systemic risk factors - semester 1 Flashcards
Smoking
Effect on healing and treatment response:
Gingival fibroblast function is affected
* Migration to site of injury is inhibited
* Collagen production & deposition decreased
Gingival vascularity is reduced
* Reduced blood and gingival
crevicular fluid (GCF) flow
clinical feature:
Number and depth of perio pockets is increased - pocketing and re-pocketing
More loss of attachment (LOA)
Alveolar bone loss
Tooth loss
Reduction in signs of inflammation- especially in colour and consistency
Furcations
Increased risk of oral malignancy
Extrinsic staining
Halitosis
Pigmentation (on tongue, mucosal tissues)
can increase the tooth decay because it reduces the amount of the saliva in the mouth which may lead to dry mouth and causing more loss of attachment, alveolar bone loss and tooth loss
diabetes
Large epidemiological studies show increased risk of periodontitis in those
with diabetes
No difference between type one or type two diabetes. Diabetes is the condition that results in greater risk of attachment loss and bone loss due to poor insulin. this is due to the release of cytokines when advanced glycogen end products bind to their receptor
Risk of progression/recurrence of periodontal disease is related to diabetic
control (metabolic) control
Exaggerated response to plaque - more bleeding on probing and higher
gingival index scores
• Increased risk of acute periodontal infection
• Frequent fungal infections
• Increased periodontal pocketing
• Increased attachment loss
• Increased alveolar bone loss
• Impaired saliva flow
• Burning tongue syndrome
Osteoporosis and Periodontitis
Bisphosphonates
* Two phosphate groups attached to a central carbon atom
* This molecule attaches to bone and disrupts the function of osteoclasts, inhibiting
bone resorption
a chronic long-term disease in which bone density decrease. so basically osteoblasts are less than osteoclast activity. this happens because of low vitamin D, age, genetic, gender, smoking, calcium and early menopause/hormone change. Low bone mineral density in the oral bones may be associated with low systemic bone density. May lead to more rapid resorption of alveolar bone- invasion of pathogenic bacteria. Osteoporosis- increased systemic production of cytokines (IL-1 and IL-6) that may have effects on bone throughout the body- including the oral cavity.
Bisphosphonate-related osteonecrosis of the jaw
(BRONJ)
Use of Bisphosphonates and osteonecrosis of the jaw
* Aka ONJ (osteonecrosis of the jaw)
* Usually occurs when there is injury to the oral structures there is decreased
healing (due to bisphosphonates treatment)
Hormonal Changes
Puberty
Menstrual -Synthetic hormones
pregnancy
Menopause and Post menopause-
- Decrease in circulating hormones
- Loss of estrogen levels
- Oral manifestations: dry mouth, burning sensation, altered taste
HIV
Older studies showed strong relationship between HIV and
periodontitis
However, newer studies show that HIV does not have a greater
influence on periodontal disease progression
Behavioural and environmental factors play an important role in
the progression of disease
Response to periodontal therapy is may not be as favourable
especially when combined with smoking habit
Psychosocial Stress
- Etiological significance in chronic periodontitis is fully supported
by research - Associated with:
- Depressed immune responsiveness
- Lowered host resistance- impaired cellular defence mechanism
- Release of pro-inflammatory cytokines (IL-6)
- Other common risk factors need to be accounted for when
reviewing these studies - smoking
Clinical Presentation
• Dental neglect
• Changes in diet
• Smoking habit
• Bruxing habit
• Financial stress and coping
capabilities
• Increase in attachment loss
• Bone loss
• Necrotising Gingivitis (NG) –
associated with stress
Genetic Influence
- Current research indicates that certain individuals have a
genetically determined immune response which increases their
susceptibility to periodontal disease - Cross-sectional studies have shown patients who are IL-1-
positive (a periodontitis-associated genotype) and non-smokers
have an increased risk of advanced periodontitis at an earlier age
than IL-1 negative patients - Periodontal disease is a consequence of the complex interaction
with the host, genetic factors and environmental factors - Defective PMN production or function increases susceptibility to
recurrent bacterial infections - Treatment outcomes are heavily dependent on the environmental
and behavioral factors whether genetics are a factor or not
Systemic Medications
- Composition of plaque
- Alteration of salivary flow
- Effects on gingival tissue
Oral Cavity
Source of infection
* Bacteremia – presence
of bacteria in the blood
* Oral bacteria can enter
the bloodstream by way
of oral pathology- e.g.
inflammation of tissue
* Immunosuppressed
patients are at higher
risk of systemic
complication from oral
infections
Infective Endocarditis
- Bacterial infection caused by bacteria that adhere to the lining of
the heart chambers and heart valves - May have a rapid onset and fatal outcome
- Oral organisms are common aetiological factors
- Maintenance of periodontal health reduces the risk of oral
bacteremia in pts susceptible to periodontal disease
Pneumonia
- An acute inflammation of the lungs- inhaled bacteria
- Studies have shown 50% of healthy adults aspirate oropharyngeal contents during sleep
- Oral bacteria- carried into airways of the throat and lungs can increase risk for respiratory diseases
- Adults: bacterial pneumonia associated with aspiration of oral bacteria into the lower respiratory tract, which is normally sterile
Heart Disease
Bacteria are thought to affect the risk of heart disease in several ways
* Oral bacteria may directly infect the blood vessel walls causing local
inflammation and contributing to the build up of fatty deposits inside the
heart arteries
* Can cause small blood clots that contribute to congestion of arteries
* One study reported . . .
* Patients 60 yrs and younger- risk of cardiovascular disease was 2.7 times higher
than those with little or no periodontal infection
* Investigators concluded that periodontal disease is an important risk factor for
cardiovascular disease for individuals under 60 yrs
Periodontitis and pregnancy outcomes
> 60% of infant deaths not due to birth defects are
attributed to low birth weight
* Oral bacterial by-products can enter the
bloodstream, cross the placenta and harm the
fetus
* Recent study found women who had low birth
weight babies were more likely to have more
sextants of bleeding, plaque and calculus and to
have fewer healthy teeth, when compare with
mothers who delivered normal birth weight babies
Increased hormones and a change in oral microbiome can lead to periodontitis during pregnancy. inflammatory mediators cytokines released during Periodontal Disease can be associated cause: preeclampsia, gestational diabetes, gestational hypertension, pre-term birth, low birth weight, miscarriage/early pregnancy loss.Gingival tissues during pregnancy: inflamed, redness, bleeding and pain - plaque induced but exacerbated by increased levels of sex hormones of estrogen and progesterone.
