Exam 2 Additional Points

function of mast cells

release histamine which causes vasodilation

function of neutrophils

phagocytosis

function of macrophages

phaocytosis and release of cytokines

diapedesis

inflammatory cells leave the capillaries and migrate towards inflammation

gentics has a ____ association with influencing host response with periodontal disease

moderate

genetics influences host response by altering _____ _____ and response to ______ factors

gene function

environmental/microbial

no ____ gene causes periodontitis

single

100s do

Obesity has a ____ association of influencing host response with periodontal disease

mild

chronic long term stress has been linked to ____ ____

periodontal destruction

how does stress lead to periodontal destruction

cortisol release supresses neutrophils and lymphocyte functions leading to a weaken immune response

hormonal alterations can accentuate ____ response to bacteria

gingival

leads to increased gingival inflammation

what are examples of hormonal alterations

puberty

pregnancy

oral contraceptives

menopause

pregnancy associated gingivitis begins in the ___ trimester and peaks at ___ months

2nd

8

what makes something strong evidence for systemic risk factors in periodontitis

variables associated with increased disease progression that are proven by longitudinal and interventional studies

what makes something weak evidence for systemic risk factors in periodontitis

variables associated with increased disease progression that are supported primarily by cross-sectional studies

what HIV related diseases increase susceptibility to peridontal disease

linear gingival erythema

NUG
NUP

current _______ therapies have reduces the prevalence of HIV related diseases

antiretroviral

What characterized neutropenia

<1000 neutrophils per ul

decreased neutrophils reduces first line immune defenses increasing infection susceptibility

what is cyclic neutropenia

neutrophil depletion that happens every 21 days

recurrent ulcers, infections, periodontitis

Kostmann syndrome

congenital neutropenia

leads to periodontitis and caries

what gentic syndrome is associated with decreased neutrophils

Down Syndrome

which genetic syndrome is associated with altered connective tissue metabolism

Ehlers Danlos syndrome

thin gingiva, recession

Cardiovascular diseases link to periodontal inflammation

direct pathway

periodontal bacteria and LPS stimulate inflammation in blood vessels

this promoted inflammatory mediator (IL1, IL6, TNF, prostaglandins)

Cardiovascular diseases link to periodontal inflammation

indirect pathway

periodontal bacteria stimulates the livers acute phase response

release of CRP

amplifying local inflammation

Adverse pregnancy outcomes link to periodontal inflammation

infection of the periodontium stimulated production of ____ and ____

cytokines and prostaglandins

Adverse pregnancy outcomes link to periodontal inflammation

prostaglandins promote

uterine contractions

cervical softening

may lead to triggering labor too early

_____ is an important confounder in CVD

smokingl

____ is associated with CVD

smoking

not a causitive relationship

periodontal therapy can reduce ______ _____

systemic inflammation

is there evidence that periodontal therapy will prevent CVD or inprove cardiovascular outcomes

NO

periodontitis during therapy is associated with ________ increased risk of adverse pregnancy outcomes

mild-moderate

does periodontal treatment significantly reduce risk of adverse pregnancy outcomes

no

SRP is considered safe during the ____ trimester

2nd

does calculus cause periodontal disease

no

however, it provides a rough surface for plaque to adhere to and created areas that are hard to clean. It maintains and accentuated periodontal disease by facilitating plaqur retention

how does gingival overgrowth affect PD

makes oral hygiene difficult → worsens periodontal disease

how does furcation involvement affact PD disease

difficult to treat

how do root concavities affect PD

makes instrumentation and thourough cleaning more difficult

how do intermediate bifurcation ridges affect PD

interfere with measuring horizontal bone loss

extraction trauma can damage the ____ ____

attachment apparatus

high restorations cause ____ ___

occlusal trauma

tooth mobility lowers response to ______

therapy

the ability to restore stability is _____ proportional to mobility caused by loss of supporting bone

inversely

smokers have a ____x increased risk of periodontitis and CAL

2-4

smoking combined with DM increases periodontitis risk to ____x

6.6

is there a dose response with smoking and periodontal risk

yes

greater smoking exposure is associated with greater risk of PD

smoking _____ periodontal destruction and predicts lon-term ____ loss

accelerates

toot

for nonsurgical or surgical therapy, smokers only achieve ____-____% of the clincal improvement seen in nonsmokers

