5- relationship with systemic pathologies

What are predisposing factors that contribute to periodontal disease?

Any local agent or condition that contributes to biofilm accumulation- dental anatomy, position of the tooth in arch, restorations…

What is a modifying factor?

Any agent or condition that alters the way an individual responds to the presence of biofilm (systemic diseases, smoking, medications...)

Systemic risk factors:

Smoking Hyperglycemia (in diabetic patients)

Reduced intake of antioxidant micronutrients (eg Vit C)

Drugs- system modulators, immunological steroid sex hormones (elevated levels), haematological disorders

What 6 genetic disorders can cause periodontitis as a manifestation?

Diseases associated with immunological disorders- Papillon- Lefevre

Diseases affecting oral mucosa and gingival tissue- epidermolysis bullosa

Diseases affecting connective tissues- Ehler-Danlos Sdr

Metabolic and endocrinological disorders

Diseases with acquired immunodeficiency- HIV

Inflammatory diseases (inflammatory bowel disease)

What diseases/systemic conditions affecting the supporting periodontal tissue can lead to their loss? (Independently of periodontitis)

Neoplasms- squamous cell carcinoma or langerhans cells histocytosis

How do you control risk factors as first step of treating periodontitis?

Stop smoking, control diabetes- increases prevalence, progression and severity of periodontitis

Type 1- lack of insulin due to autoimmune reaction in pancreas

2- insulin resistance associated with chronically high blood sugar

What is the bidirectional relationship between diabetes and periodontal disease?

How periodontal disease affects diabetes-

• Worsens glycaemic control

• Increases risk of diabetic complications

• More common in diabetic patients

How diabetes affects periodontal disease-

• Periodontitis is more common and progresses faster, especially if diabetes is poorly controlled

• Causes increased inflammatory response in periodontal tissues

How does tobacco affect periodontal disease? Local vs systemic MOA?

Increases risk by 5-20 x

Dose dependent effect

Altered wound healing and microbiota, bad breath, impaired neutrophil function, altered proliferation of T and B lymphocytes

Locally- direct irritant of oral mucous membranes

Systemically- alters immune response and interferes with multiple cellular processes

4 General benefits of quitting smoking?

Decreased risk of myocardial infarction

Decrease in high bp and cholesterol

Increased exercise and lung capacity

Decreased risk of cancer and respiratory tract infections

4 Oral health benefits of quitting smoking?

Decreased risk of oral cancer

Decreased incidence of oral leukoplakia

Better autoimmune reponse and reponse to perio treatment

Increased periodontal vascularisation + prognosis

Which patients may require a more personalised treatment approach?(5)

Moderate (6-15 cig) or severe (more than 16 cig a day)

Have aggressive forms of periodontal disease

Have underlying disease/systemic condition that poses increased risk to patient

Genetic predisposition

Despite repeated attempts at treatment- perio status worsens

What are the 4 main cardiovascular diseases?

Coronary heart disease

Cerebrovascular accidents- ACV or strokes

Congestive heart failure

Peripheral arterial pathologies

What are some non modifiable vs modifiable risk factors of CVD?

Male, elderly, family history

Smoking, diabetes, high bp, obesity, sedentariness

CVD is mainly due to…

Atherosclerosis- thickening of blood vessel wall due to accumulation of lipids and fibrous components

Inflammation- emerging risk factor

It’s safe to do perio treatment on CVD patients

What hormones increase vascular permeability?

Estrogen and progesterone

What are the main clinical signs of pregnancy gingivitis?

Presence of plaque in the gingival margin- esp anteriors and molars- increased inflammatory response

Increased gingival exudate during 2/3rd trimester

Changes in color and gingival contour

Bop, greater probing depth, max peak of pseudobags in 2nd tri

No insertion loss or bone loss- reversible after childbirth

Scaling can be done safely- but avoid in 1st trimester due to stress for fetus- avoid tetracyclines and metronidazole and perio surgeries

What is a pregnancy (pyogenic) granuloma?

Exophytic growth of pedunculated base

Painful

Located mainly in the anterior sector of maxilla

Due to exaggerated response to irritants (e.g calculus)

Rapid growth

Easy bleeding