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DEN2SKC > WEEK 4 > Flashcards

WEEK 4 Flashcards

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1
Q

How does periodontitis present in down syndrome patients?

A
  • poor oral hygiene
  • increased rate of destruction due to immune system defects
  • small conical roots –> rapid attachment loss
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2
Q

What is leukocyte adhesion deficiency?

A

neutrophils trapped in blood vessels, can’t stick to endothelial in order to transverse into periodontal sites

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3
Q

How does periodontitis present in leukocyte adhesion deficiency syndromes?

A
  • severe bone loss (before eruption)
  • inflammation is minimal for the amount of bone loss (since neutrophils are not working and they are the first line of defense)
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4
Q

What is palmoplantar keratosis

A

mutation in cathepsin C gene
includes papillon lefevre (hyperkeratotic lesions) and Haim-munk syndrome (deformed fingers and nails)

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5
Q

How does palmoplantar keratosis effect periodontal tissues?

A
  • rapid destruction
  • severe bone loss
  • intense inflammation
  • premature exfoliation
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6
Q

What is chediak-Higashi syndrome?

A

mutation in LYST gene resulting in a decrease in phagocytosis, albinism, abnormal bleeding

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7
Q

How does chediak higashi syndrome effect periodontal tissues?

A
  • severe bone loss
  • inflammation
  • effects secondary dentition
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8
Q

What is hyperimmunoglobulin E syndromes?

A

mutations in gene effecting intracellular signalling, causes skin abscesses, eczema and pulmonary infections.

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9
Q

How do hyperimmunoglobulin E syndromes effect periodontal tissues?

A

intraoral infections with sterile hyperinflammation

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10
Q

What is ehlers danlos syndrome?

A

mutations in fibrillar collagen genes causing joint hypermobility, easy bruising, pullable skin

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11
Q

How does ehlers danlos syndrome effect the periodontal tissues?

A

lack keratinized gingiva, thin friable tissues, bone loss

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12
Q

What is hypophosphatasia?

A

mutations in the alkaline phosphatase gene causing skeletal deformities, fractures, and bone pain

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13
Q

How does hypophosphatasia effect periodontal tissues?

A

increased risk of losing adult dentition, infants have premature loss of primary incisors

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14
Q

what is chronic granulomatous disease?

A

mutation in genes encoding NADPH oxide –> neutrophils and macrophages are unable to produce oxidative bursts to kill pahogens

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15
Q

how does chronic granulomatus disease effect periodontal tissues?

A

sterile inflammation and tissue destruction

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16
Q

What are clinical features of patients who smoke?

A

minimal BOP
deep pockets
more recession
furcations
bone and tooth loss.

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17
Q

How is the host response effected for patients who smoke?

A

decreased cellular immunity, IgA and IgG, angiogenesis, antibodies.
Increased proinflammatory cytokines
impaired fibroblast function –> poor tissue repair

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18
Q

How does smoking effect the biofilm?

A

more anerobic pathogenic bacteria in shallow pockets
supportive restorative dentistry is less effective

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19
Q

How does smoking affect healing after treatment?

A

decreased fibroblast function, epithelial function, anti-inflammatory cytokines, oxygen and nutrient supply

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20
Q

How does smoking effect periodontitis?

A

reduces signs of gingival inflammation, less GCF volume

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21
Q

What happens when a smoker stops smoking?

A

does not reverse the damage however rate of attachment loss slows, and there is a better response to periodontal therapy

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22
Q

How do you determine the severity of a smoker?

A

cumulative dose overtime. number of cigs per day x years of smoking

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23
Q

How many Australian adults had diabetes between 2017 - 2018?

A

1 million

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24
Q

What are the clinical features of a diabetics mouth?

