Systemic Factors_Jose_09192022 Flashcards
Final exam!! VIP: Diff between risk factors, risk indicator and risk determinants and risk marker
Risk factors –> identified through longitudinal studies and present before disease onset
Risk indicator –> identified through Cross sectional but not confirmed through longitudinal
Risk determinant –> cannot be modified (age, genetics)
Risk markers –> indicators of disease. PD, CAL, Furcation involvement
Stress and periodontitis
Boyapati and Wang 2007 study, reported that stress influences the stimulation of the autonomous nervous system with hyper-release of epinephrine by the adrenal medulla, which in turn increases glucose levels and influences altered immunity.
Risk of periodontitis:
Genco et al. 1999: Prospective cohort study. Recruited subjects with and without financial strain, they reported that the subjects with high financial stress who copied with it inadequately, had a higher risk of having more severe attachment loss (OR = 2.24) and alveolar bone loss (OR = 1.91) than those with low levels of financial strain within the same coping group. They also reported that individuals who possessed good coping behaviors, even when under financial strain, exhibited no more periodontal disease than those individuals not under financial strain
Relationship between BMI and periodontal disease Odds
Saito et al. 2001, reported the OR for periodontal disease in relation to the patients BMI:
22 – 24.9: 2.0 OR
25 – 29.9: 3.3 OR
>30: 4.3 OR
Higher BMI combined with a high waist-hip ratio significantly increases a patient’s risk of also having periodontitis.
The systemic characteristics of upper body obesity (abdominal adiposity) likely have a significant effect on periodontal inflammation and increase the severity of disease when it is present.
Mnemonic: Saito (Japanese name) - Sumo wrestlers have high BMI
Relationship between RA & Periodontitis
Both present similar pathogens, P. Gingivalis and AA was detected in the synovial fluid of patients with RA (Reichert et al., 2013)
In 2017 World workshop, RA was listed as one of the systemic disorders that have a major impact on the loss of periodontal tissue by influencing periodontal inflammation; being an inflammatory disease (Albandar et al., 2018)
- Periodontal therapy
Risk and treatment of periodontitis:
According to Mercado et al. 2001, patient with RA vs healthy (Non-RA) have:
- More missing teeth: 11.6 vs 6.7
- 2x more bone loss: 69% vs 34%
- More PD >6mm: 45% vs 25%
Similar findings were reported by Dissick et al. 2010, where RA patients had a higher prevalence of moderate to severe periodontitis:
- RA: 51% vs Control: 26% * Everything is doubled
T score Z score definition
2.5 standard deviations
If your test produces a z-score of 2.5, this means that your estimate is 2.5 standard deviations from the predicted mean. The predicted mean and distribution of your estimate are generated by the null hypothesis of the statistical test you are using.
Why do smokers have trouble healing? Name 4 studies
Grossi ‘96: Vasoconstriction of vessels. Also showed that SRP in smokers has 0.5 less CAL gain than in nonsmokers (1.8 vs. 1.3)
Palmer ‘05: Fewer blood vessels
Johnson & Hill ‘04: Nicotine attaches to root surfaces and prevents fibroblast attachment. Systemically, nicotine decreases collagen and increases collagenase
MacFarlane ‘92: Phagocytosis is impaired by nicotine
Which 2 different studies proved that smoking changes the subgingival plaque?
Zambron ‘96: Smoking causes dysbiosis of subgingival plaque (more Red Complex; specifically T. forsythia)
Haffajee and Socransky ‘01: Current smokers have different bacteria in the plaque (notably, more F. nucleatum, P. intermedia, T. forsythia, P. gingivalis, T. denticola) (e.g., Red and Orange Complex)
Are smokers more likely to have periodontitis? By how much?
Tomar & Asma ‘00: Long-term retrospective study from NHANES data. Current smokers are 4x more likely to have periodontitis (OR = 3.97). The washout period (to remove the risk of periodontitis from smoking) is 11 years
Ravida ‘20: Tooth loss per year (for nonsmokers, former smokers, light smokers, and heavy smokers): 0.03, 0.05, 0.08, 0.11 , 15 year washout period
Bergstrom ‘89: Smokers are 2.5x more likely to have periodontitis, and their disease is more severe
What is the tooth loss in smokers with periodontitis?
