Perio Study Guide For Test 3

Front 1

What 3 classification of medications can cause a gingival overgrowth?

Back 1

1) Antiseizure -->phenytoin aka dialantin,
2) Calcium Channel Blockers (CCB's) --> nifedipine (used in tx of angina, hypertension and cardiac arrhythmias
3) Immunosuppressants-->cyclosporine

Front 2

What are systemic risk factors?

Back 2

They can modify the host response to conditions like perio disease. They con't cause the disease.

Front 3

What are some proven systemic risk factors of Periodontal disease?

Back 3

Smoking
Diabetes
Hormone alteration,
psychosocial stress,
genetic factors
AIDS & some systemic meds.

Front 4

Why is there a dual relationship between Perio Disease & Systemic health?

Back 4

Perio disease may have an adverse effect on systemic health.
Systemic health may increase the severity or assist in the initiation of perio disease.

Front 5

Why is smoking a risk factor of perio disease?

Back 5

Because of what it does to the body… Cigarette smoke is acidic.
Impairs fibroblast function (limits tissue turnover) Increased keratinization of epithelial cells (fibrotic gingiva)
Reduces PMN's ability to "eat well & die"
Causes vasoconstriction (tissues become ischemic, less blood supply & nutrients-->leads to impaired wound healing.)

Front 6

What may be responsible for more than HALF of the cases of perio disease in the US?

Back 6

Smoking!
Suppresses Immune response
Products of the cigarette smoke remain on root surfaces & in GCF so provide a reservoir of irritants for soft tissue-->thus preventing tissue attachment.

Front 7

What are some risks of smokeless tobacco?

Back 7

Greater risk of recession
Greater risk of oral cancer

Front 8

There are more than _________ (number) chemicals in tobacco/smoke and ______ (number) of them are known carcinogens!

Back 8

4000 chemicals and 43 of them are known carcinogens

Front 9

What bacterias (by name) are at higher levels among smokers?

Back 9

T.forsythensis & P Gingivalis
(Smokers do not respond as well to conventional therapies for perio disease.)

Front 10

Clinically, what do you tend to see orally in smokers?

Back 10

Tissue is more fibrotic, pale & has rolled margins.
More calculus but the same levels of plaque
Absense or diminished BOP-->due to fibrotic tissue. Nicotine stomatitis

Front 11

What is a benefit of quiting smoking regarding gingival bleeding & inflammation?

Back 11

There will be more bleeding & inflammation.
This is good as the body is seeing the immune response returning to normal. The bleeding and inflammation will subside with good OH
May take a year or more to get normal color & consistance depending on length & severity of habit.

Front 12

What is Type I vs Type II diabetes?

Back 12

Type I: Insulin dependent (5-10% of cases)
Type II: Non-insulin dependent (90-95% of cases)

Front 13

Why would diabetics be more likely to have perio disease?

Back 13

Delayed wound healing
Suseptible to infection

*Controlled diabetics do not experience the same severity of oral health issues as uncontrolled diabetics.* Remember, insulin is what helps get the sugar into the cell.

Front 14

What are some symptoms of Type I diabetes?

Back 14

Excessive thirst (polydipsia)

Excessive urination (polyuria)

Front 15

What is happening in the body for Type I diabetes to occur?

Back 15

Pancrease does not produce insulin….so person has to take injections

Front 16

What is happening in the body for Type II diabetes to occur?

Back 16

The body isn't using the insulin that is produced effectively.

Front 17

What are some risk factors of Type II diabetes?

Back 17

Obesity Aging

Front 18

What is gestational diabetes?

Back 18

Diabetes that occurs during pregnancy…usually disappears after pregnancy

Front 19

Approximately what % of pregnant women are impacted by gestational diabetes?

Back 19

4%
*There is research indicating the risk for developing Type II later in life will increase if you had gestational diabetes

Front 20

What is the "big deal" about perio disease in pregnant women?

Back 20

They are 7-8 times more likely to deliver a premature baby with low birth weight!

Front 21

Since periodontitis means there is a high level of pro-inflammatory cytokins in the system, what does this mean to the diabetic patient?

Back 21

Cytokines increase insulin resistance by 50%.

