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Applied Dental Hygiene 2 > Systemic risk factors > Flashcards

Systemic risk factors Flashcards

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1
Q

What is the prevalence of smoking in UK?

A

more men smoke

16% men, 13% women

since 2011, largest fall in smokers in 18-24 year olds

approx 3 million vapers in UK

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2
Q

What substance makes smoking addictive?

A

nicotine

other constituents in tobacco kill

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3
Q

What cancers are related to smoking?

A

Lung

Mouth

Pharynx

Larynx

Bladder

Pancreas

Kidney

Oesophagus

Stomach

Leukaemia

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4
Q

What potentially fatal diseases are related to smoking?

A

Ischaemic/respiratory heart disease

Obstructive lung disease eg bronchitis

Stroke

Pneumonia

Aortic aneurysm

Foetal/neonate death

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5
Q

What non-fatal diseases are related to smoking?

A

periodontal disease

low birth weight baby

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6
Q

What is tobacco smoking related to?

A
  • Periodontitis
  • Periodontitis that is refractory to treatment (ie non-responsive)
  • Necrotising periodontal diseases (NG/NP)
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7
Q

What is smokeless tobacco related to?

A
  • Localised recession manifesting as attachment loss
  • Increased oral cancer risk
  • Severe active periodontal disease
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8
Q

What do earlier studies show about tobacco smokers?

A
  • Higher levels of periodontal disease
  • Poorer oral hygiene (OH)
  • Hypothesised that poor OH may be responsible for higher disease levels ie smoking indirectly affected periodontium
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9
Q

What have cross-sectional and longitudinal studies show about tobacco smoking?

A

risk factor for periodontal disease

in comparison to non-smokers…

  • Greater bone loss and attachment loss
  • Increased numbers of deeper pockets
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10
Q

What is the clinical appearance in smokers?

A

Fibrotic ‘tight’ gingiva, rolled margins

Less gingival redness and bleeding

More severe, widespread disease than same age non-smoking control

Anterior, maxilla, palate are worst affected

Anterior recession causing open embrasures

Nicotine staining

Calculus

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11
Q

What is the clinical appearance in necrotising gingivitis?

A

Painful, interdental necrosis

Bleeding gingivae with little provocation

Necrotic ulcers affecting interdental papillae

Ulcers are painful and covered by grey slough

‘punched out’ appearance

Possible halitosis

Possible lymph nodes involvement

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12
Q

What do most adults with NPD have in common?

A

smokers

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13
Q

Approximately how many toxic substances are in cigarette smoke?

A

> 4000

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14
Q

What are the 3 types of toxic substances in cigarette smoke?

A

particles

gases

free radicals

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15
Q

What are the 3 types of toxic particles in cigarette smoke?

A

nicotine

benzene

benzo(a)pyrene

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16
Q

What are the 6 types of gases in cigarette smoke?

A

Hydrogen cyanide

Carbon monoxide (carboxyhaemoglobin)

Ammonia

Formaldehyde

Dimethylnitrosamine

Acrolein

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17
Q

What do the free radicals do in cigarette smoke?

A

These react with cholesterol leading to atheroma in artery walls

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18
Q

What is the metabolite of nicotine which measures exposure to tobacco smoke?

A

cotinine

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19
Q

What are the effects of nicotine in the pathogenesis of smoking?

A

reduction in chemotaxis

migration of oral PMNs

affects PMN’s respiratory burst

adversely affects fibroblast function

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20
Q

What are the other effects on the pathogenesis of smoking?

A

inhibition of phagocytosis of neutrophils (PMNs)

reduced antibody production IgG2

altered peripheral blood T-cell subset ratios

reduced bone mineralisation

adverse micro-circulation, gingival circulation and blood flow

possible vasoconstriction of gingival capillaries

chronic hypoxia of periodontal tissues

high proportion of small vessels compared to normal, no difference in vascular density

fewer gingival vessels

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21
Q

What may inflammatory response not always accompanied by in smokers?

