chapter 14 “Impact of Systemic Disease Conditions Periodontal Health”

Is plaque still important when a patient has a systemic disease?

Yes. Plaque biofilm is the main local cause. But Systemic conditions can make the body respond more severely.

What does diabetes contribute to in periodontal disease ?

A hyperinflammatory response

Does well-controlled diabetes increase periodontal risk the same way poorly controlled diabetes does ?

No. There is no increased risk IF diabetes is well controlled

What type of diabetes situation is more concerning for periodontal health?

Undiagnosed or poorly controlled diabetes

What happens to periodontal health as sugar blood level climb?

Periodontal health declines

Why can diabetes cause more attachment loss?

High blood sugar increase the immune-inflammatory response, which can contribute to tissue destruction

How does diabetes affect wound healing ?

It can impair wound healing after surgical and non-surgical periodontal therapy

What is the long term periodontal treatment response like in poorly controlled diabetes ?

Less favorable

What are AGE’s?

Advanced Glycation End products formed when glucose binds to biomolecules

What does glycation mean ?

Glucose binds to proteins or biomolecules, forming AGEs

How does excessive AGEs affect collagen?

They impair collagen’s normal function and make tissues stiffer and less able to repair

What happens when AGEs link collegen fibers?

Alters extracellular matrix and increase stiffness in tissue

AGEs can increase vascular stiffness and impair blood flow . _____ = _____

Poor blood flow = poorer healing

AGEs + collegen is linked to _____

Diabetes complications

What are RAGEs ?

Receptors for Advanced Glycation End Products

What happens when AGEs bind to RAGEs ?

They trigger proinflammatory cytokines and pathologic tissue destruction

What physiological impacts are linked to AGEs+RAGEs ?

Increased periodontal and systemic inflammation, insulin resistance, impaired healing repair

What oral complications may be seen with diabetes ?

• reduced salivary flow

• Candidiasis risk

• Rapid periodontal destruction

• Multiple abscesses

• Cheilosis

• Burning of tongue or mouth

What dies reduced salivary flow increase the risk of?

Candidiasis , and oral disease

What is the RDH role with diabetic patients ?

• screen

• Educate

• Understand the diabetes-perio link

• Collaborate with medical providers

Can dental hygienist diagnose diabetes

No. RDH can screen, recognize signs, educate, and refer

What is stress?

A physiological and psychological response

What is acute stress?

Short term stress that prepares the body for a fight or flight reaction

Why is acute stress considered adaptive?

It helps the body survive or respond quickly to immediate situations.

What is chronic stress?

Long-term stress that becomes harmful and disrupts the body’s normal balance.

What does maladaptive mean in relation to chronic stress considered?

The stress response is no longer helpful and starts interfering with health

What does homeostasis mean ?

the body normal internal balance

What hormone mediates chronic stress considered?

Cortisol

What are possible effects of cortisol ?

• ^ BP

• ^ HR

• Natural immunosuppressive effect

What does immunosuppressive mean ?

It means the immune systems is weakened or suppressed

How can chronic stress affect the immune system ?

It may suppress immune function and alter the inflammatory response

What is the relationship between stress and periodontal disease ?

There is a positive relationship , meaning higher stress can be associated with higher periodontal disease risk

What types of stress are significant risk factors ?

• financial stress

• Depression

How can stress change behaviors that affect periodontal health ?

Stress can lead to poor oral hygiene, smoking, poor diet, poor nutrition, poor sleep, alcohol use

How does poor self-care during stress affect periodontal health ?

It can increase plaque biofilm accumulation and gingival inflammation .

What are health impairing behaviors related to chronic stress ?

• poor oral hygiene

• Alcohol and cigarette consumption

• Altered sleep patterns

• Poor nutritional intake

Why may stressed patients need more frequent professional care ?

Because stress can weaken immune response and worsen oral hygiene habits, increasing periodontal risk

What should the RDH tell patients about stress?

Stress can have adverse effects on periodontal health and may make inflammation harder to control

What is the RDH’s role with stressed patients ?

• recognize stress as a risk factors

• Educate the patient

• Encourage good home care

• Recommend more frequent care if needed

• Collaborate with other health professionals

Effects of chronic stress can manifest as what ?

• anxiety

• Depression

• Impaired cognition

• Altered self esteem

Do hormone changes directly cause periodontal disease by themselves ?

No. Plaque biofilm initiates the inflammation, but hormones can exaggerate the host response .

What is the main effect of elevated hormones during puberty ?

They amplify the host response to plaque biofilm

What is puberty gingivitis ?

Gingival inflammation during puberty caused by plaque biofilm and exaggerated hormonal changes.

Does puberty gingivitis only affect girls ?