This means it is compounding the insulin problem and not using the existing insulin properly--> now more difficult to control Type II diabetes. As such, the insulin does may need to be temporarily increased. ("Sick Day" regimin)

Front 22

Uncontrolled or poorly controlled diabetics are _____times more likely to develop perio disease than non-diabetics.

Back 22

2-3 times

Front 23

How does diabetes affect periodontal health?

Back 23

> of glucose in GCF-->food source for bacteria
Defective PMN's-->impared 1st line of defense
Advanced Glycated End product (AGE)--> increased hyperglycemia-->stimulates macrophages to increase cytokine production--> inflammation & more macrophages in the area. Its a catch 22.

Front 24

At what age might you see periodontitis appear in Type I diabetics?

Back 24

As early as age 12…may need to increase appoints to 3-4 month recare.

Front 25

__________(habit) & diabetes make a really bad combination?

Back 25

Smoking!

Front 26

What are some oral manifestations of diabetes?

Back 26

Reduced salivary flow
Burning Tongue
Easy gingival bleeding
Candida (due to extra glucose..not getting into cell)

Front 27

What are some Tx considerations for the diabetic Pt?

Back 27

Schedule AM appts
Avoid long appts
Pt should eat at appropriate times (allow snack breaks)

**Encourage Pt to tell you if they notice changes in how they feel durin appt.**

Front 28

What is osteopenia?

Back 28

Pre-osteoperosis-->loss of bone mineralization

Front 29

How can osteopenia be a risk factor for perio disease?

Back 29

You have thinner bone..you won't lose your teeth however, unless you have the bugs…but the bone is now less dense.

Front 30

Who is typically more at risk for osteopenia?

Back 30

Women
Inactive People
Wheelchair bound
Malnutrition
*There is a correlation between density of the MN and the hipbone-->risk factor for osteoperosis.*

Front 31

So will someone with osteoperosis develop perio disease? Why or why not?

Back 31

Not necessarily…you may have weak bone but you GOTTA HAVE the BUGS!

Front 32

What are bisphosphonates used to Tx?

Back 32

Osteoperosis and certain types of cancer.

Front 33

What is the problem with bisphosphoneates when it comes to perio disease?

Back 33

They stay in your system for years and years and don't allow for the turnover of bone.
You get a buildup of new bone but NO breakdown of dead/old bone..this will inhibit the healing and impact the blood supply to the area-->results in Osteonecrosis of the jaw!

Front 34

For the Pt who has used bisphosphonates, what is our role as DH's?

Back 34

Do a thorough HH
Educate the Pt on risks of Bisphosphoneates related to perio disease

Front 35

How can a change in hormones be a risk factor for Perio Disease?

Back 35

Increased sex hormones can increase blood flow to gingival tissue-->leads to increased sensitivity to local irritants (plaque) --> leads to a change in the microflora in the sulcus and the type of bacteria in the plaque.

*Pt needs good home care during puberity & pregnancy!*

Front 36

Which month of pregnancy are hormones reaching their peak? (Inflamation of gingiva reaches peak)

Back 36

8th month…so pregnancy can lead to gingivitis because you're more sensitive to plaque and this leads to gingivitis or pyogenic granuloma.

Front 37

Why might you instruct an overweight female to lose weight before ever getting pregnant?

Back 37

To avoid gestational diabetes and more likely to deliver a healthy baby.

Front 38

What do you need to keep in mind about oral contraceptives & perio disease?

Back 38

BC pills can create an exaggerated response to plaque.

*It’s the level of synthetic hormone not the type that cause problems.*
*Not as big a problem with modern day BC pills as they once were.*

Front 39

For someone experiencing menopause or post-menopause what can we suggest if they are experiencing xerostomia symptoms?

Back 39

Utilizing xyletol gum/candy. (avoid cinnamon)

What they are experiencing is usually from lower levels of circulating hormones.

Front 40

Why would stress be a risk factor of perio disease?

Back 40

People under stress may change their behaviors R/T: Neglect of OH
Change in Diet I
ncrease smoking
Bruxism
*The production of cortisone under stress causes immunosupression.*

Front 41

How does genetics play a role as a risk factor for Perio disease?

