Chapter 6

Question 1

why are some patients more at risk than others for perio

Answer 1

• bacteria insufficient alone

- require a susceptible host

Question 2

what are systemic risk determinants/indicators for perio

Answer 2

• genetics
• age
• race
• gender

Question 3

what are evidence for genetics to be a risk determinants for perio

Answer 3

• perio associated with genetic traits
• separated twins
• genetics perio studies
• 50% advanced perio risk to hereditary
• people are not all at an equal risk
• IL-1 gene - 7x more likely
• carried by 30% of population

Question 4

what is epidemiological evidence for age, race and gender to be a risk determinant for perio

Answer 4

• difficult to prove causal factors
• age: cumulative effect of bacteria and not decreased host response
• gender (males more incidence and severity): genetics vs values
• race: no firm evidence that race is significant risk factor in destructive perio but may be genetic link with particular families

Question 5

how is stress a systemic factor for perio (2 reasons)

Answer 5

• may depress immune response to periodontal pathogens
  1. change behaviours
  2. increase production of glucocorticosteroids (antiinflammatory, reduce resistance to infection)

Question 6

what is diabetes

Answer 6

• absolute deficiency of insult (type 1) or low insulin levels and insulin resistance (type 2)
• unable to utilize glucose
• effects all organs including the blood vessels or the periodontium
• worse with poor metabolic control
• hyperglycemia (elevated glucose) may suppress the host’s immune system
• blood sugars should be between 4-7

Question 7

why are patients with diabetes more prone to perio

Answer 7

• poor wound healing
• recurrent infections
• periodontal abscesses
• impaired PMN function: chemotaxis (movement to the inflamed area), phagocytosis (engulfing bacteria)
• smoking + diabetes = increase incidence of destructive periodontitis

Question 8

what happens during pregnancy

Answer 8

• estrogen/progestin levels elevated

- exaggerated gingival response

Question 9

what is pregnancy gingivitis

Answer 9

• bacteria prevotella intermedia caused by elevated hormones
• increased tooth mobility (body is changing, body doesn’t know what ligaments need to stretch so they all do)
• reversible
• changes in the PDL

Question 10

what is puberty gingivitis

Answer 10

• hormonal imbalance
• estrogen and progesterone levels
• reversible
• similar to pregnancy gingivitis
• also caused by prevotella intermedia

Question 11

what is osteoporosis in relation to perio

Answer 11

• not an established risk factor but a risk indicator
• bone more porous
• greater CAL
• increased tooth loss
• estrogen depletion/menopause increases risk of perio

Question 12

what are bisphosphonates

Answer 12

• any of a group of drugs used to limit the loss of bone density in conditions such as osteoporosis and bone cancer
• for osteoporosis and bone metastasis
• very long half life, stay int the body
• IV vs oral

Question 13

what is osteonecrosis of the jaw

Answer 13

• exposed necrotic bone more than 8 weeks

- exo, implants, end, ortho, spontaneous

Question 14

what are oral bisphosphonates used for

Answer 14

• osteoporosis

- ex: fosamax, actonel, boniva

Question 15

what are intravenous bisphosphonates used for

Answer 15

• bone metastases

- ex: acedia, zometa

Question 16

what can we and can’t we do when patients take bisphosphonates for ONJ

Answer 16

• no elective dental procedures with IV
• risk factors – all prior dental tx before
• concerns with dental procedures:
• oral: after 3 years, considered at high risk for ONJ
• If taking longer than 3 years, testing prior to treatment. if levels are too low, drug ‘holiday’ of 3 months and retesting to see if have gone up before INVASIVE tx

Question 17

what are the periodontal findings for HIV patients

Answer 17

• impaired host response (CD4)
• NUG (necrotizing ulcerative gingivitis or NUP (periodontitis) may be the first sign of HIV infection
• NUP causes rapid destruction, microbiology similar to non-HIV infected

Question 18

how vitamin deficiencies affect perio

Answer 18

• vitamin C: normal function of fibroblasts, osteoblasts and odontoblasts. impaired wound healing
• vitamin D deficiency: perio risk as well as poor tx outcome

Question 19

how does smoking affect perio

Answer 19

• an established risk factor
• direct correlation between pack/years smoking and perio
• 2-6 times more
• less BOP
• former smokers is an intermediate between never smokers and current smokers
• modulates subgingival microbiota, promotes colonization

Question 20

what are the local effects of smoking

Answer 20

• in the oral cavity (heat, dryness, increase plaque and calculus)
• impaires PMN chemotaxis and phagocytosis

Question 21

how does smokeless tobacco affect perio

Answer 21

• may also contribute to perio
• may lead to cancerous changes
• common to see gingival recession

Question 22

how does alcohol abuse affect perio

Answer 22

• poor OHI
• nutritional deficiencies
• also affects PMNs, clotting, bone metabolism and healing

Question 23

what drugs can cause gingival overgrowth

Answer 23

• phenytoin
• cyclosporin (for organ rejection and immune compromised conditions ie chrones)
• calcium channel blockers (antihypertensive)

Question 24

how does diabetes affect perio

Answer 24

• untreated perio can complicate metabolic control of diabetics
• severe attachment loss increased with decreasing diabetic control
• control periodontal infection; reduce insulin requirements
• pro inflammatory cytokine production: bidirectional, effect perio tissues and insulin receptors

Question 25

how does cardiovascular disease affect perio

Answer 25

- periodontal pathogens enter the bloodstream - this increases production of inflammatory substances (cytokines such as IL) - cytokines may increase fibrinogen levels which may cause clot formation - C-reactive protein (CRP) is an inflammatory serum marker for cardiovascular disease and possibly periodontitis - this results in atherosclerosis - successful periodontal therapy could decrease these serum markers - if the patient has periodontitis: 50% increased risk for heart disease, 30% increased risk for stroke - a recent study suggested that there may not be an association between periodontitis and development of coronary artery calcification - more research is needed

Question 26

how can perio lead to pre-term delivery and low birthweight babies

Answer 26

- periodontal infection leads to inflammation - inflammation is initiated through chemical mediators such as prostaglandins - elevated levels of PGE2 is seen in periodontal inflammation - PGE2 is responsible for uterine contractions (induce labor)

Question 27

how does perio affect respiratory conditions

Answer 27

- increase risk to pneumonia, bronchitis, emphysema - elderly - long term care facilities - impact on health care system

Question 28

how does perio affect alzheimer's

Answer 28

- early exposure to inflammatory diseases may increase the risk for developing alzheimer''s disease later in life - this is a topic of on-going research