Systemic Risk Factors 1 Flashcards
Give some examples of individual risk factors
- Smoking
- Stress
- Diabetes
- Genetic factors
- Osteoporosis
- Alcohol
- Dietry calcium
- Obesity
Tobacco kills how many people?
More than 7 millions people annually
How many people are killed due to direct tobacco use?
6 milion
How many people are killed as a result second hand smoke?
890,000 people
Approx how many people smoke in the world?
1.1 Billion
State the primary reason smokers keep smoking
As nicotine is additive and smokers develop a dependence for ir
Wha greens in cigarettes kills smokers
Tar
Name some smoking related disease
- Cancer
- ischaemic/respiratory heart disease
- obstructive lung disease
- Periodontal disease
- Babies bon with a low birth weight
Name some oral conditions tobacco smoking is related to
- Periodontitis
- Periodontitis that is refractory to treatment
- Necrotising periodontal disease
Name some oral conditions smokeless tobacco is related to
- Localised recession manifesting as attachment loss
2. Severe activation periodontal disease
What did Early studies on tobacco show?
Smokers had a higher levels of periodontal disease and poorer oral hygiene
What hypothesis did early researchers reach in regards to tobacco smokers
Hypothesise that poorer oral hygiene maybe responsible for higher disease levels
Newer research has found a direct link between smoking and its effect on the periodonitum
What have cross sectional and longitudinal studies show smokers have?
Smokers have:
1. Greater bone loss and attachment loss
2. Increased numbers of deeper pockets
Than non smoker with similar plaque levels
Describe the Erie County studies
Had more than 1300 subjects
Smokers were categorised according to cigarette packs they smoke a years
When asking patient abut their smoking habits what do you wan to know?
How many cigarettes they smoke
For how long they have been smoking
How much more likely are current smokers to develop periodontitis than non smokers?
4 times more likely
In current smokers what percentage of their periodontitis is attributed to smoking?
74.8%
Describe the clinical appearance of periodontitis in a smoker
- Fibrotic tight gingiva
- Rolled margins
- Less gingival redness and bleeding
- More severe widespread disease then the same aged non smoker
- Anterior, maxilla palate worst effected
6 Nicotine staining and calculus - Anterior recession, open embrasures
Describe features of necrotising gingivitis
- Painful interdental necrosis
- Bleeding gingiva
- Necrotic ulcers affecting interdental papillae
- Punched out appearance
- Painful ulcers covered in grey slough
- Possible halitosis
- Possible lymph nodes involvement
Name some toxic substances in cigarettes
- Nicotine, Benzene
- Hydrogen cyandie
- Carbon monoxide 4. ammonia,
- formaldehyde,
- Free radicals dimethylnitrosamine,
- acrolein
What effect does nicotine have on neutrophils?
- Inhibits phagocytosis of neutrophil
* 2. Reduction in chemotaxis and migration of oral neutrophils exposed t
What has been introduced as a ‘safer’ alternative to smoking?
Vaping
How many vapers are there in the uk?
2.8 million
What is the main benefit of vaping/ using e cigarettes?
Aids smokers to quitting smoking
How does nicotine effect fibroblasts?
Affects fibroblast function and penetrates the oral epithelium
How does nicotine affect our body immunological responses?
- Inhibits phagocytosis of neutrophil
- Reduces chemotaxis and migration of oral neutrophils
- affects fibroblast function
- Reduces antibody production
- Alters peripheral blood immune regulatory T cell subset ratios
- Reduces bone mineralisation
- Is cytotoxic
How does nicotine effect the blood?
- Has adverse effect in the micro circulation, gingival circulation and blood flow
- Possibly could cause vasoconstriction of gingival capillaries
- Chronic hypoxia of periodontal tissues
- there’s a higher proportion of small blood vessels in smokers
What does evidence suggest about smokers inflammatory response?