Back 41

Down's syndrome leads to increased Perio risk
Having the cytokine IL-1-->leads to more inflamation and more MMP's; neutrophil abnormalities can increase risk.

Front 42

What portion of Down's folks have abnormal neutrophil function?

Back 42

1/2….they are more prone to infection and congenital heart disease too.
*60-80% of Down's Pt's have perio disease-->need 3-4 month recall.*

Front 43

What does the IL-1 genotype+ (positive) mean?

Back 43

It’s a mutation in genes that causes an elevated IL-1 production…67% of patients with severe perodontitis are IL-1 genotype positive.

Front 44

People with the IL-1 genotype + represent what % of the population?

Back 44

30%

Front 45

IL-1 genotype + have a ______ times greater risk of severe periodontitis than IL-1 - (negative)?

Back 45

7 times greater risk of sever perodontitis than the IL1 genotype -

Front 46

Since HIV Pt's have a compromised immune system what does this mean for perio disease?

Back 46

Increased Severity of Perio disease too..the immunosuppression affects the oral cavity as well.
3-4 Month recall.

Front 47

HIV Pt's may present with linear gingival erythema. What does this mean?

Back 47

They may have a 2-3mm band of erythema along the margins of teeth.
Can be localized
May not have BOP
Tx with debridement and use antimicrobial rinses to keep any fungal infections in check!

Front 48

HIV Pt's may present with NUG. What is NUG?

Back 48

Necrotizing Ulcerative Gingivitis
(Has the same appearance as non HIV's PT's with condition but is more often found in HIV Pt's.)

Front 49

What is NUP and how does it look different from NUG?

Back 49

Necrotizing Ulcerative Periodontitis
It has a pseudomembrane along the gum line.
NUP is more severe, has a rapid progression and the response to Tx depends upon which stage of HIV the Pt is in.

Front 50

Why is alcohol abuse a risk factor for Perio disease?

Back 50

Due to neglect and malnutrition

Front 51

What 3 classification of medications can cause a gingival overgrowth?

Back 51

1)Antiseizure -->phenytoin aka dialantin,
2) Calcium Channel Blockers (CCB's) --> nifedipine (used in tx of angina, hypertension and cardiac arrhythmias
3)Immunosuppressants-->cyclosporine

Front 52

What do these 3 classes of Meds influence gingival fibroblasts to over produce?

Back 52

Collagen matrix which leads to gingival enlargement-->Gingival Hyperplasia!

Front 53

What is crutial for Pt's with gingival hyperplasia?

Back 53

Good OH
More Frequent Visits
Use antimicrobial mouthwash
(surgical intervention may be waranted)

*We may need to send a letter to their Dr letting them know if the gingival effects of the med's.*

Front 54

In the Periodontitis Pt there is an increase of cytokine production. How does this impact the diabetes Pt?

Back 54

Increased cytokins means insulin can't be taken into the cell which means the glucose can't get into the cell and diabetes can get worse.

Front 55

What conditions can Perio Disease contribute to? (health wise)

Back 55

Development of Heart Disease
Premature/underweight babies
Poorly controlled diabetes
Alzheimers disease

Front 56

Why is someone with endocarditis more at risk for a perio-systemic disease?

Back 56

Because bacteria/by-products are being introduced into the blood stream whenever an invasive procedure is performed in the mouth.
This could cause bactermia--> this is why endocarditis Pt's will pre-medicate.

Front 57

Since oral bacteria has been found in the lower respiratory tract who is at greater risk for perio disease?

Back 57

Pt's who aren't amblitatory (this is why the hospital wants Pt's up & moving around)
Pt's with Emphesima or Cronic Respiratory Problems

Front 58

Why does untreated perio disease make it more difficult for diabetics to control their blood sugar levels?

Back 58

The chronic release of cytokines interferes with the insulin bringing glucose into the cell

Front 59

What are 2 possible ways that oral bacteria affect the risk of heart disease?

Back 59

1) Oral bacteria may directly infect blood vessel wall..local inflammation & buildup of fatty deposits inside the heart arteries.
2) Oral bacteria may enter the blood & cause small blood clots which contribute to clogged arteries

Front 60

What does C-reactive protein in the blood indicate?

