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2nd yr - CSA- Tugnait > Systemic Risk Factors 1 > Flashcards

Systemic Risk Factors 1 Flashcards

1
Q

Give some examples of individual risk factors

A
  1. Smoking
  2. Stress
  3. Diabetes
  4. Genetic factors
  5. Osteoporosis
  6. Alcohol
  7. Dietry calcium
  8. Obesity
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2
Q

Tobacco kills how many people?

A

More than 7 millions people annually

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3
Q

How many people are killed due to direct tobacco use?

A

6 milion

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4
Q

How many people are killed as a result second hand smoke?

A

890,000 people

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5
Q

Approx how many people smoke in the world?

A

1.1 Billion

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6
Q

State the primary reason smokers keep smoking

A

As nicotine is additive and smokers develop a dependence for ir

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7
Q

Wha greens in cigarettes kills smokers

A

Tar

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8
Q

Name some smoking related disease

A
  1. Cancer
  2. ischaemic/respiratory heart disease
  3. obstructive lung disease
  4. Periodontal disease
  5. Babies bon with a low birth weight
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9
Q

Name some oral conditions tobacco smoking is related to

A
  1. Periodontitis
  2. Periodontitis that is refractory to treatment
  3. Necrotising periodontal disease
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10
Q

Name some oral conditions smokeless tobacco is related to

A
  1. Localised recession manifesting as attachment loss

2. Severe activation periodontal disease

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11
Q

What did Early studies on tobacco show?

A

Smokers had a higher levels of periodontal disease and poorer oral hygiene

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12
Q

What hypothesis did early researchers reach in regards to tobacco smokers

A

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

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13
Q

What have cross sectional and longitudinal studies show smokers have?

A

Smokers have:
1. Greater bone loss and attachment loss
2. Increased numbers of deeper pockets
Than non smoker with similar plaque levels

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14
Q

Describe the Erie County studies

A

Had more than 1300 subjects

Smokers were categorised according to cigarette packs they smoke a years

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15
Q

When asking patient abut their smoking habits what do you wan to know?

A

How many cigarettes they smoke

For how long they have been smoking

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16
Q

How much more likely are current smokers to develop periodontitis than non smokers?

A

4 times more likely

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17
Q

In current smokers what percentage of their periodontitis is attributed to smoking?

A

74.8%

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18
Q

Describe the clinical appearance of periodontitis in a smoker

A
  1. Fibrotic tight gingiva
  2. Rolled margins
  3. Less gingival redness and bleeding
  4. More severe widespread disease then the same aged non smoker
  5. Anterior, maxilla palate worst effected
    6 Nicotine staining and calculus
  6. Anterior recession, open embrasures
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19
Q

Describe features of necrotising gingivitis

A
  1. Painful interdental necrosis
  2. Bleeding gingiva
  3. Necrotic ulcers affecting interdental papillae
  4. Punched out appearance
  5. Painful ulcers covered in grey slough
  6. Possible halitosis
  7. Possible lymph nodes involvement
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20
Q

Name some toxic substances in cigarettes

A
  1. Nicotine, Benzene
  2. Hydrogen cyandie
  3. Carbon monoxide 4. ammonia,
  4. formaldehyde,
  5. Free radicals dimethylnitrosamine,
  6. acrolein
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21
Q

What effect does nicotine have on neutrophils?

A
  1. Inhibits phagocytosis of neutrophil

* 2. Reduction in chemotaxis and migration of oral neutrophils exposed t

22
Q

What has been introduced as a ‘safer’ alternative to smoking?

A

Vaping

23
Q

How many vapers are there in the uk?

A

2.8 million

24
Q

What is the main benefit of vaping/ using e cigarettes?

A

Aids smokers to quitting smoking

25
Q

How does nicotine effect fibroblasts?

A

Affects fibroblast function and penetrates the oral epithelium

26
Q

How does nicotine affect our body immunological responses?

A
  1. Inhibits phagocytosis of neutrophil
  2. Reduces chemotaxis and migration of oral neutrophils
  3. affects fibroblast function
  4. Reduces antibody production
  5. Alters peripheral blood immune regulatory T cell subset ratios
  6. Reduces bone mineralisation
  7. Is cytotoxic
27
Q

How does nicotine effect the blood?

