Unit 14 - Systemic Risk Factors That Amplify Susceptibilty to Peridontal Disease Flashcards
What are conditions or diseases that increase an individual’s susceptibility to periodontal disease by modifying or amplifying the host response to periodontal pathogens?
Systemic risk factors
What are the proven systemic risk factors?
Diabetes
Stress
Leukemia
Neutropenia
Metabloic syndrome
Hormonal variations
Down syndome
HIV
AIDS
Research is showing evidence for these other grade modifiers:
Obestity
Rheumatoid athritis
Alzheimer’s
What other systemic diseases have an impact on perdiodontal health?
Pnuemonia
Cardiovascular diseases
Alzheimer’s
Arthritis
Gastrointestional diseases
Thydroid diseases
What is the disease in which the body does not produce or properly use insulin?
Diabetes
What are the three types of diabetes?
Type I: 5 - 10% aused by damage to the pancreas
Type II: 90 - 95% develops when the body does not make enough insulin
Gestational: occurs during pregnancy
High susceptibility to infection occurs when the A1c glucose level is above
8%
What is the increased risk to infection range of a finger-stick test?
180 - 300mg/dL
What is the unacceptable range for a finger-stick test?
Greater than 300mg/dL
How is diabetes related to periodontal disease?
Studies have shown that diabetes leads to a hyperinflammatory response to dental biofilm which can lead to accelerated periodontal destruction
High glucose level = ________ function
Reduced PMN
What is defective neurtrophilic function?
Impairment of the immune response to infection
Hyperresponsive monocytes / macrophages leads to
Elevated production of proinflammatory cytokines in response to periodontal pathogens
What does AGE stand for?
Advanced glycation end products
What does RAGE stand for?
Receptor for advanced glycation end products
How are AGE and RAGE related to the periodontium by poorly / uncontrolled diabetes?
Excessive AGE modified proteins can be found in the oral cavity of a diabetic and interact with a cell receptor (RAGE) stimulating the release of proinflammatory cytokines. This can lead to exaggerated periodontal and systemic inflammation, insulin resistance and impaired tissue repair
What the symptoms of a poor response to periodontal therapy?
Reduced salivary flow
Burning mouth or tongue
What are signs of a poor response to periodontal therapy?
Inflammation
Extensive attachment loss
Progressive alveolar bone loss
Periodontal abscesses
Candidiasis
Prolonged periods of stress can cause
Supression of the immune system
What are the closely related metablic disturbances that occur together, increasing risk of heart disease, stroke, and diabetes?
High blood pressure
High blood sugar
Excess body fat around the waist
Abnormal cholesterol or triglyceride levels
Proinflammatory state
Increase tendency toward thrombosis
Having metabloic sydrome is associated with
A higher prevalence of periodontitis
What is metabolic syndrome?
Closely related metabolic disturbances that occur together, increasing risk of heart disease, stroke and diabetes
In the US _____ have metabloic syndrome
1 in 3 adults
How does metabloic syndrome have an impant on periodontal status?
Via chronic low-grade inflammation of prolonged duration
How does hypertension affect the periodontium?
Impairs blood flow that supplies the periodonitum
Lifestyle modifications that should be suggested to improve the perdiontal risk of metabloic syndrome
Increase physical activity
Practice good nutrition
Signs in the gingiva of leukemia-associated gingivitis
Swollen, glazed, spongy tissues
Red to deep purple in colour
Gingival enlargement
Why does inflammation of oral mucous membranes when undergoing chemotherapy?
Chemotherapy attacks and kills the rapidly dividing cells of the mucous membranes
Sloughing of the mucosa from oral mucositis can be
Localized or generalized
Reduced flow of saliva encourages growth of
Canadida albicans
Increased growth of Candida albicans causes
Oral candidasis
What should the dental hyienist look for in leukemia patients?
Spontaneous gingival bleeding and gingival enlargement for no apparent reason
Does chemotherapy cause a sore and sensitive mouth that bleeds easily?
Yes
How manage oral pain from oral mucositis
Topical anaesthetics have limited success
Prophylactic use of chlorhexidine may reduce frequency of oral mucositis and oral pathogens
Periodontal and oral manifeatations of HIV infection
Hairy leukoplakia
Candidiasis
Herpes labialis
Herpes zoster
Recurrent aphthous ulcers
Kaposi sarcoma
Linear gingival erythema
Manifestations of HIV infection are known as
Linear gingival erythema
Linear gingival erythema is characterized by a
2 -3 mm marginal bane of intense redness in the free gingiva
Is linear gingival erythema assosciated with pocketing?
No
Does linear gingival erythema affect clinical attachment loss or alveolar bone levels?
No
Is it safe to perform periodontal therapy on an HIV infected individual?
Yes, as long as the immune system is competent
How is linear gingival erythema treated?
With standard periodontal procedures plus use of chlorhexidine gluconate
Increase in hormone levels causes in creased blood circulation to the gingival tissues and may cause increased sensitivity to local irritants such as plaque biofilm in this disease.
Pubertal gingivitis
What happens with pregnancy gingivitis?
Exaggerated response to small amounts of plaque due to increased estrogen levels and elevated progesterone levels.
What is a pyogenic granuloma?
Pregnancy tumour which is the papilla reacting strongly to plaque
What can be suggested for a pregnant client having frequent vomiting that is causing erosion?
Baking soda rinse
What happens during menopause and postmenopause to the periodontium?
Decreased levels of circulating hormones in result in oral changes: dry mouth
burning sensation
altered taste
bone loss may worsen
What is the effect of gingiva called during menopause or postmenopause?
Menopausal gingivostomatitis
What are the characteristics of menopausal gingivostomatitis?
Gingiva bleed readily
Abnormally pale
Dry
Shiny
Erythematous
Does osteroporosis intitate periodontitis?
No
Can osteoporosis exacerbate the alveolar bone loss seen in preexisting periodonitits?
Yes
What can be recommended to menopause clients?
Calcium supplements
Weight-bearing exercise
Meticulous self-care
What are biphosphonates?
Most commonly prescribed medication to inhibit systemic bone resorption
Biphosphonates cause a rare disorder called
MRONJ
MRONJ is characterized by
Painful exposued bone in the mouth that fails to heal after extraction or oral surgery
Neutropenia is
Abnormally few number of neutrophils in blood
What does neutropenia lead to?
Increased susceptibilty for infection
PMN abnormalities can lead to
Overwhelming bacterial infection and severe periodontal destruction
Neutropenia is characterized by
The presence of abnormally few number of neutrophils in the blood which leads to increase susceptibilty to infection
Why do people with down syndrome have a higher risk of periodontal disease?
Abnormal PMN function in about 50% of people with down syndrome
How many medications have the potential to enlarge the gingiva?
20
What are the three major classes of drugs that can englarge the gingiva?
Anticonvulsants
Immunosuppresives
Calcium channel blockers
