perio week 8

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75 Terms

1
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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

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Systemic risk factors are conditions or diseases that increase an individual’s susceptibility to periodontal disease by modifying or amplifying the

Host response

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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

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DIABETES MELLITUS Is

A chronic lifelong metabolic disorder in which the body does not produce or properly use insulin

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Types of diabetes mellitus

Type 1 DM – Type II DM – Gestational

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Diabetes is well controlled if the——-

are stabilized within the recommended range

Blood glucose levels

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A1C should be less than

7%

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Target range for blood glucose is in diabetic patients

80 to 120

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Increased risk infection is

180- 300

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relationship

between diabetes and periodontal disease

Bidirectional

Untreated pd——> uncontrolled diabetes

< ——-

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Periodontal disease is considered a complication of

uncontrolled diabetes

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Individuals with well-controlled diabetes have ________periodontal disease than persons with out diabetes

No more

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Individuals with undiagnosed or _____________ diabetes are more likely to have periodontal disease than those without diabetes

Uncontrolled

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High blood sugar leads to increased glucose in

gingival crevicular fluid and blood

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Defective ___________________________,

impedes the normal initial immune response

Neutrophil, chemotaxis and phagocytosis

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In diabetic patients there is an elevation of

proinflammatory_____________ in response to

the periodontal pathogens present

Cytokines

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The rate of periodontal disease is ——times greater

than in nondiabetics

3

18
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Implications of uncontrolled diabetes for

periodontium

:—- periodontal therapies (impaired wound healing)

Poor response

19
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If the patient is also a smoker and over the age of 45, they are ——times more likely to experience

severe periodontitis

20

20
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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

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Glycation is

the metabolic process in which glucose in the bloodstream (from sugars and carbs) irreversibly attach to proteins and lipids

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Age and Rage causes

releases inflammatory cytokines

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response prepares the cardiovascular, musculoskeletal and neuroendocrine systems to respond to a fight or flight situation (essential adaptive instinct for

survival) is

Acute stress

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can impair the immune system and biologic equilibrium,

Chronic stress

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When Cortisol levels are excessive=

High BP, Tachycardia (increase heart rate), Increase susceptibility to infection; due to suppression of inflammatory response

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Stress is regulated by

Cortisol hormone

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Cortisol helps maintain

normal blood pressure, heart rate and regulate inflammation

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Stress changes behavior examples

Poor self-care – Dietary habits – Smoking – Increased alcohol consumption – Noncompliance

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Changes in hormone levels may have an effect on the periodontium, particularly in the presence of plaque-induced gingivitis examples

Puberty

– Pregnancy

– Menopause

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Puberty is increase in hormones causes —- to gingival tissues

Increased blood circulation

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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

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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

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Bacteria causing gingival inflammation during pregnancy in the —— trimester

P. Intermediates

C. Retus

2end

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During pregnancy

Gestational hormones act as

Growth factors for bacteria

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In pregnancy: Increased levels of —-have been shown to alter the microbial profile of subgingival plaque

Estrogen

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During pregnancy there is a depression of —— due to high levels of hormones

PMN chemotaxis

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A mushroom-like growth that forms on the

interdental gingiva or gingival margin called

During pregnancy

Pyogenic Granuloma

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Menopausal gingival problems are not common, but if they do occur it is called

Menopausal gingivititosis

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During menopause The decline in hormonal levels causes changes intraorally like

Dry mouth –

Burning sensation –

Altered taste –

Gingival recession –

Bone loss may be exacerbated

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Women who undergo hormone replacement therapy (HRT) may experience pregnancy-like symptoms of

Gingivitis

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Post menopausal women may experience —— in the jaw

osteopenia or osteoporosis

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Postmenopausal women who also smoke will lose alveolar bone height and density ——- than nonsmoking postmenopausal women

more radially

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Loss of bone mass that causes an increased

susceptibility to fractures is

Osteoporosis

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Osteoporosis occurs in

Postmenopausal women

– Sedentary individuals

– Bedridden individuals

– Individuals on long

-term steroid therapy

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A combination of closely related metabolic disturbances like Increased blood pressure – High blood sugar – Excess body fat around the waist (abdominal obesity)

METABOLIC SYNDROME

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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

47
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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

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LINEAR GINGIVAL ERYTHEMA Previously known as

HIV associated gingivities

49
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Cheilosis Is

painful inflammation at the corners of the lip

50
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In linear gingival erythema there is no——-

Does not always respond to conventional plaque control or——

attachment loss

Periodontal instrumentation

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• Initial treatment for linear gingival erythema should be ————- plus ———— mouth rinse

periodintal scaling

0.12% chlorohexidine

52
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Disorder characterized by abnormally few numbers of Neutrophils in

the blood

NEUTROPENIA

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Impaired _____________________________ most likely explain the high prevalence and severity of periodontitis with ones of down syndrome

PMN, Chemotaxis, and phagocytes

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LEUKEMIA-ASSOCIATED GINGIVITIS

• Gingival Enlargement due to increase in

cancer cells in the gingiva

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Inflammation of the oral mucosa membranes caused when chemotherapy attacks and kills the cells of the mucous membrane is known as

oral mucositis

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Examples od Sugar-containing medicines can also alter plaque composition

Cough drops – Cough syrup – Vitamins – Antacids

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Patients with xerostomia suffer from an increase in:

_Oral candidiasis

– Root surface caries

– Excess plaque formation

58
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3 major classes of medications that causes gingival enlargement

_Anticonvulsants

– Immunosuppressives

– Calcium channel blocker

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meds that enlarge the gingiva work by influencing the ——— to overproduce collagen when the gingiva is inflamed due to plaqu

gingival fibroblats

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PHENYTOIN is the most commonly used ———medication

used in the treatment of ——

anticonvulsent

epilipsy

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trade name of phenytoin is

Dilantin/ Dilantin Kapseals

62
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cyclosporine is ——-agent

immunosuppressive

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cyclosporine reduces body’s ————in organ transplants orr used in autoimmune conditions such as rheumatiod arthritis

immune response

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Nifedipine is a

calicium channel blocker

65
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Nifedipine is a ——-used to treat people with hypertension, angina, and cardiac arrhythmias

coronary vasodilator

66
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But some nutritional deficiencies and _________________________ can modify the

severity and extent of periodontal disease

refined carbohydrates

67
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vitamine c is known as ———

ascorbic acid

68
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Vitamine E Protects the cell membranes from oxidative damage and reduces the production of _______

PGE

69
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Patients taking magnesium containing

supplements noted:

_shallower pocket depths

– less periodontal attachment loss

70
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Smokeless tobacco is associated with severe ____________________________________ on buccal surfaces of teeth

recession and loss of attachment

71
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Heavy Smoker smokes more than ———- cigarretts a day

10

72
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Smokers are more likely to be colonized by——

P. gingivalis

73
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Smoking is associated with lower oxygen

tension in the periodontal pocket, favoring———-

anrobic

74
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Decreased signs of inflammation and decreased blood flow due to ___________________ in nicotine

vasoconstrictors

75
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