Systemic risk factors 2

Question 1

what affect does smoking have on patient outcomes?

Answer 1

worse treatment outcomes

Less pocket depth reduction following PMPR as less of the pocket is made of inflammatory swelling

Healing impaired as less fibroblasts, epithelial cell function, reduced host response and vascularity

Question 2

smoking can cause oral lesions -> cancer, why?

Answer 2

contains carcinogens and toxic substances

Question 3

smoking can cause staining on the teeth, how can this effect oral health?

Answer 3

Rough surface for plaque retention

Question 4

smoking can cause more calculus, why?

Answer 4

Increased salivary flow due to irritants particulate matter in smoke

Question 5

other than periodontitis and cancer what other oral condition is smoking a risk factor for?

Answer 5

necrotising gingivitis

Question 6

remember with smoking gingiva may appear healthy even if there is disease due to reduced inflammation and immune response

Question 7

why is there a reduced inflammatory and immune response in smokers?

Answer 7

Reduced neutrophil function (chemotaxis, phagocytosis and bacterial killing)

Reduced number of Th cells

Reduced IgA and IgG

Higher levels of MMPs- collagenases and prostaglandin E2 causing tissue break down

Question 8

what does smoking do to vascularity of periodontium?

Answer 8

impairs vascularity of periodontium
fewer large vessels and more small vessels

Question 9

what affect does reduced vascularity have on periodontium?

Answer 9

less inflammatory response
less bleeding on probing
reduced healing ability
rebound effect

Question 10

what is the rebound effect from smoking?

Answer 10

When quit smoking vascularity and immune response quickly returns to normal so warn patients that there will likely be significant increase in bleeding when carrying out OH. Seeing a true picture of gum health.

Question 11

smoking reduces levels of gingival crevicular fluid, what affect does this have on the pockets?

Answer 11

Ig and other defence molecules cant reach the pocket
Reduces flushing of pocket to remove the bacteria and their waste

Question 12

how does smoking affect the biofilm?

Answer 12

more pathogenic plaque biofilm

Question 13

what are the 3 smoker classifications when approaching smoking cessation?

Answer 13

pre-contemplators - not interested

contemplators - interested but not ready to change

active quitters - making an attempt

Question 14

what do the As in the 5As approach to smoking cessation stand for?

Answer 14

ask
advise
assess
assist
arrange

Question 15

what does ask mean in the 5As approach to smoking cessation?

Answer 15

ask about the smoking use status

Question 16

what does advise mean in the 5As approach to smoking cessation?

Answer 16

advise about the advantages and value of stopping

Question 17

what does assess mean in the 5As approach to smoking cessation?

Answer 17

assess how motivated a patient is to stop

Question 18

what does assist mean in the 5As approach to smoking cessation?

Answer 18

assist those who wish to stop

Question 19

what does arrange mean in the 5As approach to smoking cessation?

Answer 19

monitoring, follow-up and referral

Question 20

what approach to smoking cessation is used for patients who do not wish to stop?

Answer 20

the 5Rs approach

Question 21

what do the Rs stand for in the 5Rs approach?

Answer 21

relevance
risk
rewards
road blocks
repetition

Question 22

what does relevance mean in the 5Rs approach?

Answer 22

why its important to stop smoking

Question 23

what does risk mean in the 5Rs approach?

Answer 23

risks if they continue to smoke

Question 24

what does rewards mean in the 5Rs approach?

Answer 24

rewards for stopping e.g. money, health

Question 25

what does road blocks mean in the 5Rs approach?

Answer 25

road blocks must be identified e.g. weight

Question 26

what does repetition mean in the 5Rs approach?

Answer 26

repetition at each appointment

it is your duty as a dentist to advise smoking cessation even if they don’t want to hear it

Question 27

what did the Genco study of 1999 do?

IMPORTANT STUDY

Answer 27

link periodontitis to stress

Those who couldn’t deal with stress had increased change of periodontal progression

Question 28

what is the psychoneurogenic model for stress?

Answer 28

Hormones interact with sympathetic nervous system, both can interact on the immune system

Some bacteria can feed off stress hormones

Question 29

what is the behaviour orientated model for stress?

Answer 29

Stress results in changed behaviour e.g. ^ smoking, ^ alcohol

Question 30

stress is a risk factor for which periodontal condition?

Answer 30

necrotising gingivitis

Question 31

how does stress affect saliva?

Answer 31

reduced salivary flow

increased viscosity due to increased glycoprotein content

increased acidity

promotes plaque formation

Question 32

what gives an idea of the genetic susceptibility of a patient to periodontitis?

Answer 32

Extent of previous periodontal disease (bone loss/LOA/BOP)

Age

Level of oral hygiene

Question 33

how does oral hygiene link to genetics?

Answer 33

Can have gingivitis and poor oral hygiene but never get periodontal disease

Get patients with good oral hygiene but get periodontitis at young age stage 3/4 grade C periodontitis

Question 34

how does genetics link to periodontal pathogen levels?

Answer 34

High levels of periodontal pathogens in subjects with gingivitis but don’t progress to periodontitis

Question 35

remember
Genetic systemic diseases can be associated with aggressive periodontal disease, often leading to early tooth loss

Down’s syndrome
papillon-lefevre syndrome
chediak-higashi syndrome
ehlers-danlos syndrome
hypophosphatasia