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Dentistry Module 4 > Periodontology > Flashcards

Periodontology Flashcards

1
Q

What are the main systemic risk factors for periodontal disease?

A

Smoking, stress and genetic susceptibility

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2
Q

How would you calculate pack years?

A

Number of packets per day x years of smoking = pack years

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3
Q

If Mr Atkins has 1 packet of cigarettes each day and has smoked for 30 years, what is his pack years?

A

30 pack years

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4
Q

What does 1g of pipe Tabacco compare to in number of cigarettes smoked?

A

1g pipe tobacco = 1 cigarette

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5
Q

What is 1 cigar equivalent to in number of cigarettes?

A

5 cigarettes

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6
Q

How many cigarettes would a patient smoke per day to be considered as having a high level of nicotine dependancy?

A

15-20 cigarettes

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7
Q

What is important to notify smokers about in regards to periodontal treatment outcome?

A

Warn these patients early on about likelihood of having a reduced periodontal treatment outcome

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8
Q

According to the Prochaska 1993 model, what is a pre-contemplator?

A

A smoking patient who is not interested in smoking cessation

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9
Q

According to the Prochaska 1993 model, what is a contemplator?

A

A patient who is interested in smoking cessation but is not ready to carry it out

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10
Q

According to the Prochaska 1993 model, what are active quitters ?

A

Patients who are making an attempt to stop smoking

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11
Q

According to the Prochaska 1993 model, what type of patient is of most interest to dentists in terms of brief intervention?

A

Contemplators

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12
Q

When giving a brief intervention for smoking cessation, what is the approach that should be used?

A

The 5 A’s approach

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13
Q

Define the 5 A’s approach

A

Ask
Advise
Assess
Assist
Arrange

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14
Q

Why does smoking cause an increased salivary flow rate and what is the consequence of this?

A

Increased parotid flow rate due to irritant particulate matter in smoke. This raises pH, calcium concentration and precipitation of calcium phosphate thus calculus build-up occurs.

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15
Q

What are three key oral diseases that smoking is a risk factor for?

A
  • periodontal disease
  • Necrotising gingivitis
  • Oral cancer
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16
Q

What effect does smoking have on periodontal tissues?

A

Reduces vascularity, inflammatory and immune responses

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17
Q

Which key cell type does smoking have direct toxic effects on?

A

Fibroblasts

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18
Q

What is the rebound effect?

A

After smoking cessation, there is a rapid recovery of both the inflammatory response and vascularity of the periodontal tissues

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19
Q

What is the result of the rebound effect?

A

Increased BOP

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20
Q

What is a key periodontal treatment outcome of healing in smokers compared to non-smokers?

A

Smokers have less pocket depth reduction

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21
Q

What effect does stress have on salivary flow and what are the consequences?

A

Decreases salivary flow, favouring plaque formation

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22
Q

What is the key study that looks into financial strain and depression found to be associated with increased periodontal breakdown?

A

Genco, et al 1999

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23
Q

What systemic risk factor of periodontitis is non-modifiable?

A

Genetic susceptibility

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24
Q

What stage and grade would a periodontal patient have if they were thought to have high genetic susceptibility?

A

Stage 3/4 Grade C

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25
Q

How would you assess a patient’s genetic susceptibility?

A
  1. Extent of previous periodontal disease
  2. Age
  3. Level of oral hygiene
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26
Q

How are genes affected to cause genetic susceptibility to periodontitis?

A

Natural variations within the structure of genes results in altered protein production. If this occurs in a periodontal disease-modifying gene the resultant altered protein production leads to increased susceptibility to periodontitis.

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27
Q

Give some examples of very rare, genetic systemic disease which are associated with very destructive periodontal disease

A
  1. Down’s syndrome
  2. Papillon-lefevre syndrome
  3. Ehlers-Danlos syndrome
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28
Q

what type of immune system do periodontitis patients tend to have?

A

A hyper-responsive immune system

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29
Q

For someone to be considered obese, what must there BMI be?

A

> 30

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30
Q

How can an increase in adipose (fat) tissue cause an increase in anaerobes?

A

Adipose tissues produce cytokines, which are an energy source for bacteria, increasing proteolytic activity and thus anaerobes

31
Q

What products are found in almost all ‘bad’ foods and increase oxidative stress?

A

Advanced glycation end (AGE) products

32
Q

How more likely is an obese patient with sleep apnoea to develop periodontitis than a solely obese person? And why?

A

36% higher chance because sleep regulates the immune system and inflammatory processes

33
Q

What type of diet favours plaque formation?

A

High carbohydrate diet

34
Q

What three factors would encourage symbiosis in obese patients?

A
  • weight loss
  • reduced intake of refined carbohydrate + AGE products
  • pre-biotic diet
35
Q

What is diabetes mellitus? And how does it present?

A

Type II diabetes, presents as chronic hyperglycaemia

36
Q

What are the five major complications of diabetes mellitus?

A
  • atherosclerosis
  • retinopathy
  • nephropathy
  • Neuropathy
  • Impaired wound healing
37
Q

what may be an oral indication of undiagnosed diabetes?

