Periodontal Disease and Systemic Health Flashcards Preview

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Flashcards in Periodontal Disease and Systemic Health Deck (17):
1

Common Modifying Factors of periodontal disease

Diabetes

Pregnancy

Puberety

Menopause

Smoking

Obesity

2

Modifying factors can influence 5

  • Susceptibility to gingivitis and perio
  • Plaque growth and composition
  • Clinical presentation
  • Disease progression
  • Response to periodontal therapy

3

4 main oral and periodontal effects of diabetes mellitus

Xerostomia

Candida infections

Periodontitis

Multiple periodontal abcesses

4

Periodontitis effect on insulin resistance

Increases insulin resistance

Glycemic control improved after periodontal therapy

 

5

Diabetes effects on bacteria

  • Spirochetes increase in poorly controlled diabetes
  • P intermedia C rectus P gingivalis in Type 2
  • Capnocytophaga predominance seen in Type 1 diabetes

6

Diabetes effects on host response

 

  • PMN function, chemotaxis impaired
    • PMN enzymes( beta glucoronidase and elastase increase)
    • Collagenase increases-->tissue destruction
  • Cytokines monocytes and MO 
    • Increase in PGE, IL-1 beta, TNF alpha
    • Advanced glycation end products (AGE) create destructive phenotype of macrophages
  • Connective tissue
    • Decrease in matrix synthesis by fibroblasts and osteoblasts
    • Reactive oxygen species damage cells
    • AGE creates thickening of vascular endothelium, synthesis of wound healing steroids

7

Diabetes effects on healing and treatment response

  • Decreased synthesis of collagen by fibroblasts
  • Increased degradation by collagenase
  • Glycosylation of existing collagen and wound margins
  • Defective remodeling and rapid degradation of newly synthesized, poorly cross-linked collagen

8

When to time periodontal treatment on a diabetic

  • Early morning
  • Avoid hypoglycemia
  • May need to change insulin(consult MD)
  • Know what to do in medical emergency

9

Pregnancy, puberty and menopause effects on

Estrogen 2

vascular/inflammation

gingival inflammation

periods

 

  • Estrogen affects salivary peroxidases
  • Estrogen increases collagen metabolism, angiogenesis
  • Increases vascular response and inflammatory mediators
  • Gingival inflammation increases in puberty & pregnancy
  • Increase in bleeding during period in women with gingivitis
  • These populations may have exaggerated bleeding, does not indicate disease r infection

10

Special note about 2nd trimester in pregnant women

2nd trimester (and 3rd) is when gingival inflammation is the highest

2nd trimester is best time to do perio treatment

Avoid antibiotics

11

Pregnancy effects on microbiota

Increase in P. intermedia

Naphthoquinones from steroids used by P intermedia

Increase in Spirochetes

12

Pregnancy effects on host 3

  • Increase in vascular permeability
    • resulting in increase gingival exudate
  • Decrease in keratinization
  • Decrease in PMN chemotaxis and phagocytosis, Ab, T cell response

13

Smoking effects on Periodontitis

  • Increased
    • pocket depth
    • atachment loss
    • bone loss
    • tooth loss
    • rate of destruction
    • severity
    • Generalized Aggressive Perio in young adults

14

Smoking effects on Micro

  • No effect on rate of plaque accumulation
  • Increased colonization of shallow periodontal pockets by perio pathogens
  • Increased levels of periodontal pathogens in deep periodontal pockets
  • Qualitative rather than quantitative alterations- range from no differneces to increased levels of pathogens

15

Less favorable response to mechanical thrapy in smkers has been associated with

  • Increased residual levels of 
  • T. forsythia
  • A a.
  • P. gingivalis

16

Immune-inflammatory response effects in smokers

  • Altered neutrophil chemotaxis, phagocytosis, and oxidative burst
  • Increase TNF-alpha and PGE2 in gingival crevicular fluid
  • Increase Neutrophil collagenase and elastase in gingival crevicular fluid
  • Increase production of PGE2 by monocytes in response to lipoppolysaccharides 

17

Physiologic effect in smokers

  • Decreased gingival blood vessels with increase inflammation
  • Decrease GCF flow and bleeding on probingwith increase inflammation
  • Decreased subgingival temperature
  • Increased tie needed to recover from local anesthesia