risk factors
TRANSCRIPT
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Risk Factors
Associated with
Periodontal Disease
Dr. Samjhana Kashaju Joshi
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Periodontitis is an inflammatory condition
initiated by microbial plaque
influenced by an array of factors that affect the development and progression of the disease.
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The development and course of periodontitis
depends upon
specific inherited, behavioral or environment conditions ---so called risk factors.
Risk factor --- can be modified Risk determinant---cannot be modified
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Risk factors
Smoking Diabetes Stress Drugs Systemic disease Nutrition
Risk determinants
•Genetics•Socioeconomic status•Gender
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Smoking
Major risk factor
Can be attributed to current or former smoking
Severity is directly related to both –the number of cigarettes smoked per day- the numbers of years a patient has smoked
Clinically---Smokers exhibit reduced gingival bleeding and inflammation---greater levels of periodontal pocketing in anterior maxillary segment
Impairment of local neutrophil function by tobacco smoke and its components
Affect the healing ability
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Diabetes
Type 1 diabetes ( IDDM)
Type 2 diabetes ( NIDDM)
Factors contributing are---
The degree of diabetic control The age of onset The duration of the disease
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Complex mechanism
a) Dysregulation of polymorph function b) Altered collagen metabolism c) Microvascular damage
“Share similar pathogenic mechanisms with diabetic foot ulcers”
Bi-directional relationship -- Diabetes and Periodontal disease
“Successful treatment and maintenance of periodontal health in diabetic patients should be a major goal, to improve
both the oral and general health of the patient”
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Stress
Has impact on the normal functioning of the immune system
--Negative life events --Unemployment --Social strain
Mechanism
Specific periodontal pathogens can utilize stress hormones to stimulate growth and expression of virulence factors
providing another potential mechanism linking stress levels with periodontitis
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Drugs
Anticonvulsant– Phenytion Immunosuppressant– Cyclosporin Calcium channel–blocking drugs as Nifedipine, Amlodipine
Induces gingival overgrowth classically begins in the inter-dental papillae
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Complex interaction between
the drugs, host fibroblasts and inflammatory cells
resulting in an increased deposition of connective tissue
supporting a hyperproliferative epithelium
Difficulty in plaque control adds oedematous inflammatory
component to the overgrowth
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Management should begin by change in medication in consultation with the patient’s physician.
Mechanical cleaning and meticulous plaque control.
Surgical removal of residual redundant tissue may also be required.
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Systemic Disease
Tissue destruction associated with periodontitis results from the
host response to bacterial insult.
Bystander Damage---periodontal pathogens and the immune
response
Systemic conditions affect the host defense mechanism
--positive impact on disease progression
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Systemic conditions and periodontitis
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Nutrition
Potential role of diet and nutrition
Severe Vitamin C deficiency---Scorbutic gingivitis
Ulcerative gingivitis, gingival hemorrhage, rapid periodontal pocket formation, tooth loss
Vitamin- C – an important antioxidant
Role in the inhibition of reactive oxygen species (ROS)
tissue damage in periodontal disease
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Genetic Factors
Major role in determining disease severity
Caused by gene polymorphisms, IL-1 acting as a contributory risk factor
IL-1 activates the inflammatory and immune responses to bacterial virulence factors stimulates the release of host proteolytic enzymes and osteoclastic activation --- results in periodontal tissue breakdown
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Genetic conditions and periodontal diseases
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Socioeconomic status
Complex, multi-faceted parameter
Higher socioeconomic status-
better plaque control and increased dental visits
decreased prevalence of periodontal disease
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Gender
Higher in males
Related to poorer plaque control and lower dental attendance rates in males
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Tooth-related factors
Increased risk due to an increased risk of plaque retention--- inaccessibility to cleaning.
Occlusal forces—Class II div 2 malocclusions, loss of posterior support.
Affects both the healthy periodontium and the affected teeth with existing periodontal disease.
Removal of --Occlusal interferences in both centric occlusion and lateral excursive movements
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Local risk factors for periodontal disease
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Microbial factors
Over 500 bacteria have
been identified
Authors categorized
bacterial species into
colour coded groups
based on their
pathogenecity:
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Lets take “History” of every patient very carefully keeping all these probable risk factors in our mind!!!
Lets always think of “Risk Assessment”
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Complexity 1 BPE Score 1 – 3 in any sextant
Complexity 2 BPE Score of 4 in any sextant Surgery involving the periodontal tissuesComplexity 3 Surgical procedures associated with osseointegrated implants. Surgical procedures involving periodontal tissue augmentation
and/or bone removal (e.g. crown lengthening surgery).
PERIODONTAL TREATMENT ASSESSMENT
Based upon the Basic Periodontal Examination (BPE) Criteria:
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BPE score of 4 in any sextant and including one or more of the following:
Patient’s age under 35 years.
Smoking 10+ cigarettes daily.
A concurrent medical factor that is directly affecting the periodontal tissues.
Root morphology that adversely affects prognosis.
Rapid periodontal breakdown >2 mm attachment loss in any one year.
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Complexity 1 cases may be treated in general practice,
Complexity 2 cases either referred or treated by the GDP and
Complexity 3 cases mostly referred.
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