Perio 3 - Etiology and Risk Factors of Periodontal Disease (Dr. Gyurko)

Etiology

Define the following:

The cause of a disease

Risk factor

Define the following:

A modifying characteristic that is associated with an increased chance of developing a disease

Extrinsic

Intrinsic or extrinsic factor?

Plaque

Extrinsic

Intrinsic or extrinsic factor?

Smoking

Extrinsic

Intrinsic or extrinsic factor?

Dental restorations

Intrinsic

Intrinsic or extrinsic factor?

Genetics

Intrinsic

Intrinsic or extrinsic factor?

Age

Intrinsic

Intrinsic or extrinsic factor?

Gender

Intrinsic

Intrinsic or extrinsic factor?

Race

Intrinsic

Intrinsic or extrinsic factor?

Diabetes

Intrinsic

Intrinsic or extrinsic factor?

Tooth anatomy

Unknown

What is the cause of idiopathic factors?

periodontitis

____________ is an inflammatory disease initiated by bacteria

True (does not always correspond with amount of plaque)

T/F: For some people only gingivitis develops, for others it progresses to periodontitis

- Gram-negative anaerobes

- Inflammatory response

- Destruction of PDL and bone

- Deeper periodontal pockets (--> more bacteria)

What is the positive feedback loop of inflammation causing periodontitis?

gram negative anaerobes

What type of bacteria contributes to the host response/destruction of PDL and bone?

- PGE2

- IL1B

- Collagenase

What are contributors of the host inflammatory response?

- Contain more bacteria

- Contain more Gram-negative anaerobe bacteria

- Harder to keep clean

Development of deeper pockets creates a positive feedback loop. What are three characteristics of deeper pockets?

True (only groups of bacteria)

T/F: No single bacterial strain has been identified as a cause of periodontitis

- Red complex

- Orange complex

What are the groups of bacteria that have been seen as bacteria with disease-potential?

600 strains

Other yet un-identified bacteria may play significant roles in the causative agents of periodontitis. What is the current estimated number of strains in the mouth?

False (tissue damage is caused by the body's immune response to the bacteria)

T/F: Tissue damage is directly caused by bacteria

- P. gingivalis

- T. forsythensis

- T. denticola

What 3 bacteria make up the red complex?

Periodontal attachment loss

What can lead to these?

- Periodontal pocket formation

- Gingival recession

- Root exposure

- Bone loss

- Tooth loosening

- Tooth loss

Gingiva

Gingivitis affects what tissues?

- Gingiva

- PDL

- Bone

Periodontitis affects what tissues?

It is a fixed reference point to measure pocket depth and disease progression

Why is the periodontal attachment level considered a key landmark in periodontal assessment?

attachment loss

What characterizes periodontitis?

Gingivitis

Gingivitis or periodontitis?

- Inflammation only

- No attachment loss

- No bone loss

Periodontitis

Gingivitis or periodontitis?

- Inflammation

- Attachment loss

- Bone loss

gingivitis

Gingivitis or periodontitis?

periodontitis

Gingivitis or periodontitis?

Symbiosis

Define the following:

A co-existence of two organisms, which may be beneficial to one or the other. Ex: Biofilm in a healthy mouth

Dysbiosis

Define the following:

An imbalance of bacteria and the host. In this case a disproportionate immune response to periodontal bacteria causes tissue injury and bone loss

A) Clinical Health

What state has proportionate host response and health promoting symbiosis?

A) Clinical Health

B) Gingivitis

C) Periodontitis

B) Gingivitis

What state has proportionate host response and incipient dysbiosis?

A) Clinical Health

B) Gingivitis

C) Periodontitis

C) Periodontitis

What state has disproportionate host response and frank dysbiosis?

A) Clinical Health

B) Gingivitis

C) Periodontitis

- Removal of plaque/calculus

- Improved home care

What can resolve gingival inflammation?

- Brushing

- Flossing

- Prophylaxis

What are three ways plaque and calculus are removed?

gram negative anaerobes

When you remove plaque, which component of the positive feedback cycle are you eliminating?

- Smoking

- Diabetes

What are the two major risk factors for periodontitis?

Minor

Major or minor risk factor for periodontitis?

Genetics

Minor

Major or minor risk factor for periodontitis?

Age

Minor

Major or minor risk factor for periodontitis?

Gender

Minor

Major or minor risk factor for periodontitis?

Race

Minor

Major or minor risk factor for periodontitis?

Obesity

Minor

Major or minor risk factor for periodontitis?

Poor nutrition

Minor

Major or minor risk factor for periodontitis?

Alcohol consumption

Minor

Major or minor risk factor for periodontitis?

Medication

Minor

Major or minor risk factor for periodontitis?

Dental restorations

Minor

Major or minor risk factor for periodontitis?

Occlusal trauma

less

Do smokers have more or less teeth compared to non-smokers?

deeper

Do smokers have shallower or deeper periodontal pockets compared to non-smokers?

more

Do smokers have more or less supragingival calculus compared to non-smokers?

more

Do smokers have more or less attachment loss compared to non-smokers?

more

Do smokers have more or less bone loss compared to non-smokers?

LESS

Do smokers have more or less gingival bleeding on probing compared to non-smokers?

C) Heavy smokers (4.75x for periodontal attachment loss and 7.28x for severe bone loss)

The Erie County cross-sectional study (1426 subjects) found greater relative risk of periodontal attachment loss and severe bone loss among which populations?

