Exam

Question 1

Smoking

Answer 1

18 light icebergs with 2000 cows on 2 to 15 coats. We can change 21 paddles with 12 to 20 rivers of alfalfa 18 feet high. 22 coasts of 18 bud lights jangled 20 ram 17s. 20 times the great yang scott found 22 greener pastures 11 miles past the 22 darts.

Question 2

18 light icebergs with 2000 cows on 2 to 15 coats. We can change 21 paddles with 12 to 20 rivers of alfalfa 18 feet high. 22 coasts of 18 bud lights jangled 20 ram 17s. 20 times the great yang scott found 22 greener pastures 11 miles past the 22 darts.

Answer 2

Leite 2018
Bergstrom 2000
Calsina 2002
Kotsakis 2015
Chang 2021
Patel 2012
Ravida 2020
Alfadda 2018
Costa 2022
Buduneli 2018
Jiang 2020
Ramoa 2017
Yang 2020
Scott 2022
Greer 2011
Duarte 2022

Question 3

Diabetes

Answer 3

There are 2000 positions for 13 tailors working on 18 poles at the opera 22 times in 21 roman villages. 18 songs about 97 gross snails were grazing on 18 rich treats at 91-96 west. The 98 tailors made 22 patties, and all the hats needed for 20 years.

Question 4

There are 2000 positions for 13 tailors working on 18 poles at the opera 22 times in 21 roman villages. 18 songs about 97 gross snails were grazing on 18 rich treats at 91-96 west. The 98 tailors made 22 patties, and all the hats needed for 20 years.

Answer 4

AAP position paper 2000
Taylor 2013
Polak 2018
Chopra 2022
Romano 2021
Sanz 2018
Grossi 1997
Graziani 2018
Emrich 1991
Westfelt 1996
Taylor 1998
Pattayil 2022
Alqahatani 2020

Question 5

Pregnancy hormones

Answer 5

17 ions saw 14 figure skaters doing 20-21 bends. 18 of them dropped into Orlando 22 times, 96 times more often back when Robert deler in 1994.

Question 6

17 ions saw 14 figure skaters doing 20-21 bends. 18 of them dropped into Orlando 22 times, 96 times more often back when Robert deler in 1994.

Answer 6

Ionnidou 2017
Shiau 2014
Figuero 2020
Bendek 2021
Daalderop 2018
Orlandi 2022
Offenbacher 1996
Raber-Durlacher 1994

Question 7

Leite 2018

Answer 7

smoking increases peridoontitis risk by 85%
positive association
review of studies 12 months or longer, but most studies were shorter than 5 years
Did not stratify between light and heavy smokers

Question 8

Bergstrom 2000

Answer 8

assessed professional musicians over 20 years
smokers had more diseased sites
non smokers had less diseased sites
former smokers were inbetween
smokers had significant bone loss, where former smokers and non smokers did not
limited smokers in the sample size

Question 9

Calsina 2002

Answer 9

smokers had a greater likelehood of established periodontal disease, and former smokers were inbetween
1-10 was 2.3X, 11-30 was 4X, 30+ was 12X risk
cross sectional study
population was periodontal private practice patients

Question 10

Kotsakis 2015

Answer 10

smokers had less favorable reaction to surgical therapy
the differences are not clinically relevant
smokers are still candidates for surgical therapy, however they may have diminished results

Question 11

Chang 2021

Answer 11

smokers had less reduction in non-surgical therapy, especially in deeper sites
differences are not clinically significant

Question 12

Patel 2012

Answer 12

smoking had a negative effect on bone regeneration
There was a lot of heterogeneity in the regeneration procedures
smoking was not always the primary focus of the studies

Question 13

Ravida 2020

Answer 13

The wash out period of smoking cessation before periodontal risks reverted to non smoker is 15 years for tooth loss
retrospective study so some bias expected

Question 14

Alfadda 2018

Answer 14

smokers have a higher rate of implant failure
systematic review
failure rate of 8.3% vs 4.3%

Question 15

Costa 2022

Answer 15

peri-implantitis is more frequent in current smokers than non smokers
cumulative smoking exposure and shorter smoking cessation is important
30% rate for smokers vs 19 and 18% for former smokers and non-smokers
cross sectional study
did not evaluate different implant surfaces

Question 16

Buduneli 2018

Answer 16

oxygen tension decreased which could affect vascular responsiveness
vasoconstriction in the arteries is counteracted by increase in BP, so flow is similar
higher number of micro vessels with lower internal circumference in oral tissues

Question 17

Jiang 2020

Answer 17

initial studies found no difference in oral microflora, but more recent studies with 16S sequencing did
More periopathogens were found even in areas with no evidence of disease
more established periopathogens are likely responsible for periodontal disease progression and poorer treatment results

Question 18

Ramoa 2017

Answer 18

waterpipes have similar effect as cigarettes
ecigarettes are very limited studies, and have very heterogenic compounds in them so are challenging to study
different voltages make a very different vapour

Question 19

Yang 2020

Answer 19

ecigarettes have some health impact such as oral irritation
weak or moderate evidence of deterioration of periodontal tissues
increase in plaque index

Question 20

Scott 2022

Answer 20

There is some evidence of improvement in periodontal parameters from cannabis, such as improvement in inflammasomes and cannabinoid interactions
Still direct toxicity to the cells, and immune alterations
most studies are confounded with cigarette smoking.