Ravida ‘20: Retrospective study. Depends on how much they are smokin’.
Just remember the numbers: 0.11 , 0.08, 0.05, 0.03
Heavy smoker (≥10 cig/day): 0.11 teeth/year
Light smoker (<10 cig/day): 0.08 teeth/year
Former smoker: 0.05 teeth/year
Never smoker: 0.03 teeth/year
Washout period: 15 years
How well do smokers respond to SRP?
Grossi ‘96: more details needed
About half a mm less PD reduction in smokers
PD reduction in Smokers: 1.29 mm (1.25 mm CAL gain)
PD reduction in Nonsmokers: 1.76 mm (1.63 mm CAL gain)
How well do smokers respond to periodontal treatment?
(Hint: It is one of the first ever studies to look at smoking & periodontal treatment outcomes)
Kaldahl ‘96: Prospective longitudinal 7 year study. 74 patients with moderate to advanced periodontitis underwent 4 treatment modalities: coronal scaling only, root planing, ModWidman, Flap with Osseous. Measured PD, CAL, recession, BOP, PI, at 6 sites.
Heavy and light smokers had significantly worse results than the nonsmokers (respectively, about 0.5mm worse CAL gains) - estimated from visuals
Heavy smokers (≥20 cig/day) and
Light smokers (<20 cig/day) : about 0.5 mm CAL gain
Nonsmokers: about 1.0 mm CAL gain
-Smoking status:
Heavy smokers (HS)> or = 20 cigarettes/day (n = 31)Light smokers (LS)< or = 19 cigarettes/day (n = 15)Past smokers (PS)had a history of smoking but had quit by the initial exam (n = 10)Non-smokers (NS)had never smoked (n = 18)
- Treatment: All patients were treated with four modalities of periodontal therapy (4 quads randomly assigned: coronal scaling, root planing (RP), modified Widman surgery (MW), and flap with osseous resectional surgery (OS)), then followed by 3mo. SPT.
- Clinical measurements (6 sites/tooth): PD, CAL, REC, BOP, and supragingival plaque (PL), horizontal probing attachment level (HAL) for molar furcations.
How well do smokers respond to flap surgery?
Preber & Bergstrom ‘90: Retrospective study MWF/12 months FU.
Heavy smokers had about half the PD reduction of nonsmokers
Heavy smokers (≥20 cig/day): PD reduction of 0.76 mm
Nonsmokers: PD reduction of 1.27 mm
How well do smokers respond to regeneration?
Tonetti ‘95: Retrospective study with 1 year followup. Smokers: ≥10 cig/day. Smokers have about half the CAL gain in regeneration
Nonsmokers: 5.2 mm CAL gain
Smokers: 2.1 mm CAL gain
How does Diabetes affect wound healing?
Mealy ‘06:
- Altered function of neutrophils, monocytes, macrophages, fibroblasts
- Less collagen formation (due to less fibroblast activity and more MMP)
- AGE’s (advanced glycation end products) thicken the microvasculature, which changes cellular transport
- More inflammatory cytokines (IL-1ß, TNF-alpha)
How likely are diabetics to develop periodontitis? Name 3 studies.
Basically, diabetics are 2 to 3 times more likely to get periodontitis
Grossi ‘94: Cross-sectional. Showed a risk indicator of Diabetes & periodontitis and relative risk of smoking. Diabetics have an OR: 2.32 of developing periodontitis. Smoking had a relative risk of attachment loss with OR 2.05 (for light smokers) to 4.75 (for heavy smokers)
Emrich ‘91: When using CAL loss to measure disease: Diabetics have an OR of 2.81. When using bone loss to measure disease: OR: 3.43
Tsai ‘02: Well-controlled diabetics are at no increased risk of periodontitis. However, uncontrolled Diabetics are 2.9x more likely
Mnemonic: “Grossi Emrich Tsai” - Diabetics are Gross, Rich and drink Chai”
Grossi 1994 Risk indicators