No , boys and girls

What signs are associated with puberty gingivitis ?

• increased biofilm

• Swelling

• Bleeding

• Inflammation

Is puberty gingivitis reversible ?

Yes, with good home care.

What is RDH role for adolescents during puberty ?

• Stress daily biofilm control

• Provide frequent professional care if needed

• include periodontal exams in routine visits

What does pregnancy do to existing gingival inflammation ?

It’s exaggerates existing gingival inflammation

What causes pregnancy gingivitis ?

Plaque biofilm initiates it, and hormone changes exacerbate it .

During which trimester is pregnancy gingivitis usually worse ?

The 2nd and 3rd trimesters

How do estrogen levels affect subgingival biofilm during pregnancy ?

Increased estrogen can alter microbial profile of the subgingival biofilm

Why can even small amounts of plaque cause inflammation ?

Hormonal changes make the tissue more reactive to plaque

What is a pyogenic granuloma ?

A benign exophytic soft tissue growth, usually near the gingival margin, that bleeds easily

What is another name for pyogenic granuloma during pregnancy ?

Pregnancy tumor

Is a pregnancy tumor cancer ?

No , it’s benign

What should the RDH stress to pregnancy patients ?

• oral heath

• Routine dental care

• Preventative dental care during pregnancy

• Postpartum checkups

What decade of life menopause commonly associated with ?

The 4th to 6th decade of life

What hormone declines during menopause ?

Estrogen

What oral condition can menopause trigger ?

Menopausal gingivostomatitis

How can estrogen decline affect bone ?

It can lead to systemic bone loss

Why is osteoporosis important in periodontal care ?

Bone loss can affect the supporting structures of the teeth, and some osteoporosis medications carry MRONJ risk.

What does MRONJ stand for ?

Medication Related Osteonecrosis of the Jaw

Estrogen deficiency + plaque biofilm …

Can increase the host inflammatory response → leading to connective tissue destruction, alveolar bone resorption, and tooth loss.

What are bone resorting cytokines ?

Inflammatory chemical messengers that promote bone breakdown.

What is the RDH role for menopausal patients ?

• educate them about osteoporosis

• Stress self care and professional care

• Monitor medication and side effects

• Watch for MRONJ symptoms

What is the host inflammatory response process like for Estrogen deficiency + buildup of plaque biofilm

Increased production of bone resorbing cytokines produced by monocytes, macrophages, and osteoblasts

Estrogen levels fluctuate and eventually _____

Decline

Menopause causes many drastic ______ and _____ changes

Physical , behavioral

What is a metabolic syndrome ?

A cluster of related metabolic disturbances that initiate a proinflammatory state

What conditions are includes in metabolic syndrome ?

High blood pressure, hyperglycemia, high cholesterol, abdominal obesity,

Having how many metabolic syndrome factors are associated with higher periodontal risk ?

Three or more

Why does metabolic syndrome increase periodontal risk ?

It contributes to low grade chronic inflammation, and increases susceptibility to periodontal disease

What are adipocytes

Fat cells

What are adipokines ?

Inflammatory substance released by fat cells

What do adipokines cause ?

An inflammatory state, insulin resistance, and increased risk or periodontal disease

What is the metabolic syndrome chain ?

Obesity → increased adipocytes → increased adipokines → inflammatory state → increased insulin resistance → increased susceptibility to periodontal infection

What systemic diseases are patients with metabolic syndrome at risk for ?

Diabetes and cardiovascular disease

What lifestyles modifications are recommended for metabolic syndrome ?

Diet and exercise

How can periodontal therapy help patients with metabolic syndrome ?

It can improve the periodontium and reduce periodontal inflammation

What immune cells are mainly affected by HIV ?

CB4+ T cells ( T helpers )

Why does HIV affect oral health ?

It weakens immune function, increasing risk for infection, cancers, and delayed healing

What are oral manifestation of HIV/AIDs

• hairy leukoplakia

• Candidiasis

• Herpes labialis

• Herpes zoster

• Recurrent intraoral herpes

• Kaposi sarcoma

• Recurrent aphthous ulcers

What is linear gingival erythema ?

A gingival manifestation of HIV infection

What does linear gingival erythema look like ?

A 2-3mm of marginal band of intense redness in the free gingiva

What does erythema mean ?

Redness

How has antiretroviral therapy affected linear gingival erythema ?

It has reduced its prevalence

What type of therapy is used to treat HIV ?

Antiretroviral therapy (aka HAART : Highly Active Antiretroviral therapy)

When is periodontal therapy safe for HIV-infected patients ?

When the patient has an undetectable viral level, and a high CD4+ count

What should RDH be aware of when treating HIV-infected patients ?

• Coordinate care with other health professionals

• Drug interactions

• Strict infection control