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CSA > systemic risk factors part 1 > Flashcards

systemic risk factors part 1 Flashcards

to develop understanding of tobacco smoking and stress as a risk factor for perio disease

1
Q

can individual risk factors be altered

A

some can potentially be altered and some cannot

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2
Q

when is world NO tobacco day

A

31st May

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3
Q

who is world no tobacco day sponsored by

A

WHO

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4
Q

what does world no tobacco day highlight

A

highlights the health risks of tobacco use and promotes effective actions to reduce tobacco consumption

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5
Q

how many people die due to tobacco

A

more than 7 mil each year

and half of its users

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6
Q

how many people die from direct tobacco

A

6 million

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7
Q

how many deaths are due to non smokers being exposed to tobacco

A

890000

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8
Q

how much % of people who smoke live in low income countries

A

80% of the 1.1 billion people who smoke

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9
Q

in the uk how many men smoke

A

17% OR 4 million

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10
Q

how many women in the Uk SMOKE

A

13.3% or 3 million

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11
Q

how many people vape in great Britain

A

2.8 million

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12
Q

why do smokers keep smoking

A

because of nicotine dependance

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13
Q

does nicotine kill

A

no but the other harmful substances do eg tar

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14
Q

what are smoking related diseases

A

cancer:
ischaemic/resp heart diseases, obstructive lung disease,stroke, pneumonia, aortic aneurysm,
non fatal: low birth weight babies and perio disease

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15
Q

what is tobacco smoking related to

A

periodontitis
necrotising periodontal disease
periodontitis that is refractory to treatment

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16
Q

what diseases is smokeless tobacco related to

A

increased cancer risk

increases CAL

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17
Q

what did earlier studies show

A

high levels of poor OHI
higher levels of perio disease therefore the smoking indirectly affects the periodontium and poor OHI directly affects the periodontium

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18
Q

what does current data now support

A

that smoking directly affects the periodontium

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19
Q

what do smokers have in regards to epidemiology

A

greater bone loss and attachment loss
greater pocket depths
than NON SMOKERS WITH SIMILAR PLAQUE

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20
Q

IN CURRENT SMOKERS WHAT % IS IT ESTIMATED THAT the periodontitis is an attribute due to smoking

A

74.8%

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21
Q

what does smoking have a detrimental affect on

A

the incidence and the progression of the periodontitis

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22
Q

what are the clinical appearance of smoker tissues

A 
fibrotic tissues with rolled margins 
less gingival redness and bleeding
more severe widespread disease than same non aged smoker 
anterior maxilla palette worst affected 
anterior recession 
open embrasures 
nicotine staining and calculus
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23
Q

what are the clinical symptoms of necrotising gingivitis NG

A 
rapid onset specific features, 
painful, interdental necrosis, bleeding gingiva
punched out interdental papilla 
ulcers painful 
possible halitosis 
possible lymph node involvement
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24
Q

how many toxic substances are found in cigarette smoke

A

more than 4000

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25
Q

what particles are found in cigarette smoke

A

nicotine benzene benzo(a)pyrene

26
Q

what gases are found in cigarette smoke

A 
hydrogen cyanide, 
carbon monoxide 
ammonia 
formaldehyde 
dimethylnitrosamine  
acrolein
27
Q

what do free radicals in cigarette smoke react with

A

react with chlesterol on the walls of arteries leading to atheroma

28
Q

what is cotinine

A

a metabolite of nicotine

29
Q

what does cotinine do

A

measures the exposure to tobacco smoke

30
Q

what are the effects of smoking

A

reduction in the migration and chemotaxis of PMN exposed to nicotine
inhibition of the phagocytosis of neutrophils( PMNS)
nicotine effects PMS respiratory burst

31
Q

what does nicotine also effect

A 
fibroblast function 
reduces serum antibody IgG 
reduced bone mineralisation 
cytotoxic, vasoactive constituents 
altered T cell numbers
32
Q

pathogenesis 3

A

chronic hypoxia of perio tissues
possible vasoconstriction of gingival capillaries
adverse effect on microcirculation

33
Q

What do smokers suffer from overall

A

Less gingival bleeding
Less bleeding on probing
Fewer vessels clinically and histologically
Healing response altered

34
Q

What are the clinical characteristics in regards to perio disease

A

Rapid onset and poorer response to surgical and non surgical therapy

35
Q

How many refractory patients have been found to be smokers

A

90%

36
Q

What do smokers and non smokers have a difference in regarding blood vessels

A

Higher proportion of smaller blood vessels compared to larger ones but no difference in vascular density

37
Q

Out of 14 studies how many show no difference in microbiological differences between smokers and non smokers

A

6

38
Q

In how many studies is there a potential for smokers to habour more perio pathogens

A

8

39
Q

What was shown in a 6 month study in smokers

A 
Less inflammation 
Less GCF 
less IgG to actinomycetes A 
Poorer perio outcome 
Also NO microbial differences
40
Q

What are clinical implications of smoking

A

Smoking cessation advice in regards to general health and oral health- CVD and cancer

41
Q

What do we need to record in patients notes

A

Smoking cessation advice for Medico legal reasons

Also need to explain poorer response to treatment if they continue smoking

42
Q

How many patients quit smoking when giving advice from health professionals

A

5% of patients quitting

43
Q

How long does it take for a smoker tissue to return to normal architecture

A

Approx 12 months

44
Q

How long does it take after smoking cessation for the recovery of inflammation- leading to increased bleeding

A

6 months

45
Q

What do we suggest for smoking cessation

A

NHS stop smoking services

Nicotine replacement therapy(NRT)

46
Q

What can be used for NRT

A

Bupropion(Zyban)

Varenicline(champix)

47
Q

What are the three As

A

Ask - establish and record smoking status
Advise - personal benefits of quitting
Act - offer help

48
Q

How much more are smokers more likely to quit with help

A

4 times

49
Q

What do e cigarettes not contain

A

Do not contain tobacco but still have nicotine

50
Q

What does e cigarettes have

A

Nicotine propylene glycol and vegetable glycerine

51
Q

What does stress affect

A

Host immune response

More susceptible to perio disease

52
Q

What is psychological stress

A

Can be defined as the physiological and psychological changes that occur in the body when an external demand or stressor taxes an individuals adaptive capacity

53
Q

Types of psychological stress

A

Disasters or crisis
Major life events
Micro stressors
Acute stressor/chronic stressor

54
Q

What is an acute stressor

A

Short term and time limited events

55
Q

What is your chronic stressor

A

Conditions that are long lasting

56
Q

What is stress induced response transmitted to

A

The hypothalamus pituitary adrenal a is HPA

57
Q

What hormone is released from the hypothalamus

A

Corticotrophin releasing hormone CRH

58
Q

What hormone is released from the pituitary gland to the adrenal gland

A

ACTH- adrenocorticotrophic hormone

59
Q

What does the adrenal gland release

A

Cortisol
Glucocorticoids
Catecholamines( norepinephrine and epinephrine)

60
Q

What do glucocorticoids do

A

Decrease production of pro inflammatory cytokines

61
Q

What is the pathway of stress

A

Activation of biological system—> activation of hypothalamus- pituitary- adrenal axis —-> increased glucocorticoids and epinephrine levels in the body —-> leads to immune suppression.

OR
Chronic state of inflammation—-> activation of macrophages and dendritic cells and endothelium —-> release of pro inflammatory cytokines

62
Q

What can changes in behaviour include

A 
Poor OH 
smoking 
Increased alcohol 
Insomnia 
Poor nutrition

CSA (51 decks)

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