Risk factors

Question 1

What process gives rise to periodontitis?

Answer 1

dysbiosis

Question 2

what factors alter someone’s susceptibility to periodontal disease?

Answer 2

genetics
inflammatory drive
biofilm

Question 3

what is management dependant upon?

Answer 3

risk factor control

if grade A and B - usually plaque control based

Question 4

what results in breakdown of the periodontium and bone resorption?

Answer 4

inflammatory response

Question 5

what is essential to prevent an aberrant host response and dysbiosis?

Answer 5

immune fitness - immune response to plaque

Question 6

what can alter immune response?

Answer 6

diet
genetics
hyperglycaemia

Question 7

what is the gut microbiome driven by?

Answer 7

nutrition

Question 8

what does an increasing carb intake result in?

Answer 8

higher circulating glucose

Question 9

what is a result of having more adipose tissue?

Answer 9

insulin doesnt work as effectively and inhibits hormones that make you feel full (leptin)

Question 10

what hormone makes you feel full and can be interrupted by adipose tissue?

Answer 10

leptin

Question 11

what does adipose tissue do to the inflammatory drive?

Answer 11

increases inflammatory drive

Question 12

what is the result of increased inflammatory drive?

Answer 12

more oxidative stress - hyperresponsive immune system

Question 13

what does adipose tissue produce?

Answer 13

cytokines
Tnf alpha IL6
Pro inflammatory mediators
adipokines

Question 14

why are cytokines bad?

Answer 14

bacteria use as energy source
= increase in anaerobes
= dysbiosis

Question 15

what risk does poorly controlled diabetes have on periodontitis?

Answer 15

x3

Question 16

what are found in bad foods that increase oxidative stress?

Answer 16

advanced glycation end products (AGE)

Question 17

how can we reduce the risk of dysbiosis from obesity?

Answer 17

encourage symbiosis
- weight loss to reset oral microbiome
- reduced refined carbs and AGE products
- prebiotic diet: cruciferous diet to feed gut microbiome

Question 18

what can obesity lead to?

Answer 18

diabetes

Question 19

signs of diabetes?

Answer 19

bop
lack of immune fitness - suppuration

Question 20

what is the determining factor of the association between DM and chronic periodontitis?

Answer 20

degree of blood glucose (glycaemic) control

Question 21

are all diabetes patients at risk of periodontitis?

Answer 21

no, only ones with poorly controlled glycaemic levels

Question 22

what should glycated haemoglobin levels be?

Answer 22

48 mmol below/ 6.5% below

Question 23

what may indicate undiagnosed periodontitis?

Answer 23

recurrent perio abscesses - pus
exaggerated perio inflammation

Question 24

what are the problems with uncontrolled diabetes?

Answer 24

increased formation of AGE products
altered immune cell function
altered fibroblast function
poor wound healing

Question 25

what effect has AGE got on collagen?

Answer 25

reduced collagen production increased collagenase (removes collagen) impaired collagen turnover

Question 26

what can chronic hyperglycaemia alter with immune cell function?

Answer 26

reduced neutrophil function = persistent infection hyperresponsive monocyte and macrophages = oxidative stress altered fibroblast function = reduced tissue formation and healing

Question 27

what are the effects of poor glycaemic control on periodontitis?

Answer 27

increase risk - pockets leak bacteria and exotoxins throughout immune system = increased insulin resistence

Question 28

what vitamin is essential for collagen?

Answer 28

c

Question 29

what is vitamin D essential for?

Answer 29

skeletal development modulation of immune system

Question 30

how much vitamin D do we need?

Answer 30

40-60ug a day

Question 31

what foods may help inflammation?

Answer 31

omega 3 cruciferous vegetables

Question 32

what are key dietary advice points for perio?

Answer 32

healthy diet - cruciferous veggies - vit D and C, fresh fruit and veg reduce carbs be aware of AGE foods

Question 33

what are the oral effects of stress?

Answer 33

reduced salivary flow - plaque formation increased stress hormones - reduce gingival blood flow

Question 34

what are the stress hormones?

Answer 34

noradrenaline adrenaline

Question 35

how does smoking effect the periodontium?

Answer 35

staining calculus build up more keratin

Question 36

why does smoking cause calculus build up?

Answer 36

increase saliva flow = increase pH = precipitate of calcium phosphate

Question 37

why do smokers gums look healthy?

Answer 37

less BOP - reduced inflammatory response and vascularity higher amount of keratin laid down on surface

Question 38

what is smoking a major risk factor for?

Answer 38

necrotising gingivits