systemic risk factors Flashcards
Give examples of individual risk factors
- Smoking
- Stress
- Diabetes
- Genetic factors
- Osteoporosis
- Alcohol
- Dietary calcium
- Obesity
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 clinical appearance of periodontitis in a smoker
- Fibrotic tight gingiva
- Rolled margins
- Less gingival redness and bleeding
- More severe and widespread disease than the same aged non smoker
- Anterior maxilla palate worst affected
- Nicotine staining and calculus
- Anterior recession and 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
What effect does nicotine have on neutrophils?
- Inhibits phagocytosis of neutrophil
- Reduction in chemotaxis and migration of oral neutrophils exposed to nicotine
How does nicotine effect fibroblasts
Affects fibroblast function and penetrates the oral epithelium
How does nicotine aft our body immunological responses
- Inhibits phagocytes of neutrophil
- Reduces chemotaxis and migration of oral neutrophils
- Affects fibroblast function
- Reduces antibody production
- Alters peripheral blood immune regulatory T cells 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 suffer about smokers inflammatory response
Smokers with periodontal disease have the associated vascularity so worn bleed as much as a non smoker
Overall what would see clinically in a smoker suffering from periodontitis
- Less gingival redness
- Less bleeding on probing
- Fewer vessels clinically and histologically
- Healing response may be affected by impairment of revascularisation
What are the clinical characteristics of a smoker with periodontal disease
- Relatively the periodontal disease starts earlier
- More rapid disease progression
- Poorer response to non surgical therapy
How is the treatment of periodontal disease affected by a patients smoking status
- Smokers repose less well to periodontal therapy
- Over 90% of refractory patients have been found to be 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
How can stress affect the oral environment?
Known to affect host immune response making an individual more susceptible to periodontal disease
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
