Systemic risk factors 2 Flashcards
what affect does smoking have on patient outcomes?
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
smoking can cause oral lesions -> cancer, why?
contains carcinogens and toxic substances
smoking can cause staining on the teeth, how can this effect oral health?
Rough surface for plaque retention
smoking can cause more calculus, why?
Increased salivary flow due to irritants particulate matter in smoke
other than periodontitis and cancer what other oral condition is smoking a risk factor for?
necrotising gingivitis
remember with smoking gingiva may appear healthy even if there is disease due to reduced inflammation and immune response
why is there a reduced inflammatory and immune response in smokers?
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
what does smoking do to vascularity of periodontium?
impairs vascularity of periodontium
fewer large vessels and more small vessels
what affect does reduced vascularity have on periodontium?
less inflammatory response
less bleeding on probing
reduced healing ability
rebound effect
what is the rebound effect from smoking?
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.
smoking reduces levels of gingival crevicular fluid, what affect does this have on the pockets?
Ig and other defence molecules cant reach the pocket
Reduces flushing of pocket to remove the bacteria and their waste
how does smoking affect the biofilm?
more pathogenic plaque biofilm
what are the 3 smoker classifications when approaching smoking cessation?
pre-contemplators - not interested
contemplators - interested but not ready to change
active quitters - making an attempt
what do the As in the 5As approach to smoking cessation stand for?
ask
advise
assess
assist
arrange
what does ask mean in the 5As approach to smoking cessation?
ask about the smoking use status
what does advise mean in the 5As approach to smoking cessation?
advise about the advantages and value of stopping
what does assess mean in the 5As approach to smoking cessation?
assess how motivated a patient is to stop
what does assist mean in the 5As approach to smoking cessation?
assist those who wish to stop
what does arrange mean in the 5As approach to smoking cessation?
monitoring, follow-up and referral
what approach to smoking cessation is used for patients who do not wish to stop?
the 5Rs approach
what do the Rs stand for in the 5Rs approach?
relevance
risk
rewards
road blocks
repetition
what does relevance mean in the 5Rs approach?
why its important to stop smoking
what does risk mean in the 5Rs approach?
risks if they continue to smoke
what does rewards mean in the 5Rs approach?
rewards for stopping e.g. money, health
what does road blocks mean in the 5Rs approach?
road blocks must be identified e.g. weight
what does repetition mean in the 5Rs approach?
repetition at each appointment
it is your duty as a dentist to advise smoking cessation even if they don’t want to hear it
what did the Genco study of 1999 do?
IMPORTANT STUDY
link periodontitis to stress
Those who couldn’t deal with stress had increased change of periodontal progression
what is the psychoneurogenic model for stress?
Hormones interact with sympathetic nervous system, both can interact on the immune system
Some bacteria can feed off stress hormones
what is the behaviour orientated model for stress?
Stress results in changed behaviour e.g. ^ smoking, ^ alcohol
stress is a risk factor for which periodontal condition?
necrotising gingivitis
how does stress affect saliva?
reduced salivary flow
increased viscosity due to increased glycoprotein content
increased acidity
promotes plaque formation
what gives an idea of the genetic susceptibility of a patient to periodontitis?
Extent of previous periodontal disease (bone loss/LOA/BOP)
Age
Level of oral hygiene
how does oral hygiene link to genetics?
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
how does genetics link to periodontal pathogen levels?
High levels of periodontal pathogens in subjects with gingivitis but don’t progress to periodontitis
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
