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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
what particles are found in cigarette smoke
nicotine benzene benzo(a)pyrene
26
what gases are found in cigarette smoke
``` hydrogen cyanide, carbon monoxide ammonia formaldehyde dimethylnitrosamine acrolein ```
27
what do free radicals in cigarette smoke react with
react with chlesterol on the walls of arteries leading to atheroma
28
what is cotinine
a metabolite of nicotine
29
what does cotinine do
measures the exposure to tobacco smoke
30
what are the effects of smoking
reduction in the migration and chemotaxis of PMN exposed to nicotine inhibition of the phagocytosis of neutrophils( PMNS) nicotine effects PMS respiratory burst
31
what does nicotine also effect
``` fibroblast function reduces serum antibody IgG reduced bone mineralisation cytotoxic, vasoactive constituents altered T cell numbers ```
32
pathogenesis 3
chronic hypoxia of perio tissues possible vasoconstriction of gingival capillaries adverse effect on microcirculation
33
What do smokers suffer from overall
Less gingival bleeding Less bleeding on probing Fewer vessels clinically and histologically Healing response altered
34
What are the clinical characteristics in regards to perio disease
Rapid onset and poorer response to surgical and non surgical therapy
35
How many refractory patients have been found to be smokers
90%
36
What do smokers and non smokers have a difference in regarding blood vessels
Higher proportion of smaller blood vessels compared to larger ones but no difference in vascular density
37
Out of 14 studies how many show no difference in microbiological differences between smokers and non smokers
6
38
In how many studies is there a potential for smokers to habour more perio pathogens
8
39
What was shown in a 6 month study in smokers
``` Less inflammation Less GCF less IgG to actinomycetes A Poorer perio outcome Also NO microbial differences ```
40
What are clinical implications of smoking
Smoking cessation advice in regards to general health and oral health- CVD and cancer
41
What do we need to record in patients notes
Smoking cessation advice for Medico legal reasons | Also need to explain poorer response to treatment if they continue smoking
42
How many patients quit smoking when giving advice from health professionals
5% of patients quitting
43
How long does it take for a smoker tissue to return to normal architecture
Approx 12 months
44
How long does it take after smoking cessation for the recovery of inflammation- leading to increased bleeding
6 months
45
What do we suggest for smoking cessation
NHS stop smoking services | Nicotine replacement therapy(NRT)
46
What can be used for NRT
Bupropion(Zyban) | Varenicline(champix)
47
What are the three As
Ask - establish and record smoking status Advise - personal benefits of quitting Act - offer help
48
How much more are smokers more likely to quit with help
4 times
49
What do e cigarettes not contain
Do not contain tobacco but still have nicotine
50
What does e cigarettes have
Nicotine propylene glycol and vegetable glycerine
51
What does stress affect
Host immune response | More susceptible to perio disease
52
What is psychological stress
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
Types of psychological stress
Disasters or crisis Major life events Micro stressors Acute stressor/chronic stressor
54
What is an acute stressor
Short term and time limited events
55
What is your chronic stressor
Conditions that are long lasting
56
What is stress induced response transmitted to
The hypothalamus pituitary adrenal a is HPA
57
What hormone is released from the hypothalamus
Corticotrophin releasing hormone CRH
58
What hormone is released from the pituitary gland to the adrenal gland
ACTH- adrenocorticotrophic hormone
59
What does the adrenal gland release
Cortisol Glucocorticoids Catecholamines( norepinephrine and epinephrine)
60
What do glucocorticoids do
Decrease production of pro inflammatory cytokines
61
What is the pathway of stress
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
What can changes in behaviour include
``` Poor OH smoking Increased alcohol Insomnia Poor nutrition ```

CSA (51 decks)

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