A
  1. Has adverse effect in the micro circulation, gingival circulation and blood flow
  2. Possibly could cause vasoconstriction of gingival capillaries
  3. Chronic hypoxia of periodontal tissues
  4. there’s a higher proportion of small blood vessels in smokers
28
Q

What does evidence suggest about smokers inflammatory response?

A

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

29
Q

What might ICAM-1 expression affect?

A

Neutrophil emigration from vessels

30
Q

Overall what would you see clinically in a smoker suffering from periodontitis

A

Overall:

  1. Less gingival redness
  2. Less bleeding on probing
  3. Fewer vessels clinically and histologically
  4. Healing repose may be affected by impairment of revascularisation
31
Q

Does smoking affect the microbiology of the oral environment?

A

In 6 studies no microbiological differences found in smokers & non-smokers
In 8 studies, trend for smokers to harbour more potential periodontal pathogens

32
Q

What are the clinical characteristics of smokers with perio

A
  1. Relatively the perio starts earlier and there rapid disease progression
  2. Theres a poor response to non surgical therapy
33
Q

How is the treatment of periodontitis affected by a patients smoking status?

A
  1. Smoker respond less well to periodontal therapy
  2. Over 90% of refractory patients have been found to be smokers
  3. a 6 month study shows a decrease in inflammation and GCF and IGA conc and poorer periodontal outcome in smokers
34
Q

What should you advice to patients who smoke?

A

Advice them of the adverse effects of smoking on their oral and periodontal health (+general health)You should explain poorer response to periodontal therapy

35
Q

What is essential to the preventative arm of your periodontal therapy?

A

SMOKING CESSATION

36
Q

What must you record when treating a patient who smokes?

A

Record giving advice in patient’s notes (NB medico-legal reasons)

37
Q

What are some changes that can occur when a patient stops smoking?

A
  1. Approx 6 months theres a recovery of inflammatory response leads to transient increased bleeding
  2. After 12 months the normal architecture returns
38
Q

is smoking cessation useful?

A

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

39
Q

What can you suggest to patients who want to quit?

A

Suggest to them the NHS stop smoking services

Also recommend replacement therapy

40
Q

How do you give hood smoking cessation advice?

A

Be practical, supportive & encourage
Very Brief Advice: 3 As
Ask (establish and record smoking status)
Advise (on personal benefits of quitting)
Act (offer help)

41
Q

Are e cigarettes safe?

A

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

42
Q

How can stress affect the oral environment?

A

Stress known to affect host immune response

Individual more susceptible to periodontal disease

43
Q

What is psychological stress?

A

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 (

44
Q

Give some examples of psychological stresses

A
  1. Disasters or crisises eg major floods, earthquakes
  2. Major life events eg divorce, imprisonment, death of loved one
  3. Micro stressors
45
Q

How can stressors be categorised?

A
  1. Acute stressor

2. Chronic stressor

46
Q

Who is an acute stressor?

A

Someone who experiences stress short term and for time limited events

47
Q

Who is a chronic stressor?

A

Someone who experiences stress that is long lasting

48
Q

Talk through the response that stress induces

A
  1. Stress induced response is transmitted to the hypothalamus-pituitary-adrenal axis
  2. Corticotrophin-releasing hormone (CRH) from pituitary
  3. Glucocorticoids from adrenal cortex which decrease production of proinflammatory cytokines
49
Q

What are the 3 effects of stress?

A
  1. Behavioural changes
  2. Activation of biological system which activates the Hypothalamic-Pituitary-Adrenal Axis
  3. Can lead to a chronic state of inflammation thought the activation of macrophages, dendritic cells and endothelium
50
Q

What happens when the Hypothalamic-Pituitary-Adrenal Axis is activated?

A

IT increases the circulating glucocorticoids and epinephrine levels in the body which leads to immune suppression

51
Q

Give some examples of how the immune response can be supressed

A

reduction in lymphocyte population, lymphocyte proliferation, natural killer cell activity and antibody production and re-activation of latent viral infections

52
Q

What is the link between stress and periodontal disease?

A

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

2nd yr - CSA- Tugnait (3 decks)

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