Risk Factors - Perio Midterm

Reproducibility can be improved by _________.

Either increasing or decreasing force (either all or no sites will bleed reproducibly).

Periodontitis risk factors can be:

Environmental, behavioral, or biologic

Diabetes: Level of _________ is important

Glycemic control

Risk assessment involves _____.

Identifying elements that predispose or influence the progression of periodontal disease

Microbiology - Effects of smoking

Increased complexity of the microbiome and colonization of periodontal pockets by periodontal pathogens

In healthy subjects, % bleeding on probing sites has a ________ relationship with _________.

Linear relationship with probing force

Risk factors are identified by __________.

Longitudinal studies of patients with the disease of interest.

Smoking is associated with:

Multiple diseases that reduce life expectancy and quality of life

Former smokers respond to periodontal therapy similar to ______.

Nonsmokers

To be considered a risk factor, the exposure must _______.

Occur before disease onset

Absence of bleeding on probing is an indicator of ________.

Periodontal stability

Direct relationship between diabetes and _______.

Periodontitis

To decrease risk for periodontitis, increase the number of years since _______

Quitting smoking

Negative effects of smoking on the host are ______.

Reversible

_____________ is a reason for bleeding on probing in absence of disease

Tissue trauma

No risk factor difference between _________

Type 1 or Type 2 diabetes

Diabetes - Metabolic disorder is characterized by

chronic hyperglycemia

Periodontal disease is one of many ______

complications of diabetes

Composition (quality) of plaque is

important

Diabetes complications can include

microvascular and macrovascular diseases

Interventions can help ______

modify risk factors

Smoking is a major risk factor for _______

periodontitis and affects the prevalence, extent, and severity of the disease

Uncontrolled diabetics have a _____ response to therapy

poor

What is risk assessment?

- Disease risk is the probability that an individual will develop a specific disease in a given period - Determined by numerous components

Smoking cessation counseling - 5 A's

1. ASK patient about smoking status 2. ADVISE smokers of the associations between oral disease and smoking 3. ASSESS the patients interest to attempt to quit 4. ASSIST the patient in the attempt 5. ARRANGE for referral or follow up

Bacterial and microbial cross-section / longitudinal studies include: (3 terms)

1. Aggregatibactor actimomycetemcomitans 2. Porphyromonas gingivalis 3. Tannerella forsythia

Poorly controlled diabetics can cause: (4 terms)

1. Altered immune function (PMNs) 2. Qualitative changes in bacteria 3. Altered collagen structure and function 4. Severe gingival inflammation, deep pockets, rapid bone loss, and periodontal abcesses

Immune-inflammatory response (4 terms)

1. Altered neutrophil chemotaxis, phagocytosis, oxidative bust 2. Increased tumor necrosis factor-alpha and prostaglandin E2 in gingival crevicular fluid 3. Increased neutrophil collagenase and elastase in gingival crevicular fluid 4. Increased production of prostaglandin E2 by monocytes in response to lipopolysaccharide

Patient education should include: (2 terms)

1. Concerning their risk 2. Suitable intervention strategies that should be implemented

Physiology - Effects of smoking (4 terms)

1. Decreased gingival blood vessels with increased inflammation 2. Decreased gingival crevicular fluid flow and bleeding on probing with increased inflammation 3. Decreased subgingival temperature 4. Increased time needed to recover from local anesthesia

Risk indicator - Osteoporosis impact (3 terms)

1. Does not initiate periodontitis 2. Reduced bone mass aggravates periodontal disease progression 3. Studies are conflicting, but there may be a link

Stress - Periodontitis (3 terms)

1. Emotional stress may interfere with normal immune function 2. Stressful events lead to greater prevalence of periodontal disease 3. Increased incidence of necrotizing ulcerative gingivitis during periods of high stress

Bacteria: Anatomic factors that harbor bacterial plaque (7 terms)

1. Furcations 2. Root concavities 3. Grooves 4. Cervical enamel projections 5. Enamel pearls 6. Overhanging margins 7. Calculus

Risk Determinants / Background characteristics of perio disease

1. Genetic factors 2. Age 3. Gender 4. Socioeconomic status 5. Stress

Non-modifiable risk factors of plaque (5 terms)

1. Genetics 2. Age 3. Gender 4. Socioeconomic status 5. Stress

Socioeconomic status - Periodontitis (3 terms)