A

Recurrent periodontal abscesses &/or exaggerated periodontal inflammation

38
Q

What are the four main issues associated with uncontrolled diabetes?

A
  1. Increased formation of AGE products
  2. Altered immune cell function
  3. Altered fibroblast function
  4. Poor wound healing
39
Q

What do AGE products alter?

A

The structure and function of proteins, specifically of interest is collagen.

40
Q

what does altered fibroblast function due to diabetes result in?

A

Reduced tissue formation and reduced healing potential

41
Q

What dental conditions can short term alcohol intake result in?

A

-dental trauma
-facial injury

42
Q

What dental conditions can long term alcohol intake result in?

A
  • oral cancer
  • periodontal disease
  • non-carious tooth surface loss
43
Q

What vitamin is essential for collagen production?

A

Vitamin C

44
Q

What vitamin is essential for skeletal development?

A

Vitamin D

45
Q

What vitamin defends against oxidative stress and free radicals, promoting chemotaxis?

A

Vitamin C

46
Q

what vitamin is essential for iron absorption?

A

Vitamin C

47
Q

What vitamin deficiency is associated with autoimmunity?

A

Deficiency in vitamin D

48
Q

Plant fibre critical as a food source for gut’s healthy bacteria

A

Pre-biotics

49
Q

Live bacteria and yeasts promoted as having various health benefits

A

Probiotics

50
Q

What are examples of cruciferous vegetables?

A

Cabbage, cauliflower and broccoli

51
Q

Why are cruciferous vegetables beneficial as part of a balanced diet?

A
  • anti-inflammatory
  • support symbiosis
  • antioxidant
52
Q

What type of cell are the best defence for periodontitis, when they are not subjected to oxidative stress?

A

Neutrophils

53
Q

What are the 6 most common chronic systemic diseases associated with periodontitis?

A
  1. Cardiovascular disease
  2. Diabetes
  3. Pulmonary disease
  4. Kidney disease
  5. Rheumatoid arthritis
  6. Adverse pregnancy outcomes
54
Q

Explain how presence of generalised inflammation can interfere with uptake of blood glucose into cells, resulting in elevated blood glucose levels.

A

Generalised inflammation causes inhibition of insulin binding and therefore reduces glucose uptake in cell

55
Q

What is the concern over blood glucose levels remaining high in regards to periodontitis?

A

If levels remain high, other proteins will bind to excess sugar on red blood cells resulting in AGE products which promote inflammatory complications

56
Q

How do AGE products make tissue remodelling more difficult and thus interfere with wound healing?

A

By cross linking fibres of connective tissue

57
Q

Why is the periodontal pocket wall ulcerated and leaky?

A

Because periodontal pocket is filled with pathogenic anaerobic biofilm resulting in an inflammatory reaction in the adjacent gingival tissues making the pocket wall ulcerated and leaky

58
Q

What is the key factor accounting for the possible link between periodontal disease and systemic chronic disease?

A

The leaking of pro-inflammatory mediators &/or the periodontal bacteria into the systemic bloodstream, raising systemic inflammation.

59
Q

What study model does not guarantee that treated periodontitis will result in improved CVD?

A

The common susceptibility model

60
Q

Explain ‘the direct bacterial effects on platelets’ mechanism of linking periodontitis and CVD

A

Certain Surface proteins on some oral bacteria mimic the host receptors that trigger thrombus (clot) formation within the vascular system

61
Q

Explain ‘ the autoimmune responses’ mechanism of linking periodontitis and CVD

A

Some perio pathogens can cause a cross reaction ( molecular mimicry) which causes the host to produce antibodies against itself leading to damage to the host cells

62
Q

Explain ‘ the invasion/uptake of bacteria into endothelial cells and macrophages’ mechanism of linking periodontitis and CVD

A

Perio pathogens access bloodstream, attach to endothelial cells lining blood vessels and contribute to atherosclerotic plaque formation

63
Q

Explain ‘the systemic inflammation’ mechanism of linking periodontitis and CVD

A

Periodontal inflammation leads to the systemic release of pro-inflammatory mediators which cause damage to the vascular tissues leading to atherosclerosis

64
Q

What does systemic release of pro-inflammatory mediators trigger?

A

The release of C-reactive protein (CRP) from the liver

65
Q

What does CRP do?

A

Further raises the systemic level of inflammation which worsens the CVD

66
Q

What is a pregnancy epulis?

A

Specific localised lesion on gingivae

67
Q

In what trimester should periodontal treatment be avoided and why?

A

First trimester, because of possible stress to foetus

68
Q

In the presence of pregnancy epulis, when should surgical excision occur?

A

Delayed until postpartum

69
Q

Which weeks does the first trimester cover?

A

Week 1 to end of week 12

70
Q

Which weeks does the second trimester cover?

A

Week 13 to end of week 26

71
Q

Which weeks does the third trimester cover?

A

Week 27 to end of pregnancy

72
Q

Why does pregnancy gingivitis occur?

A

Hormonal changes make gums more susceptible to plaque, leading to inflammation and bleeding

73
Q

What are the benefits of breastfeeding?

A

Can help protect baby against some short and long term illnesses

Dentistry Module 4 (20 decks)

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