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Systemic problems can:
Increase susceptibility to infection
– Interfere with wound healing
– Require _________________________
– Complicate __________________________
Affect clinical presentation and course of
periodontal disease
Systemic risk factors are conditions or diseases that increase an individual’s susceptibility to periodontal disease by modifying or amplifying the
Host response
PROVEN SYSTEMIC RISK FACTORS IN PERIO DISEASE
Diabetes mellitus • Leukemia • HIV/AIDS • Obesity • Osteoporosis • Stress • Metabolic Syndrome
• Hormonal variation • Down syndrome • Medications • Genetic influences • Tobacco use
DIABETES MELLITUS Is
A chronic lifelong metabolic disorder in which the body does not produce or properly use insulin
Types of diabetes mellitus
Type 1 DM – Type II DM – Gestational
Diabetes is well controlled if the——-
are stabilized within the recommended range
Blood glucose levels
A1C should be less than
7%
Target range for blood glucose is in diabetic patients
80 to 120
Increased risk infection is
180- 300
relationship
between diabetes and periodontal disease
Bidirectional
Untreated pd——> uncontrolled diabetes
< ——-
Periodontal disease is considered a complication of
uncontrolled diabetes
Individuals with well-controlled diabetes have ________periodontal disease than persons with out diabetes
No more
Individuals with undiagnosed or _____________ diabetes are more likely to have periodontal disease than those without diabetes
Uncontrolled
High blood sugar leads to increased glucose in
gingival crevicular fluid and blood
Defective ___________________________,
impedes the normal initial immune response
Neutrophil, chemotaxis and phagocytosis
In diabetic patients there is an elevation of
proinflammatory_____________ in response to
the periodontal pathogens present
Cytokines
The rate of periodontal disease is ——times greater
than in nondiabetics
3
Implications of uncontrolled diabetes for
periodontium
:—- periodontal therapies (impaired wound healing)
Poor response
If the patient is also a smoker and over the age of 45, they are ——times more likely to experience
severe periodontitis
20
ORAL EFFECTS OF UNCONTROLLED DIABETES
Reduced salivary flow
Burning mouth or tongue
Cheilosis
May have multiple periodontal abscesses, leading to rapid bone destruction
Localized tissue swelling (lateral incisor)
in an individual with uncontrolled diabetes
Glycation is
the metabolic process in which glucose in the bloodstream (from sugars and carbs) irreversibly attach to proteins and lipids
Age and Rage causes
releases inflammatory cytokines
response prepares the cardiovascular, musculoskeletal and neuroendocrine systems to respond to a fight or flight situation (essential adaptive instinct for
survival) is
Acute stress
can impair the immune system and biologic equilibrium,
Chronic stress
When Cortisol levels are excessive=
High BP, Tachycardia (increase heart rate), Increase susceptibility to infection; due to suppression of inflammatory response
Stress is regulated by
Cortisol hormone
Cortisol helps maintain
normal blood pressure, heart rate and regulate inflammation
Stress changes behavior examples
Poor self-care – Dietary habits – Smoking – Increased alcohol consumption – Noncompliance
Changes in hormone levels may have an effect on the periodontium, particularly in the presence of plaque-induced gingivitis examples
Puberty
– Pregnancy
– Menopause
Puberty is increase in hormones causes —- to gingival tissues
Increased blood circulation
Clinical features of puberty include
Accumulation of plaque biofilm
– Red, inflamed, swollen gingival tissue + BOP
– Inflammation that IS reversible with meticulous
daily self-care – Also reversible following puberty
Usually occurs in a patient who has had gingivitis before becoming pregnant
If self-care was good before becoming pregnant and the patient continues good oral hygiene, there is usually no problem
• But if there is existing gingival inflammation – exaggerated during pregnancy
Gingivitis
Bacteria causing gingival inflammation during pregnancy in the —— trimester
P. Intermediates
C. Retus
2end
During pregnancy
Gestational hormones act as
Growth factors for bacteria
In pregnancy: Increased levels of —-have been shown to alter the microbial profile of subgingival plaque
Estrogen
During pregnancy there is a depression of —— due to high levels of hormones
PMN chemotaxis
A mushroom-like growth that forms on the
interdental gingiva or gingival margin called
During pregnancy
Pyogenic Granuloma
Menopausal gingival problems are not common, but if they do occur it is called
Menopausal gingivititosis
During menopause The decline in hormonal levels causes changes intraorally like
Dry mouth –
Burning sensation –
Altered taste –
Gingival recession –
Bone loss may be exacerbated
Women who undergo hormone replacement therapy (HRT) may experience pregnancy-like symptoms of
Gingivitis
Post menopausal women may experience —— in the jaw
osteopenia or osteoporosis
Postmenopausal women who also smoke will lose alveolar bone height and density ——- than nonsmoking postmenopausal women
more radially
Loss of bone mass that causes an increased
susceptibility to fractures is
Osteoporosis
Osteoporosis occurs in
Postmenopausal women
– Sedentary individuals
– Bedridden individuals
– Individuals on long
-term steroid therapy
A combination of closely related metabolic disturbances like Increased blood pressure – High blood sugar – Excess body fat around the waist (abdominal obesity)
METABOLIC SYNDROME
A combination of closely related metabolic disturbances like Increased blood pressure – High blood sugar – Excess body fat around the waist (abdominal obesity) is known as __.