1. Gingivitis and poor oral hygiene related to lower SES 2. Decreased dental awareness and decreased frequency of dental visits 3. SES alone does not result in an increase risk

Risk Indicators of perio disease

1. HIV / AIDS 2. Osteoporosis 3. Infrequent dental visits

Risk indicator: HIV / AIDS impact: (4 terms)

1. Higher risk for periodontitis 2. Higher degree of immunosuppressive in adults with AIDS 3. Increased periodontal pocket formation and loss of attachment 4. Oral lesions prominent diagnostic feature

Periodontitis effects of smoking (NEED TO KNOW) - 7 terms

1. Increased prevalence and severity of periodontal destruction 2. Increased pocket depth, attachment loss, bone loss 3. Increased rate of periodontal destruction 4. Increased prevalence of severe periodontitis 5. Increased tooth loss 6. Increased prevalence with increased number of cigarettes smoked per day 7. Decreased prevalence and severity with smoking cessation

Risk indicator - Infrequent dental visits (3 terms)

1. Increased risk for severe periodontitis in patients who had not visited for 3 years or more 2. No more loss of attachment or bone loss in individuals who did not seek dental care for over 6 years

Gender - Periodontitis ( 3 terms)

1. Men have more attachment loss than women 2. Men have higher levels of plaque and calculus 3. Gender differences in prevalence and severity appear to be related to preventive practice vs genetic

Severe periodontitis shows alterations in: (2 terms)

1. Neutrophils 2. Monocytic hyperresponsiveness associated with severe periodontitis

HIV infection impact on oral cavity ( 7 terms)

1. Oral candidiasis 2. Linear gingival erythema 3. Oral hairy leukoplakia 4. Kaposi Sarcoma and other malignancies 5. Acute necrotizing ulcerative gingivitis (ANUG) 6. Necrotizing ulcerative gingivitis and periodontitis 7. Chronic periodontitis

Age - Periodontitis (4 terms)

1. Prevalence and severity increase with age 2. Degenerative changes related to aging process 3. Prolonged exposure to other risks over life lead to cumulative destruction rather than increased rate of destruction 4. Young individuals with perio disease are at greater risk for continued disease

Risk Markers / Predictors of perio disease

1. Previous history of periodontal disease 2. Bleeding on probing

Risk factors for Periodontitis

1. Tobacco smoking 2. Diabetes 3. Pathogenic Bacteria

Risk factors of periodontal disease

1. Tobacco smoking 2. Diabetes 3. Pathogenic bacteria and microbial tooth deposits

Non Modifiable risk factor studies included: (2 terms)

1. Twin studies - Genetic factors influence gingivitis attachment loss, and bone height 2. Sri Lankan Tea workers

Poorly controlled adult diabetic has _____ times prevalence for perio disease

2.9 times

Absence of BOP: __% sensitivity was calculated for frequent BOP

29

Current smokers are ____ times more likely to have severe periodontitis vs. non-smokers

3

Smokers with poorly controlled diabetes has ____ times more prevalence for perio disease

4.6 times

___% of periodontitis cases in the US were current smokers and ____% former smokers

42, 11

Periodontitis in type 1 diabetes teenagers increased

5-fold prevalence

Genetic factors are ___% of risk

50

Absence of BOP: Positive predictive value for disease progression was ___%

6

Tobacco smoke contains more than ______ known carcinogens

60

Periodontal disease is the ______ complication of diabetes

6th

Absence of BOP: Negative predictive value was __%

98

Smoking cessation counseling must be _________

A cornerstone of periodontal therapy

Exposure can be at:

A single point Multiple points or Continuous

Gingivitis effects of smoking (NEED TO KNOW)

Decreased gingival inflammation and bleeding on probing (VASOCONSTRICTION)

No attachment loss is a predictor for _________.

Decreased risk for future loss of attachment

There is a dose-response relationship between ______.

smoking and prevalence & severity of periodontitis

Continuous absence of BOP is a reliable predictor for ________.

the maintenance of periodontal health

Periodontitis alterations include:

Alterations in IL-1 genes

Risk markers / predictors

Associated with increased risk for disease but do not cause the disease - Previous history of periodontal disease - Bleeding on probing (Can tell us disease activity)

TRUE OR FALSE: Quantity of plaque indicates risk

FALSE: Quantity of plaque may not indicate risk

Severe existing loss of attachment is a predictor of ______________.

Future loss of attachment