ICS2/3: Risk Factors in Periodontal Disease 1

Question 1

in what ways do systemic diseases increase the chance/risk/severity of periodontal disease occuring in an individual?

Answer 1

• directly: the medical condition itself

- indirectly: the disability caused by the medical condition and/or the effects of its treatment e.g. drug therapy

Question 2

why is medical history important when it comes to periodontal health?

Answer 2

1. systemic factors may account for periodontal condition
2. systemic factors may require special precautions to protect patient during treatment e.g. steroid cover
3. systemic factors may be hazardous to dentist and healthcare workers e.g. Hep B/C

Question 3

questions to think about while considering medical history?

Answer 3

• does it affect periodontal prognosis?

- does it cause for a modification in management of patient and the disease?

Question 4

questions to think about while examining the patient?

Answer 4

• any oral manifestations of the disease?
• do the clinical findings correspond with med history and local factors?
• are there potential effects of periodontitis on the systemic disease?

Question 5

define “risk factor”

Answer 5

a factor which increases the chance that a disease may develop in an individual

Question 6

risk factors - cause and effect?

Answer 6

risk factor is biologically related to the occurrence of disease. does not imply cause and effect. presence of risk factor does not mean disease will happen. absence of risk factor does not mean disease will not happen

Question 7

what is the 2 stage model of disease development for a disease to occur?

Answer 7

1. individual must possess genetic risk factors for disease i.e. the inherent susceptibility
2. must then be exposed to the environmental risk factors
   - disease will then develop

Question 8

risk factors for periodontal disease - what are the 2 broad categories? what is each based on?

Answer 8

• systemic risk factors. subject based

- local risk factors. site based. (oral factors that increase plaque accumulation or occlusal forces)

Question 9

systemic risk factors for perio disease:
factors that affect _____?
how do these factors lead to disease development?

Answer 9

• systemic risk factors affect a bodily system (e.g. immune system)
• the systemic factor may adversely affect host response to plaque, leading to disease development

Question 10

examples of local risk factors for perio disease - plaque retentive factors? x8

Answer 10

• deficient restorations: overhangs/overcontoured restorations
• badly designed/constructed bridgework or dentures
• carious cavities
• anatomy of embrasures/contact points: affects food packing, cleansability
• malalignment of teeth
• orthodontic appliances
• anatomy of teeth: development grooves, talon cusps, furcation)
• mouth breathing

Question 11

what is a “risk marker”?

Answer 11

signs that a disease is present

Question 12

what are risk markers for periodontal disease?

Answer 12

• BOP
• mobility
• LOA
• suppuration

Question 13

risk markers - are they linked to the cause of disease? what do they allow?

Answer 13

• not linked to cause of disease

- may allow early detection of a disease

Question 14

periodontal risk factors - what are the 2 main types

Answer 14

• modifiable risk factors

- non modifiable risk factors

Question 15

what are modifiable risk factors?

Answer 15

risk factors where if appropriate counselling/treatment given, risk/severity of periodontal disease will be reduced

Question 16

examples of modifiable risk factors?

Answer 16

• oral hygiene
• smoking
• restorative overhangs/deficiencies
• poor denture/crown/bridge design
• malocclusion
• alcohol
• stress

Question 17

what are non-modifiable risk factors? which one is the most important?

Answer 17

• periodontal risk factors that cannot be changed

- most important one is susceptibility (genetic risk) to periodontal disease

Question 18

with what measures can long term periodontal stability be achieved and maintained?

Answer 18

only through the appropriate management of:

1) modifiable periodontal risk factors
2) adequate periodontal treatment

Question 19

periodontal risk assessment is important in determining what for an individual patient?

Answer 19

• periodontal prognosis
• treatment planning
• informed consent

Question 20

assessing periodontal risk in a patient - what to look out for in oral examination? x6

Answer 20

• BOP: absence or presence
• pocket depths
• LOA/true recession
• bone levels (radiograph)
• mobility
• furcation involvement
• oral hygiene
• occlusion
• plaque retentive factors

Question 21

broad categories of systemic risk factors in perio disease?

Answer 21

• genetic factors
• behavioural
• environmental
• endocrine/metabolic
• lifestyle factors
• haematological

Question 22

genetics: significance in determining susceptibility to CP?

how many disease modifying genes are involved in determining risk for CP?

Answer 22

genetics is an important determinant in individual susceptibility to CP

• no single genetic change can account for determining genetic risk to CP
• 10-20 candidate genes determine risk for CP

Question 23

what is a single nucleotide polymorphism?

Answer 23

a single nucleotide change in the genetic code

Question 24

what do genetic changes seem to affect?

Answer 24

affect host response especially with regard to neutrophil function, reducing the host’s ability to fight off periodontal infection by perio-pathogens

Question 25

highly destructive perio diseases that result in tooth loss are associated with which genetic diseases?

Answer 25

- downs syndrome - hypophosphatasia - papillo-lefevre syndrome - ehlers-danlos syndrome - chedak-higashi syndrome

Question 26

genetic factors - downs syndrome: | results in what type of systemic issues?

Answer 26

- cardiac abnormalities (40%) - immune effects - abnormal collagen biosynthesis - learning diffculties - tends to have poor OH

Question 27

genetic factors - downs syndrome: results in what type of immune defects?

Answer 27

1. neutrophil defects - chemotaxis, phagocytosis and killing defects. 2. B lymphocyte receptor defects

Question 28

chediak-higashi syndrome - what type of condition? - defects in? - what type of oral condition? - what type of tooth loss?

Answer 28

- autosomal recessive, rare - defects in neutrophil and monocyte chemotaxis, phagocytosis and reduced intracellular killing - aggressive-like periodontitis - early loss of primary & secondary teeth

Question 29

papillon lefevre syndrome - how rare? - what type of condition? - defects in? - classical signs?

Answer 29

- 1 in 4 million - autosomal recessive, chromosome 11 defect - reduced neutrophil function - signs seen in 2-4 y/o: palmar & plantar hyperkeratosis, aggressive-like periodontitis

Question 30

ehlers-danlos syndrome - genetic defects lead to defects of? - symptoms? - how many sub-types? which are the ones to take note of and why

Answer 30

- lead to defects in collagen synthesis - excssive joint mobility, skin hyperextensibility, cardiac valve defects - 10 subtypes, look out for 4 and 8 IV: tend to have bleeding VIII: associated with aggressive-like periodontitis

Question 31

``` hypophosphatasia how rare? what type of condition deficiency in? leads to? what is the result of the defect? affects which set of teeth? ```

Answer 31

- 1/100,000 - autosomal recessive - deficiency in enzyme alkaline phosphatase - abnormal mineralization of bones and teeth, abnormal cementum - premature loss of deciduous teeth - only deciduous, not permanent teeth