A

severe inflammation, bone loss, suppuration, acute infections

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25
how does uncontrolled diabetes effect the host response?
response to plaque causes more severe perio, macrophages bind to AGEs causing them to release pro-inflammatory mediators causing neutrophils to decrease in number
26
how are AGEs (advanced glycation end products) formed?
formed from glucose binding to tissue proteins (collagen)
27
what do AGEs do to periodontal tissues?
form in capillary walls, thickening them and reducing elasticity. This impairs oxygen exchange. There is poor cellular turnover in the collagen.
28
How does AGEs affect bone
impedes bone healing by stimulating apoptosis of osteoblasts. Switches on osteoclasts to resorb the bone.
29
What causes the increased inflammation in uncontrolled diabetes patients?
AGE RAGE binding, increased susceptibility to infection
30
How do uncontrolled diabetes patients respond to treatment?
more frequent infections, should consider antibiotic cover
31
What is the relationship between uncontrolled diabetes and uncontrolled periodontitis?
in order for perio treatment to work, diabetes has to be controlled.
32
What are some things to consider when you have an apt with an uncontrolled diabetes patient?
short morning apts after breakfast, defer treatment if it is really uncontrolled, use good LA, antibiotic cover, educate patient
33
How damaging is vaping in comparison to smoking in terms of periodontal tissue damage?
less than smoking but worse than non-vapers
34
how does vaping effect periodontal tissues?
increased PD, CAL, bone loss, alters host response promoting pro-inflammatory cytokine release. More pathogenic microflora
35
what is type 1 diabetes?
autoimmune decreased insulin production sudden onset young patients
36
What is type 2 diabetes?
insulin resistance gradual onset, usually obese, middle aged patients more common than type 1 lifestyle factors
37
what is gestational diabetes?
pregnancy, usually 3rd trimester and resolves after birth. Increases mothers future risk.
38
What are some chronic conditions associated with periodontitis?
obesity, osteoporosis, IBS, rheumatoid arthritis
39
How does obesity effect periodontitis?
adipocytes secrete proinflammatory cytokines leading to: induces a chronic inflammatory state poor blood supply causing poor healing increased susceptibility to infections
40
what is osteoporosis and who does it most commonly affect?
reduced trabecular bone mass and strength, common in post menopausal women due to decreased oestrogen levels.
41
How does osteoporosis effect periodontitis?
Increases risk of Osteonecrosis of the Jaw.
42
What is osteonecrosis of the jaw?
exposed jaw bones increasing susceptibility to infection, perio pathogens.
43
What percent of ONJ patients have periodontitis? How likely are perio patients to develop ONJ?
71-84% 7x
44
What is inflammatory bowel disease?
autoimmune disease like chrons and ulcerative colitis
45
What are some intra oral signs of IBS?
mucosal polyps, ulcers, periodontitis
46
How does IBS effect periodontitis?
- Similar bacterial dysbiosis and inflammatory pathogenesis in gut and mouth - Hypersensitivity response to resident microbiota and dental plaque - Oral bacteria can translocate to gut → inflammation i
47
what is rheumatoid arthritis?
chronic synovial inflammation causing destruction of the cartilage between joints. Autoimmune condition
48
How does rheumatoid arthritis effect periodontal tissues?
P. gingivalis can induce ACPA production that can lead to arthiitis Periodontitis bacteria found in synovial fluid
49
What is neutropenia?
decrease or absence of neutrophils
50
how does neutropenia effect periodontal tissues?
rapid destruction because the first line of defence is gone. leukemia causes gingival enlargement and anaemic (white) gingiva.
51
What is the management of HIV? what does it do?
Highly Active Antiretroviral Therapy (HAAT). Reduces viral load, increases T lymphocytes, helps maintain healthy perio.
52
How does HIV effect periodontal tissues?
increases risk of necrotizing perio diseases.. Causes linear gingival erythmia (red line around teeth), recession and lesions.
53
what are the disease characteristics of emotional stress and depression?
activation of hypothalamic-pituitary-adrenal axis which releases stress hormones that modulate the immune response.
54
How does emotional stress and depression effect periodontal tissues?
causes necrotising gingivitis, suppresses immunity causing perio breakdown, and there are indirect effects such as lack of oral hygiene, smoking and cariogenic diets.
55
What is oral squamous cell carcinoma?
accounts for 90% of oral cancers caused by sun, smoking, viruses.
56
How does oral squamous cell carcinoma effect periodontal tissues?
localized gingival swelling and ulcers. common in mandibular molar region.
57
What are odontogenic tumours?
neoplasm of odontogenic epithelium, can look like localised periodontitis
58
what is an example of a primary neoplasm in periodontal tissue?
osteolytic expanding lesion in jaw
59
what is an example of a secondary metastic neoplasm of periodontal tissue?
osteolytic expanding lesions in jaw metastasized from primary lesion elsewhere in the body.
60
what is granulomatosis with polyangiitis (wegners granulomatosis)?
a rare autoimmune disorder that causes inflammation of blood vessels with necrotising granulomas
61
what is langerhans cell histiocytosis?
bone lesions, 10% of cases are oral, present as radiolucency. body produces too many immature cells
62
what is giant cell granuloma?
aggressive lesions mostly found in mandible
63
what is hyperparathyroidism?
enlarged parathyroids with excessive production of parathyroid hormones. Causes increased bone resorption, loss of cortical bone, can cause brown tumours in the bone
64
What is systemic sclerosis?
autoimmune disease of connective tissues causing limited mouth opening, fibrosis of tongue, recession.
65
what is vanishing bone disease?
uncontrolled proliferation of lymphatic channels in bone, bone is replaced with angiomas or fibrosis, increases tooth mobility.
66
Which medications reduce periodontal inflammation?
antibiotics eg. amocicillin Antiinflammatory agents, e.g., NSAIDs, aspirin, omega 3, celebrex, bisphosphonates, infliximab, statins
67
what medications can exacerbate periodontitis?
chemotherapy immunosuppressants oral contraceptives any medication causing xerostomia
68
what medications are most commonly associated with drug induced gingival over growth?
calcium channel blockers cyclosporine phenytoin
69
which broad types of medication increase the risk of medication-related osteonecrosis of the a jaw?
antiresorptives
70
what are two examples of medications known to cause MRONJ
denosumab (prolia) used for osteoporosis patients bisphosphonates that increase bone density
71
exposure of what tissue increases the risk of MRONJ
bone
72
what are two dental procedures that increase the risk of MRONJ?
extractions and implants (anything where bone is exposed)
73
how much healing do patients need after a procedure before they can start BP treatment?
6 weeks
74
How does langerhan cell histiocytosis affect periodontal tissues?
bone lesions, with or without overlying skin lesions. 10% of cases are oral, the jaw lesions present as punched out radioluscencies or floating teeth.
75
How do giant cell granulomas affect periodontal tissues?
causes peripheral or central lesions, causes bone and root reabsorption.
76
How does hyperparathyroidism affect periodontal tissues?
increased bone resorption, loss of lamina dura and cortical bone leading to ground glass appearance of alveolar bone. Brown tumours.
77
How does scleroderma affect periodontal tissues?
limited mouth opening and tmj function, dysphagia (fibrosis of tongue and oesophagus), widening of PDL due to excessive collagen deposition, gingival recession, less BOP

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