A) Non-smokers

B) Light smokers

C) Heavy smokers

- Neutrophil chemotaxis and phagocytosis

- Decreased IgG antibody production

- Decreased B-helper lymphocyte numbers

What are some components of immune response that are impaired with smoking?

decrease

Does smoking increase or decrease IgG antibody production?

decrease

Does smoking increase or decrease B-helper lymphocyte numbers?

increase

Does smoking increase or decrease prevalence of periodontal pathogens?

fibroblast

Smoking alters what cell's attachment and function?

negative

Does smoking have positive or negative local effects on cytokine and growth factor production?

true

T/F: Smokers have a poor response to periodontal therapy

What is a normal fasting glucose level?

>126 mg/dl

What is a hyperglycemic fasting glucose level?

glycation

Define the following:

Non-enzymatic addition of glucose to proteins or lipids

less than 5.7%

What is the normal HbA1c level?

less than 6.5%

What is the therapeutic target for HbA1c level?

chronic

Are these acute or chronic clinical consequences of diabetes?

- Retinopathy (relative risk: 25x)

- Glomerulosclerosis (relative risk: 17x)

- Cardiovascular complications (relative risk : 2-4x)

- Neuropathy

- Impaired wound healing

chronic (2.3x risk)

Periodontal disease is an acute or chronic consequence of diabetes?

2.3x higher

Diabetics have what risk of developing periodontal disease compared to non-diabetics?

blood vessel damage

Diabetic pathways (too much glucose) lead to what?

Vascular changes (microvascular)

What diabetic pathomechanism?

- Leads to diabetic microangiopathy, resulting in kidney failure, retinopathy, atherosclerosis, and impaired wound healing

Altered host immune response

What diabetic pathomechanism?

- Impairment of neutrophil adherence, chemotaxis and phagocytosis that impairs bacterial killing

- Hyper-responsiveness of monocytes and macrophages resulting in increased pro-inflammatory cytokines and mediators

Alteration in CT metabolism

What diabetic pathomechanism?

- May uncouple the resorptive and formative responses and impair bone remodeling

Increases

The American Academy of Periodontology stated that diabetes ___________ the risk of periodontal diseases, and biologically plausible mechanism have been demonstrated in abundance.

true

T/F: American Diabetes Association stated that research shows that there is an increased prevalence of gum diseases among those with diabetes, adding serious gum disease to the list of other complications associated with diabetes, such as heart disease, stroke, and kidney disease.

true

T/F: Twin studies have showed that early forms of periodontitis (localized aggressive) may be partially inherited

inherited leukocyte deficiency

What deficiency may play a role in genetic periodontal disease?

38%

According to twin studies, what is the estimated heritability of periodontitis?

interleukin 1

What genotype has been associated with periodontitis in non-smokers?

inflammation

What does IL-1 contribute to?

B. High levels of IL-1 production

According to Kornman et al., the IL-1 gene variant is associated with:

A. Low levels of IL-1 production

B. High levels of IL-1 production

C. Increased collagen synthesis

D. Reduced bone resorption

C. Severe vs. mild periodontitis

The IL-1 gene cluster polymorphism was reported to help distinguish individuals with:

A. Gingivitis vs. periodontitis

B. Early vs. late caries

C. Severe vs. mild periodontitis

D. Aggressive vs. chronic gingivitis

- IL-1

- TNF alpha

What pro-inflammatory cytokines are key regulators of the host response to microbial infection during periodontal pathogenesis?

IL-1

What pro-inflammatroy cytokine is a major modulator of extracellular matrix catabolism and bone resorption?

True

T/F: Increased production of IL-1 may result in greater periodontal tissue destruction (i.e. alveolar bone, extracellular matrix)

increase

Does the prevalence and severity of periodontitis increase or decrease with age?

true (not an inevitable consequence of aging)

T/F: There are many older individuals without periodontitis so a true relationship cannot be formed but is most likely due to longer exposure of risk factors

no (females have better oral hygiene but may retain teeth longer with periodontitis)

Is there a difference between males and females in susceptibility to periodontitis?

No (pattern not shown worldwide, in US- Mexican-Americans and Non-Hispanic blacks show higher prevalence of periodontitis)

Is there a difference between race/ethnicity and periodontitis?

- Socio-economic status

- Access to care

Epidemiological data do not consistently show a higher prevalence of periodontitis among U.S. Mexican-Americans and non-Hispanic Black populations worldwide. What key confounding factors might better explain these observed disparities?

Yes

Do obese/overweight individuals have a higher odd ratio of having periodontal disease?

Vitamin C (scurvy)

What vitamin deficiency may contribute to severity of periodontal breakdown?

dose dependent

How is alcohol consumption associated with increased severity of attachment loss?

- Anticonvulsant

- Beta blockers

- Immuno-suppressants

- Calcium channel blockers

Gingival hyperplasia is a well-known consequence of administration of what types of medications?

Local contributing factors

All of the following are what type of factors for periodontitis?

- Overhanging / defective restorations

- Open contacts / food impaction

- Subgingival calculus deposits

- Brushing trauma (non-carious cervical lesions, NCCL)

- Tooth position (gingival recession)

- Local tooth related anatomy

- Occlusal trauma

greater

Was alveolar bone loss found greater or less around overhanging restorative margins and defective restorations?