50-75

smoking ____ bone regeneration

reduces (2mm less)

do smokers have reduce root coverage?

yes

nicotine binds to roots and breaks down keratinocytes

smoking is associated with appx ___x the risk of implant failure

2

how does smoking alter periodontal microflora

it creates a more _____ environment which alters bacterial _____

anaerobic

adherence

smokers have _____ periodontal pathogens

more

how does smoking alter immune defenses

it decreases neutrophil _____ and _____ and lowers salivary ____ and serum ___

phagocytosis

chemotaxis

IGA

IGG

smoking masks clinical ______ which reduces gingival vascular responses

inflammation

does GCF increase or decrease in smokers

it decreases in smokers

increases in INFLAMMATION

smoking ____ periodontal wound healing and revascularization

impairs

does periodontitis progession in those that quit smoking become compareable to that of never smokers

YES

treatment response for individuals that stop smoking improvesafter appx ____-____ months of cessation

12-24`

after 3-5 days of smoking cessation, gingival ____ ____ and ____ increase

blood flow

GCF

after 2 weeks of smoking cessation, ___ volume approaches that of never-smokers

GCF

after 10-20 years ___ ____ risk approaches that of never-smokers

tooth loss

does smoking cessation reverse periodontal destruction

no

impact of tobacco components on CT

nicotine/tobacco increases tissue destructive mediators such as IL1 and IL6

impact of tobacco components on bone

smoking impairs bone metabolism and regeneration

increases osteoclasts

this is a group of chronic metabolic diseases affecting metabolism of carbohydrates, lipids and proteins

DM

Type 1 diabetes

bodys immune system destroys pancreatic beta cells (autoimmune)

onset of Type 1 diabetes

childhood/young adult

Type 2 diabetes

cells do not use insulin properly, so the pancreas loses the ability to produce it

age of onset type 2 diabetes

associated with older age, obesity, physical activity, and race/ethnicity

how is type 1 diabetes treated

insulin

how is type 2 diabetes treated

lifestyle adjustments and drugs

oral glucose tolerance test - what indicates diabetic and prediabetic

this is the one where its taken 2 hours after drinking a reallt sweet drink

>200mg/dl is diabetic

140-199 is prediabetic

fasting plasma glucose test - what is indicative of diabetes and what is prediabetic

occurs after fasting for 8 hours

>126 is diabetic

100-125 is prediabetic

HbA1c tests the stability of diabetic status over _____ months and < ____% is the recommended level

3-4

6.5

6-6.5% is prediabetic

complications of DM

cardiovascular events

HTN

vision problems

renal failure

neuropathy

amputation

complicaitons with pregnancy

oral manifestations

periodontitis is considered the 6th complication of ___

DM

1/3 of patients with DM have _____ PD

sever

adults with poorly controlled DM are __x more likely to have severe PD than those without DM

3

oral manifestations of DM

xersotomia

cheilosis (lip infection)

mucosal ulcers

taste impairment

oral infections

• fungal: candidiasis

  • bacterial: periodontitis

periodontal manifestations of DM

multiple abcesses

enlarged gingiva

pedunculated gingival polyps

delayed wound healing

more severe PD

influence of diabetes on periodontal therapy outcomes

for nonsurgical and surgical therapies, patients with poor glycemic control present more rapid recurrence of deeper _____ and lss favorable long-term response

pockets

does periodontitis treatment improve glycemic control (HbA1C)

unclear

patients with DM have impaired ____ in relation to dental implants and are at increased risk of ____-_____

osseointegration

peri-implantitis

what is altered passive eruption

gingival margin is located at a more coronal level, leading to pseudopockets and esthetic concerns

what are the 3 medications that can cause gingival enlargement

cyclosporine

amlodipene

phenytoin

condition association

genetics

moderate

condition association

osteoporosis

mild

condition association

smoking

STRONG

condition association

preterm low birth weight

mild-moderate

condition association

diabetes

moderate

condition association

obesity

mild

condition association

CV disease

mild but consistant