METABOLIC SYNDROME
Oral manifistations of AIDS/ HIV examples
Hairy leukoplakia
• Candidiasis
• Herpes labialis
• Recurrent intraoral herpes
• Recurrent aphthous ulcers
• Kaposi sarcoma
• Gingival recession/ alveolar bone loss
• LGE
LINEAR GINGIVAL ERYTHEMA Previously known as
HIV associated gingivities
Cheilosis Is
painful inflammation at the corners of the lip
In linear gingival erythema there is no——-
Does not always respond to conventional plaque control or——
attachment loss
Periodontal instrumentation
• Initial treatment for linear gingival erythema should be ————- plus ———— mouth rinse
periodintal scaling
0.12% chlorohexidine
Disorder characterized by abnormally few numbers of Neutrophils in
the blood
NEUTROPENIA
Impaired _____________________________ most likely explain the high prevalence and severity of periodontitis with ones of down syndrome
PMN, Chemotaxis, and phagocytes
LEUKEMIA-ASSOCIATED GINGIVITIS
• Gingival Enlargement due to increase in
cancer cells in the gingiva
Inflammation of the oral mucosa membranes caused when chemotherapy attacks and kills the cells of the mucous membrane is known as
oral mucositis
Examples od Sugar-containing medicines can also alter plaque composition
Cough drops – Cough syrup – Vitamins – Antacids
Patients with xerostomia suffer from an increase in:
_Oral candidiasis
– Root surface caries
– Excess plaque formation
3 major classes of medications that causes gingival enlargement
_Anticonvulsants
– Immunosuppressives
– Calcium channel blocker
meds that enlarge the gingiva work by influencing the ——— to overproduce collagen when the gingiva is inflamed due to plaqu
gingival fibroblats
PHENYTOIN is the most commonly used ———medication
used in the treatment of ——
anticonvulsent
epilipsy
trade name of phenytoin is
Dilantin/ Dilantin Kapseals
cyclosporine is ——-agent
immunosuppressive
cyclosporine reduces body’s ————in organ transplants orr used in autoimmune conditions such as rheumatiod arthritis
immune response
Nifedipine is a
calicium channel blocker
Nifedipine is a ——-used to treat people with hypertension, angina, and cardiac arrhythmias
coronary vasodilator
But some nutritional deficiencies and _________________________ can modify the
severity and extent of periodontal disease
refined carbohydrates
vitamine c is known as ———
ascorbic acid
Vitamine E Protects the cell membranes from oxidative damage and reduces the production of _______
PGE
Patients taking magnesium containing
supplements noted:
_shallower pocket depths
– less periodontal attachment loss
Smokeless tobacco is associated with severe ____________________________________ on buccal surfaces of teeth
recession and loss of attachment
Heavy Smoker smokes more than ———- cigarretts a day
10
Smokers are more likely to be colonized by——
P. gingivalis
Smoking is associated with lower oxygen
tension in the periodontal pocket, favoring———-
anrobic
Decreased signs of inflammation and decreased blood flow due to ___________________ in nicotine
vasoconstrictors