A

increase in vascularity

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22
Q

What affects neutrophil emigration from vessels in smokers?

A

reduction in ICAM-1 expression

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23
Q

What happens overall as a result of smoking?

A

less gingival redness

less bleeding on probing

fewer vessels clinically and histologically

healing response may be affected by impairment of revascularisation

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24
Q

What % of refractory patients are smokers?

A

90

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25
What did a 6-month study about smoking show a decrease in?
inflammation GCF IgG titres to A.a
26
Are there any microbial differences found in smoker despite poorer periodontal outcome?
no
27
How should we manage smokers?
advise on adverse effects on oral and periodontal health record giving advice explain poorer response to therapy give smoking cessation counselling
28
What % of patients quit smoking due to brief advice from professional?
5%
29
What are the time-dependent changes after smoking cessation?
- Recovery of inflammatory response leads to transient increased bleeding (approx. 6 months) - Return to normal architecture of gingival tissues (approx. 12 months)
30
How many more times likely are smokers likely to quit with support eg NSSS?
4x more likely - may provide nicotine replacement therapy
31
What are the 3 A's in VBA?
Ask Advise Act
32
What don't e-cigarettes contain or produce?
don't contain tobacco don't produce tar or carbon monoxide
33
How do e-cigarettes work?
heating solution (e-liquid) contain nicotine usually propylene glycol and/or vegetable glycerine flavourings
34
What is psychological stress?
physiological and psychological changes when an external demand or stressor taxes and individual’s adaptive capacity refers to the emotional and physiological reactions experienced when a person confronts a life event which exceeds his/her ability to cope effectively
35
What are some types of psychological stress?
disasters of crises major life events micro-stressers eg daily hassles can be categorised as acute-stressors or chronic stressors based on how long they last
36
How does stress occur on a biological level?
Stress induced response transmitted to hypothalamus-pituitary adrenal axis Corticotrophin-releasing hormone (CRH) released from hypothalamus Adrenocorticotropic hormone (ACTH) released from pituitary Glucocorticoids released from adrenal cortex which decrease production of proinflammatory cytokines
37
What are the effects of stress?
behavioural changes activation of biological system chronic state of inflammation
38
What happens in the activation of the biological system in stress?
activation of hypothalamic-pituitary-adrenal axis increased circulating glucocorticoids and epinephrine levels - immune suppression
39
What happens in immune suppression in stress?
- reduction in ... lymphocyte production lymphocyte proliferation natural killer cell activity antibody production - and then reactivation of latent viral infections
40
What happens when there is a chronic state of inflammation in stress?
activation of ... - macrophages - dendritic cells - epithelium leading to release of proinflammatory cytokines
41
How is diabetes mellitus characterised?
chronic hyperglycaemia resulting from insulin deficiency or its impaired utilisation
42
Describe type I diabetes
Destruction of beta cells in pancreas due to autoimmune process There are islet cell antibodies at time of diagnosis Is a genetic predisposition Has abrupt onset, most often in children/teens
43
Describe type II diabetes
There is defect in beta cells and insulin resistance Usually manifests mid-life with small number of children affected Can be genetic influence Increased risk if obese, sedentary lifestyle, close relative with DM, Asian/afro-caribbean Complications possible before diagnosis
44
What 3 things can occur in type I diabetes?
unexplained weight loss polyuria polydipsia
45
How do we diagnose type I diabetes?
random venous plasma glucose >11 mmol/litre, normally 8 fasting venous plasma glucose >7 mmol/litre, normally 4-5.5
46
How do we diagnose type II diabetes?
Haemaglobin A1c may be used for diagnosis glucose binds to haemoglobin within circulating erythrocytes measure of how much haemoglobin is glycated with cut-off point at 48mmol/mol (6.5%)
47
How can we control type I diabetes?
