and Perio

Answer 27

Waste to hip ratio biggest risk (OR 2) OR for periodontitis of High WHR and * BMI 22-24.9 was **2.0** * BMI 25-29.9 was **3.3** * BMI>30 was **4.3**

Question 28

Osteoporosis T-scores

Answer 28

Question 29

Ronderos et al 2000 ## Footnote NHANES study

Answer 29

Females with **lower bone mass density** and elevated calculus scores had **more CALoss** than normal BMD with same calculus scores

Question 30

Proposed mechanisms for perio causing atherosclerosis ## Footnote Zardawi et al 2021

Answer 30

Pathogens invade epithelial cells P.gingivalis induced foam cell formation Indirect (elevated cytokines systemically)

Question 31

Matilla et al 1995 ## Footnote Prospective study

Answer 31

Poor dental health a predictor for fatal and non-fatal coronary events **correlation does not equal causation**

Question 32

Ryder et al 2021 ## Footnote P. gingivalis and alzheimers

Answer 32

*Pg* proteolytic enzyme gingipain plays a role in **initiating and progressive Alzheimer's**

Question 33

Kamer et al 2015 ## Footnote CAL and amyloid beta plaques

Answer 33

CAL >3mm MAY cause accumulate of bet amyloid and MAY cause cognitive dysfunction

Question 34

Pregnancy and Perio

Answer 34

Risk of preterm birth increases with severity of periodontal disease (Jeffcoat et al 2001) Bacterial composition or counts had no bearing on birth outcomes (Novak et al 2008) SRP in pregnant patient MAY reduce preterm birth (Jeffcoat et al 2003)

Question 35

Parsegian et al 2022 ## Footnote Review

Answer 35

Prevalence of periodontal disease is signficantly increased in patients with CKD or end-stage kidney disease

Question 36

IL-1 genetic polymorphism and perio

Answer 36

Kornman et al 1997 * IL-1 + genotypes had increased IL-1 production, **strong predictor of severe periodontitis in ages 40-60 (OR=18.9)**

Question 37

Elevated risk for periodontitis (random disorders)

Answer 37

1. Leukocyte adhesion deficiency (neturophils restricted to blood vessels; no neutrophils in periodontium) 2. Down syndrome 3. Papillon-Lefevre syndrome

Question 38

Age and perio

Answer 38

Grossi et al 1994 Age was a strong factor for attachment loss OR ranging from 2 in 35-44 y/o to 9 in 65/74 y/o