Question 21

Greer 2011

Answer 21

smokeless tobacco has a limited cancer risk
risk of periodontitis, gingival and alveolar bone damage, delayed wound healing, keratosis

Question 22

Duarte 2022

Answer 22

smoking cessation does benefit the outcome of non-surgical therapy, however it takes 15 years to reach the end of the wash out period

Question 23

AAP position paper 2000

Answer 23

diabetic patients are more likely to have periodontal disease and bone loss
PMN function is reduced, with reduced chemotaxis, adherence, and phagocytosis
fibroblast proliferation is reduced with less collagen
doxycycline is the preferred abx
long lasting insulin (bovine) vs short acting insulin (human)

Question 24

Taylor 2013

Answer 24

IL1beta, TNF alpha, IL6, OPG, RANKL are altered in poor diabetic control
does not seem to alter microbiota
AGEs are inflammatory too, and when bound to RAGE alter phenotype, enhancing oxidative stress

Question 25

Polak 2018

Answer 25

periodontitis control can affect HbA1c uncertain mechanism treatment does have a limited short term effect

Question 26

Chopra 2022

Answer 26

AGE levels in the GCF are higher in individuals with DM and periodontitis compared to healthy controls. periodontitis itself dose contribute to AGE cross sectional design study

Question 27

Romano 2021

Answer 27

bidirectional evidence of glycemic control and periodontitis. cross sectional study data calculated both ways

Question 28

Sanz 2018

Answer 28

patients with periodontitis have elevated HbA1c prior to developing diabetes tehreapy is safe and effective in reducing HbA1c the difference is mostly gone at 6 months

Question 29

Grossi 1997

Answer 29

study showing that periodontal therapy can improve HbA1c. Very short trial Doxycycline may be beneficial

Question 30

Graziani 2018

Answer 30

AAP-EFP position paper individuals with periodontitis have poorer glycemic control, and diabetic patients with periodontitis have poorer glycemic control most evidence for T2DM

Question 31

Emrich 1991

Answer 31

Pima Indian cross sectional study diabetes increases the risk of periodontal disease severity of periodontal disease is related to T2DM panoramic images used for study, and % bone loss rather than mm

Question 32

Westfelt 1996

Answer 32

very poorly controlled HbA1c initially (10+) clinical parameters improved in both diabetic and non-diabetic groups

Question 33

Taylor 1998

Answer 33

more severe bone loss progression in T2DM patients over 2 years based off quartile categorization which may be misleading

Question 34

Pattayil 2022

Answer 34

the periodontally inflamed surface was correlated with HbA1c level insulin group had better glycemic control than the diabetic medication group

Question 35

Alqahtani 2020

Answer 35

peri-implant parameters were worse among patients with T2DM than without, and that poor glycemic control was a greater risk mediator for implant inflammation than smoking

Question 36

Ionnidou 2017

Answer 36

differences between males and females is genetic or hormonal males are more prone to infection, women to autoimmune testosterone and progesterone are anti-inflammatory, estrogen pro-inflammatory women are more likely to be depressed, smoke, diabetes, HTTN, but have better OH microbiome is different

Question 37

Shiau 2014

Answer 37

estrogen deficiency with early menopause associated with rapid bone loss post-menopausal women on estrogen are half as likely to have periodontal disease then those not on estrogen Tamoxifen (estrogen blocker) can reduce bone healing and osseointegration

Question 38

Figuero 2020

Answer 38

review of periodontitis and adverse pregnancy outcoems unclear if it is a direct pathway of bacteria or inflammatory mediator driven preterm birth, pre-eclampsea, low birth weight, spontaneous abortion are more likely with periodontal disease

Question 39

Bendek 2021

Answer 39

high rate of gingivitis during pregnancy, that can lead to CAL pregnancy granulomas are prevalent periodontitis leads to a signfiicant increase in gestational diabetes, which increases T2Dm risk in the future extracellular vessicles transmit information from the periodontum to the placenta

Question 40

Daalderop 2018

Answer 40

review of systematic reviews consistent positive association between periodontal disease and preterm birth, possibly with a dose dependent relationship inconsistency in definitions between reviews

Question 41

Orlandi 2022

Answer 41

periodontal therapy improved many health parameters, reduced pro-inflammatory mediators There did seem to he an effect on preterm deliveries data was very homogenous

Question 42

Offenbacher 1996

Answer 42

mothers who had preterm birth, preeclampsia, low birth weight had significantly more periodontitis than matched controls unclear what the periodontal status was throughout pregnancy or prior to. no inflammatory information

Question 43

Raber-Durlacher 1994

Answer 43

during pregnancy experimentally created gingivitis persisted much longer than post partum in the same patients this suggests hormones play a signifciant role, not just bacteria