insulin injections/pumps balance carb intake new technology: transplantation on pancreatic islets of langerhan cells
48
How can we control type II diabetes?
diet oral-hyperglycaemic drugs exercise 25% may need insulin injections
49
How do we carry out home glucose monitoring?
- Simple finger prick - Drop of blood on strip - Direct reading in seconds - Aim for 4-7 mmol/litre under renal threshold ~10 and above hypoglycaemic level of <4
50
What are the macrovascular complications of diabetes?
Cardiovascular disease Cerebrovascular disease and stroke
51
What are the microvascular complications of diabetes?
retinopathy (blindness) neuropathy (nerve damage) nephropathy (renal failure)
52
What is the 6th complication of diabetes proposed by Loe in 1993?
periodontal disease
53
What are the implications of diabetes?
Costs NHS £23.7 billion in UK (80% on complications) 10% NHS budget and 19% hospital beds accounted for by patients with diabetes Projected cost expected to increase to £39.6 billion by 2035/6
54
What was discovered in type I DM adults in periodontal epidemiology?
poorly controlled diabetics lost more attachment and bone increased risk with age increased severity with longer diabetes duration
55
What was discovered in age 6-18 children in periodontal epidemiology?
increased inflammation and clinical attachment loss
56
What was discovered in type 2 DM Pima Indian adults?
Periodontal problems worsen with poorer control more frequent and advanced periodontal destruction with increased duration of diabetes those with severe periodontal disease are at x3.2 mortality due to ischaemic heart disease and diabetic nephropathy
57
What happens in obesity?
IL-6 stimulates TNF-alpha, both of these may cause insulin resistance (playing a role in type II DM) There is increased IL-1 beta which may cause pancreatic beta cells destruction (playing a role in type I DM)
58
Explain AGEs
Hyperglycaemia causes collagen to undergo non-enzymatic glycation to advanced glycation end products (AGEs)
59
What does AGEs cause?
increased... cross linking cytokine production
60
What is AGEs linked to?
- Microvascular complications - Atherosclerosis - Decreased production of bone matrix
61
What is RAGEs?
receptor for AGEs
62
What occurs when AGEs and RAGEs interact?
perturb vascular and inflammatory cell function... - Microvascular and macrovascular diabetes complications - Accelerated periodontal tissue destruction
63
The adipocyte production of what links obesity to periodontitis and diabetes?
proinflammatory cytokines (adipokines)
64
What is PMN?
polymorphonuclear leucocyte
65
PMNs are the first line of defence but in diabetes...
- Decreased PMN function causing increased risk of periodontitis - Enhanced respiratory burst - Delayed apoptosis causing increased tissue destruction
66
How should we provide periodontal care for diabetics?
Check HbA1C with diabetic care team Follow principles of 3 stages of therapy (initial, corrective, supportive)
67
How does the patient appear if hypoglycaemic?
pale clammy shaky confused/aggressive
68
How to manage if patient is hypoglycaemic?
Blood glucose will be <4 mmol/litre Give 3-6 glucose tablets or give glucose drink ag Lucozade
69
How to manage patients that are severely hypoglycaemic?
Give glucagon IM, SC or IV injection (1mg if adult or child over 8 years, 0.5mg if under 8 years), plus further carbohydrates on recovery Get doctor or dial 999 if no recovery in 10 minutes, and if still unconscious will need glucose IV
70
What other systemic diseases are not yet conclusive in their link to periodontitis?
cardiovascular disease COPD (chronic obstructive pulmonary disease)
71
How does familial aggregation affect periodontitis onset?
occurs early in age progresses fast
72
What is the more common form of periodontitis onset?
older patients slower progression
73
What gene polymorphism associates cancer and periodontitis?
IL-1 gene polymorphisms
74
What are the effects of osteoporosis?
Leads to reduced bone mineral density Most common in post-menopausal women but does occur in men Leads to increased risk of fracture; typically hip fractures after a fall Reduced oestrogen production after menopause results in increased bone resorption Systemic bone resorption associated with mandibular bone resorption Some studies show correlation between systemic bone loss and periodontal disease
75
What other risk factors are associated with periodontal disease?
- Dietary calcium - Vitamin D - Obesity - Etc

Applied Dental Hygiene 2 (10 decks)

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