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Classic Lit > Systemic Factors > Flashcards

Systemic Factors Flashcards

1
Q

Risk Determinants

A

Factors that cannot be modified

genetics, age, sex, ethnicity

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2
Q

Risk Factors

A

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

smoking, diabetes, pathogenic bacteria

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3
Q

Risk Indicators

A

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

Alcohol, stress, obesity

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4
Q

Risk Predictor

A

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

furcation

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5
Q

Risk Markers

A

BOP

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6
Q

RISK FACTOR - Diabetes

Diagnosis of diabetes

A

> 126 mg/dL fasting, >6.5% HbA1c

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7
Q

Taylor (1996)

A

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

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8
Q

Mealey & Ocampo (2007)

A

Diabetes increased risk of periodontitis by 3x

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9
Q

Caused by diabetes

Biological basis of impaired wound healing and decreased immune response

A
  • 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
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10
Q

HbA1C, Fasting plasma glucose, Oral glucose tolerance test

A

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

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11
Q

Kumar et al 2020

Cohort study

A

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

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

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12
Q

Emrich et al 1991

x sectional study of Pima indians (arizona)

A

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

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13
Q

Nelson et al 1990

Pima Indians and T2DM

A

similar in men and women

rate of perio was 2.6 times higher in T2DM

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14
Q

Saremi et al 2005

Prospective study, Pima indians

A

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

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15
Q

Grossi et al 1997

A

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

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16
Q

Smoking biological basis for perio

A
  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)
17
Q

Tomar & Asma 2000

NHANES-III survery - smoking and perio

A

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

18
Q

Ravida et al 2020

4 group 258pts non surgical perio therapy

A

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

19
Q

Scabbia et al 2001

RCT to evaluate flap surgery in smokers

A

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

CAL gain 1.8 (smoker) vs 2.8mm

NSSD in <7mm

20
Q

Tonetti et al 1995

Restrospective study; smoking and GTR

A

CAL gain

Smokers: 2.1 mm
Non-smokers: 5.2mm

Recurrence rate 2x higher in smokers

21
Q

Ganesan et al 2017

microbiome; smoking and diabetes

A

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

22
Q

Rhaumatoid arthritis and perio?

A
  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
23
Q

Ortiz et al 2009

Rheumatoid arthritis and periodontitis

A

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

24
Q

Mercado et al 2001

Rheumatoid arthritis, missing teeth and bone loss

A

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

25
Q

BMI

A
26
Q

waste to hip ratio

A
27
Q

Saito et al 2001

Obesity and Perio

A

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

28
Q

Osteoporosis T-scores

A
29
Q

Ronderos et al 2000

NHANES study

A

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

30
Q

Proposed mechanisms for perio causing atherosclerosis

Zardawi et al 2021

A

Pathogens invade epithelial cells

P.gingivalis induced foam cell formation

Indirect (elevated cytokines systemically)

31
Q

Matilla et al 1995

Prospective study

A

Poor dental health a predictor for fatal and non-fatal coronary events

correlation does not equal causation

32
Q

Ryder et al 2021

P. gingivalis and alzheimers

A

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

33
Q

Kamer et al 2015

CAL and amyloid beta plaques

A

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

34
Q

Pregnancy and Perio

A

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)

35
Q

Parsegian et al 2022

Review

A

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

36
Q

IL-1 genetic polymorphism and perio

A

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

37
Q

Elevated risk for periodontitis (random disorders)

A
  1. Leukocyte adhesion deficiency (neturophils restricted to blood vessels; no neutrophils in periodontium)
  2. Down syndrome
  3. Papillon-Lefevre syndrome
38
Q

Age and perio

A

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

Classic Lit (12 decks)

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