Back 60

It is a marker on blood pannels that the body is fighting inflammation (somewhere within the body)

Front 61

C-reactive protein stiumlates monocytes & macrophages. What does this mean regarding perio disease?

Back 61

The stimulation of monocytes & macrophages inturn stimulate the complement system and cause more inflamation.

*C-Reactive Protein is elevated in Pt's with periodontitis & heart disease.*

Front 62

Fibrinogen is produced in the liver in response to inflammation. It is usually elevated in Pt's with Periodontitis. Concerning Heart Disease what else does fibrinogen do?

Back 62

Causes small blood clots…can lead to an MI or stroke…. Another reason Perio disease and heart disease can be risk factors for each other.

Front 63

What is another name for Ischemic Cerebral Infarction?

Back 63

Non-hemorrahagic stroke

(A lack of blood flow so leads to a lack of Oxygen to the brain)

Front 64

What often precedes an ICF (non-hemorrhagic stroke)

Back 64

A systemic bacterial or viral infection.

*Yet another risk factor for perio disease*
*Often the infection is within 1 week of the "event"

Front 65

Studies show that which prostaglandin is ofen a factor for preterm babies and early onset of labor?

Back 65

PGE-2

Front 66

Why is Perio disease a possible risk factor for Alzheimer's?

Back 66

Because early exposure to inflammatory diseases may increase the risk of Alzheimer's

Front 67

As a reminder, what causes the host response in perio disease?

Back 67

Bacteria and their by-products
*You want whole body health.
Perio may increase the risk for several systemic disease.*

Front 68

What systemic disease might perio disease be a risk factor of?

Back 68

Coronary Heart Disease
Stroke
Respiratory Disease
Pre-term Low birth weight babies

Front 69

What causes gingivitis?

Back 69

A reaction between bacteria & by-products with the host response.

Front 70

What is the pre-cursor to getting cold sores? (What has to happen first?)

Back 70

PHG-->Primary Herpatic Gingivitis

**Remember PHG is the primary infection of Herpes Simplex virus. Its very painful! Must have this condition 1st to develop cold sores later.*

Front 71

What are some common features for all gingival diseases?

Back 71

All involve gingiva in some form

Front 72

What is the most common form of gingival disease?

Back 72

Dental plaque induced

Front 73

What would be a Tx plan for someone you suspect of having PHG?

Back 73

Prevent dehydration
Have a soft diet
Avoid alcohol
Utilize "magic mouthwash"
If temp is >101 they may need antibiotics as they are susceptible to 2ndary infections.

Front 74

**Understand how the data you collect when performing a gingival assessment may correlate to the Pt's disease state (or lack there of.)

Back 74

Know & Understand This

Front 75

What do you have to have in order for the inflammatory response to begin in gingival tissues?

Back 75

Biofilm

Front 76

When can the color of gingiva be deceptive?

Back 76

When keritinazation is present.

*Understand why this is the case.*

Front 77

What is another name for cytokines?

Back 77

Interleukins

Front 78

IL-1 is a _________.

Back 78

Cytokine

Front 79

What is a condition that a Pt might be taking cyclosporine?

Back 79

Organ Transplant…remember immuno-suppressors can result in enlarged gingival growth.

Front 80

An elevated level of _________ in the body is considered a risk factor for Heart Disease & is found in Pt's with periodontitis.

Back 80

C-Reactive Protein

Front 81

What/where is a naturally occuring concavity that is considered a local risk factor due to its plaque retention properties?

Back 81

Mesial of MX 1st pre-molar

Front 82

Excessive forces placed on healthy periodontium is considered which type of occlusal trauma?

Back 82

Primary

*Secondary would be the excessive force on unhealthy periodontium.*

Front 83

What type of diabetes is most prevelant?

Back 83

Type II

Front 84

Which Calc is more mineralized, supra or sub and what are the % or each?

Back 84

Sub G Calc is more mineralized @ 60%
Supra is only 30% mineralized.

Front 85

What might cause gingival clefts?

Back 85

Oral habits (chewing on hair pins)
Possible excessive brushing?