BSP Risk Factors

Question 1

What is the major determinant of susceptibility of periodontal disease

Answer 1

patient’s response to the bacterial challenge which is the major determinant of susceptibility

Question 2

What are risk factors

Answer 2

• Risk factors are those factors that influence the likelihood of periodontitis developing in an individual and how fast the disease progresses

Question 3

When should local risk factors be identified

Answer 3

in an examination visit and should either be corrected or educate the patient about local oral hygiene measures

Question 4

What are systemic risk factors

Answer 4

• A number of systemic diseases, states or conditions can affect the periodontium in a generalized manner

Question 5

What are the modifiable systemic factors

Answer 5

smoking
diabetes
poor diet
certain medications
stress

Question 6

What are the non modifiable risk factors

Answer 6

socioeconomic status
genetics
adolescence
pregnancy 
age 
leukemia

Question 7

What is affected by diabetes

Answer 7

 Wound healing is adversely affected by diabetes, especially if poorly controlled and this can make treatment more difficult

Question 8

How is diabetes control best assessed

Answer 8

assessed using glycates haemoglobin values

Question 9

How may patients with undiagnosed diabetes present

Answer 9

with multiple, lateral periodontal abscesses in which case contacting the GP to confirm the diabetic status of the patient is advised

Question 10

How can stress > periodontal disease

Answer 10

Prolonged or intense periods of stress can cause suppression of the immune system which might top the host-bacterial interaction in favour of bacteria increasing the attachment loss
Also effects how patients look after themselves

Question 11

How can you help manage periodontal disease related to stress

Answer 11

requires recognition of this factor and asking patients about their stress and explaining the importance of stress management and adopting coping strategies due to the effects of stress on general/oral health

Question 12

What should you do if there is drug related gingival overgrowth

Answer 12

it is prudent to liaise with medical colleagues to determine if alternative drug therapies are available especially if overgrowth is severe or not reducing despite the patient’s best efforts at good plaque control and effective personal debridement

Question 13

What are other considerations regarding risk factors

Answer 13

Hormonal change can affect the gingivae (pregnancy)

socioeconomic status

Question 14

Why are smokers more likely to have PD disease

Answer 14

due to a reduction in gingival blood flow (nicotine causes vasoconstriction), impaired white cell function, impaired wound healing and an increased production of inflammatory cytokines enhancing tissue breakdown

Question 15

What do smokers often display with

Answer 15

o Greater calculus formation
o Higher mean probing pocket depths and more sites
o Greater gingival recession
o Greater alveolar bone loss and furcation involvement
o Less bleeding on probing

Question 16

What is your responsibility regarding patients expectations and smoking

Answer 16

• It is your responsibility to make your patients fully aware of the effects that smoking will have on their periodontal health, response to treatment, risk of relapse and eventually tooth loss

Question 17

What does your approach to smoking cessation depend on

Answer 17

o Is the patient a contended smoker
o Contemplating quitting
o Or whether they have tried and failed to quit in the past

Question 18

What is a specialist for quitting smoking services

Answer 18

NHS smoke free

Question 19

For those who are unwilling to take up smoking cessation services what should you do

Answer 19

• For people who are unwilling to take up such a service, you should provide brief tobacco cessation advice

Question 20

If patients quit smoking what should they be warned of

Answer 20

remind them that there is a possible transient increase in bleeding from the gingivae on smoking cessation as the oral vascular supply returns to normal and the masking effects of smoking are removed

Question 21

What should you report upon every appointment regarding smoking

Answer 21

• You should note down your patient’s current self-reported smoking status at every regular recall appointment and it is also important to make note of the historic burden of smoking for instance in pack-years

Question 22

How is periodontitis linked to systemic health

Answer 22

• The biological mechanisms by which periodontitis might influence systemic health are linked to the fact that periodontitis causes gingival inflammation which compromises the barrier function of the gingival epithelium leading to an ingress of bacteria or bacterial products or inflammatory products into the systemic circulation

Question 23

What are established associations for periodontitis

Answer 23

CV disease
diabetes
adverse pregnancy outcomes