Smokers with periodontal may not be accompanied by equivalent increase vascularity
So theres an inflammatory response but it has reduce vascularity
Theres also a reduction in ICAM-1 expression
What might ICAM-1 expression affect?
Neutrophil emigration from vessels
Overall what would you see clinically in a smoker suffering from periodontitis
Overall:
- Less gingival redness
- Less bleeding on probing
- Fewer vessels clinically and histologically
- Healing repose may be affected by impairment of revascularisation
Does smoking affect the microbiology of the oral environment?
In 6 studies no microbiological differences found in smokers & non-smokers
In 8 studies, trend for smokers to harbour more potential periodontal pathogens
What are the clinical characteristics of smokers with perio
- Relatively the perio starts earlier and there rapid disease progression
- Theres a poor response to non surgical therapy
How is the treatment of periodontitis affected by a patients smoking status?
- Smoker respond less well to periodontal therapy
- Over 90% of refractory patients have been found to be smokers
- a 6 month study shows a decrease in inflammation and GCF and IGA conc and poorer periodontal outcome in smokers
What should you advice to patients who smoke?
Advice them of the adverse effects of smoking on their oral and periodontal health (+general health)You should explain poorer response to periodontal therapy
What is essential to the preventative arm of your periodontal therapy?
SMOKING CESSATION
What must you record when treating a patient who smokes?
Record giving advice in patient’s notes (NB medico-legal reasons)
What are some changes that can occur when a patient stops smoking?
- Approx 6 months theres a recovery of inflammatory response leads to transient increased bleeding
- After 12 months the normal architecture returns
is smoking cessation useful?
Yes as Brief advice from a health professional can result in up to 5% of patients quitting smoking
Smokers are up to 4 times more likely to quit with support
What can you suggest to patients who want to quit?
Suggest to them the NHS stop smoking services
Also recommend replacement therapy
How do you give hood smoking cessation advice?
Be practical, supportive & encourage
Very Brief Advice: 3 As
Ask (establish and record smoking status)
Advise (on personal benefits of quitting)
Act (offer help)
Are e cigarettes safe?
They are better as they don’t contain tobacco and they don’t produce tar or carbon monoxide
BUT does contain nicotine propylene glycol and/or vegetable glycerine, and flavourings
How can stress affect the oral environment?
Stress known to affect host immune response
Individual more susceptible to periodontal disease
What is psychological stress?
Psychological stress refers to the emotional and physiological reactions experienced when a person confronts a life event, such as marital conflict, financial debt or death of loved one, that exceeds his or her ability to cope effectively with the situation (
Give some examples of psychological stresses
- Disasters or crisises eg major floods, earthquakes
- Major life events eg divorce, imprisonment, death of loved one
- Micro stressors
How can stressors be categorised?
- Acute stressor
2. Chronic stressor
Who is an acute stressor?
Someone who experiences stress short term and for time limited events
Who is a chronic stressor?
Someone who experiences stress that is long lasting
Talk through the response that stress induces
- Stress induced response is transmitted to the hypothalamus-pituitary-adrenal axis
- Corticotrophin-releasing hormone (CRH) from pituitary
- Glucocorticoids from adrenal cortex which decrease production of proinflammatory cytokines
What are the 3 effects of stress?
- Behavioural changes
- Activation of biological system which activates the Hypothalamic-Pituitary-Adrenal Axis
- Can lead to a chronic state of inflammation thought the activation of macrophages, dendritic cells and endothelium
What happens when the Hypothalamic-Pituitary-Adrenal Axis is activated?
IT increases the circulating glucocorticoids and epinephrine levels in the body which leads to immune suppression
Give some examples of how the immune response can be supressed
reduction in lymphocyte population, lymphocyte proliferation, natural killer cell activity and antibody production and re-activation of latent viral infections
What is the link between stress and periodontal disease?
Correlation between periodontal disease and stress
Traumatic events, increases the risk of periodontal disease but individuals with increased ability to cope with a stressful stimulus had reduced impact on the progression of periodontal disease
