week one - modifiable/nonmodifiable factors + risk assessment Flashcards
provide two examples for each of the four types of risk factors for caries
- local
- poor OH
- tooth anatomy / existing restos - systemic
- xerostomia related to various medications or conditions
- high bacterial counts - environmental
- inadequate fluoride exposure
- frequent consumption of cariogenic foods [lifestyle] - lifestyle
- low SES
- disabilities/impairements making OH activities more difficult
caries risk factors div into two broad catergories
1. primary
- act directly on biofilm
- eg saliva, diet, fluoride
- modifying
- indirect influence
- eg low SES, lifestyle, prev dental/compliance hx
briefly describe the aetiology of periodontal disease and list the five domains of risk factors
occ when balance is changed between pathogenic bacteria and host’s inflammatory/immune responses
- can be affected by local/systemic risk factors
- grouped as modifiable/non-modifiable risk factors
- environmental [dysbiotic subgingival biofilm]
- genetic risk factors
- lifestyle eg smoking, poor diet, stress
- systemic diseases eg diabetes
- other factors such as tooth related, occlusal/functional problems, iatrogenic factors
describe local risk factors for periodontal disease
local contributing factors ^ plaque retention/pathogenicity or directly damage periodontium
- possible to eliminate some local cont factors eg removal of overhangs
- possible to compensate for local factors that cant be eliminated eg good self care arounf crowded or open contact
eg of local risk factors
- pt habits
- faulty restos/appliances
- carious lesions
- tooth morpho
- occlusal forces
- food impaction
- mature plaque accumulation
- malocclusion/malalignment
- incompetent lip seal
- calculus
describe systemic risk factors for periodontal disease
- smoking/alcohol
- strongly assoc w tooth loss
- impairs healing response, selects for periodontal pathogens, impacts host response - smoking-gingivitis
- heavy smokers present clinically w thickened, fibrotic gingival tx
- devel of ging is delayed due to reduced blood supply + suppressed normal immune response to accumulation of plaque
- masking of bleeding ^ may lead to failure to recognise presence of periodontal disease - smoking-periodontitis
- rate of periodontitis progression is more rapid among smokers
- smoking assoc w deeper pockets and ^ bone loss + smokers exhibit less reductions in probing depths
- poor wound healing of tx in surgical/non-surgical tx - obesity
- ^ BMI = ^ risk [dose-response relationship]
- chronic systemic inflammation - suggested mechanism = contribution of adipose tx [dysregulated bone metabolism] + release of pro-inflammatory mediators and host immune response - diabetes [Type I/2] [elevated blood glucose levels]
- due to defects in insulin action/prod. =**systemic inflammatory response **
- severity = higher in pts w poor glycaemic control
- ^ alv bone loss in type 2
- suggested mech
defect in PMN activity [Polymorphonuclear neutrophils - infection defence]
AGE accumulation [Advanced glycation end products - glycated proteins/lipids after sugar exposure] - ^ inflammation
^ lvls of inflammatory mediators
- PGE2
- TNF
- stress
- correlation between chronic perio dx + pyschosocial stress status = ability to cope may modify disease progression
- sugg mech = dysreg of host immune response and impact of stress of behaviours - haematological disorders
- eg leukemia
- impairs host immune response to biofilm and periodontal pathogens - osteoporosis [reduction in bone mineral density]
- POTENTIAL RISK FACTOR - FURTHER STUDIES NEEDED
- some studies to suggest possitive assoc with alv bone height, CAL and periodontitis - HIV/AIDS
- immunodifiency can manifest necrotising stomatitis, linear gingival erythema, ANUG, ANUP - hormonal fluctuations
- pregnancy
- menstruation
- menopause
- contraceptive pill
- hormone replacement therapy - genetic
- familial aggregation of aggresive types of periodontal disease - other factors that affect periodontium
- medications that affect gingival overgrowth [phenytoin, cyclosporine, Ca channel blockers]
- effect on saliva flow = xerostomia
describe the three risk characteristics of periodontal disease
- age
- prevalence/severity of perio ^ w/ age
- likely related to length of time - periodontal tx exposed to bacterial plaque - gender
- higher documented prevlance in men [57%] compared to women [39%]
- sugg gender bias in pathogenesis - SES
- related to social determinants of health
describe three other diseases in which periodontal disease is a risk factor
- cardiovascular disease
- systemic inflammatory response + impact of periodontal pathogens eg P.gingivialis in atherosclerosis development - pre and low birthweight
- PLBW <2500g
- sugg mech - bacterial by-products and assoc host inflammatory mediators and bacterial spreading
- PLBW and perio also share similar risk factors - diabetes
- impact of pre-existing perio on devel of incidient DM = unclear
- perio tx assoc w improved glycaemic control
describe the risk factors for
1. oral cancer
2. fungal [candida] infections
3. trauma
- oral cancer
- tobacco/alcohol
- HPV
- excess BW - fungal [candida] infections
- weakened immunity [HIV/AIDS, immunosuppresants]
- poorly controlled DM - sugar encourages growth of candida
- conditions/meds causing xerostomia - trauma
- greater overjet
- male gender
- incompetent lip seal
- tongue piercings
- participation in contact sports
- excessive drinking
list the visual flow ranges for saliva testing and their indications
< 3.5 mL = v low
3.5 - 5.0 mL = low
> 5.0 mL = normal
describe sensibility tests [2]
- percussion testing
- indicates PDL inflammation
- tapping on multiple teeth to reveal if a particular one is causing pain - pulp sensibility testing
- thermal testing / cold test
- may yield following results
- no response
- moderate transient response
- painful response that subsides/lingers after stimulus removal
describe the caries imbalance
1. disease indicators
2. risk factors
3. protective factors
- disease indicators
- white spots
- restorations <3 yrs
- enamel lesions
- cavities/dentin - risk factors [BAD]
- bad bacteria
- absence of saliva
- dietary habits [poor] - protective factors
- saliva and sealants
- antibacterials
- fluoride
- effective diet
define CAMBRA and the distinctions between the risk catergories for patients > 6 yo
“caries management by risk assessment”
- risk status determined by balance/imbalance of pathological and protective factors in each pt
- consistent w MID
high risk
- 1 or more diseae indicators = high risk
- in conjunction w hyposalivation = extreme risk
moderate risk
- if not obv at high/extreme risk and doubt about low risk
- monitored w appropriate measures eg fluoride
low risk
- no disease indicators, very few/no risk factors, many protective factors
distinguish between the CAMBRA risk catergories for pt < 6 yo
high risk
- 1/more disease indicators
- risk factors definitively outweigh protective factors
- mother/caregiver w current/recent decay - most likely high caries risk for child also
moderate risk
- no disease indicators
- risk factors and protective factors = balanced
low risk
- no disease indicators
- few/no risk factors
- prominent protective factors
define NCTL, distinguish between attrition/erosion/abrasion and outline their risk factors
NCTL = non carious tooth loss
- attrition
- loss of tooth tissue from tooth-tooth contact
- bruxism, uneven occ loading - erosion
- loss of tooth tx from acidic dissolution
- acidic bev/foods
- acid reflux
- social factors - abrasion
- loss of tooth tissue from foreign objects or conditions [not tooth-tooth related]
- toothbrush/technique
- piksters
