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smoking and periodontal disease/ inf of syst cond/ impact of perio infect on sys health
Terms in this set (142)
in order to have periodontal disease, you need a ____ insult to the body, and you need a susceptible ___!
bacterial / host
you need a bacterial insult to the body, and you need a susceptible host! You can't have periodontitis without these issues.t/f
____ health of the patient, and all the interactions that occur with our ___, really are the most important
systemic / environment
t/f if our systemic health is not good and stable, our teeth really don't matter that much!
bacteria debris and calculus>____>pocket formation>____
gingivitis/ alveolar bone loss
furcation involments, mobility, crown to root ratio, root form, pulpal involvement, occlusal trauma etc>___and ___
pocket formation and alveolar bone loss
___challange> host imm. inflam resp. >___ and __metabolism> clinical signs of ____ and progression
microbial/ connective tissue and bone
as many as ___trillion cigarettes are smoked annually across the globe
tobacco kills __million people each year
only ___% of people worldwide have access to smoking cessation services
about __% of people world wide are protected by smoke free laws
main risk factor associated with chronic destructive periodontal disease
2012: 8.6 mil with smoking related disease
___ deaths attributed to smoking
Much higher in ____
1/5 - europe
prevalence of current cigarette smoking among adults with 18 and over us 1997 - march 2015 (graph) has seemed to _____(inc. or dec)
most smoking deaths are related to? name 3
smoking is associated with a variety of ___and a majority of ___
cancers/ chronic systemic diseases
CO2, Ammonia, Formaldehyde, Cyanide, other toxins.
60 known carcinogens
Nicotine, "Tar", benzene, benzo(a)pyrene
Nicotine: lungs --> brain 10-20 seconds.
Nicotine: highly addictive• Increase BP, HR, Resp.
• Peripheral vasoconstriction
how long does it take for nicotine to reach the brain from the lungs
how many known carcinogens are there
major risk factor for periodontitis
___% of periodontitis in the U.S. attributable to smoking
smokers ___x more likely to have severe periodontitis
bone loss __as rapid in smokers
T/F smokers have less gingival inflammation and BOP
T/F ask pt about CURRENT smoking and PAST smoking not just today
the number of packs per day multiplied by the number of years the patient has smoked
how may cigarettes are in one pack avg.
for former smokers it is imp. to document ? (3)
how much they used to smoke
how many years they smoked
when they quit
t/f 20 cigs per day may be a convenient resp. rather than an accurate response.
t/f cultural factors may also inf. resp.
? have smoked >or= 100 cigs in their lifetime and currently smoke
? have smoked >or= 100 cigs in their lifetime and do not currently smoke
? have not smoked >or= 100 cigs in their lifetime and do not currently smoke
smoking ___ging. inflam. and BOP
smoking ____prevalence and severity of perio destruction
smoking ___pocket depth attachment loss and bone loss
smoking ___rate of perio destruction
smoking __prev. of sev. perio
smoking ___tooth loss
smoking __prev. w/ inc. # of cig smoking per day
smoking ___prev. and severity w/ smoking cessation
the 5 a's in order for tobacco secession
ask advice assess assist arrange
__ about status part of med hist
__associations bet oral disease and smoking
do not judge where pt reveals interest in quitting
___pt interest and readiness
may not be in action phase- so do this step every time
___pt with quit attempt
by seeking for help pt needs if trained use techniques
___follow -up visit / referral
keep in regular contact!!
smoking ____on rate of plaque accumulation
smoking ____colonization of shallow periodontal pockets by periodontal pathogens
smoking ___levels of periodontal pathogens in deep periodontal pockets
smoking ___neutrophil chemotaxis, phagocytosis, and oxidative burst
smoking __tumor necrosis factor - a and prostaglandin E2 in GCF
smoking __neutrophil collagenase and elastase in GCF
smoking __production of prostaglandin E2 by monocytes in response to lipopolysaccharide
smoking ___gingival blood vessels with __inflammation
smoking__GCF flow and BOP with __inflam
smoking__time needed to recover from local anesthesia
smoking___clinical resp. to root surface debridement
smoking___red. in pocket depth
smoking__gain in CAL
smoking__neg. impact of smoking with ___level of plaque control
smoking ___pocket depth red and ___gain in CAL after access flap surgery
smoking __det. of furcations after surgery
smoking __gain in CAL __bone fill __recession and ___membrane exposure after guided tissue regeneration
dec dec inc inc
smoking ___root coverage after grafting procedures for localized gingival recession
smoking __pocket depth red after bone graft procedures
smoking __risk for implant failure and periimplantitis
smoking ___pocket depth and attachment loss during maintenance therapy
smoking___disease recurrence in smokers
smoking__need for retreatment in smokers
An estimated 25.8 million individuals (both children and adults)—8.3% of the US population—have diabetes. Approximately ___million of these individuals are unaware that they have the disease.
Insulin-dependent diabetes mellitus
caused by a cell-mediated autoimmune destruction of the insulin-producing beta cells of the islets of Langerhans in the pancreas,
which results in insulin deficiency
Non-insulin-dependent diabetes mellitus
caused by peripheral resistance to insulin action, impaired insulin secretion, and increased glucose production in the liver.
MOST common form of diabetes,and it accounts for 90%to95%of all diagnosed cases in adults.
Type 1 diabetes mellitus
type 2 diabetes mellitus
Oklahoma: __th worst diabetes rate, 12%
Diabetes oral manifestations
Prevalence and Severity• Type I: 19+year olds - 39% have periodontitis
•__ frequency of periodontal abscess
inc/ inc/ inc
retino,nephro, neuro pathy
macrovascular disease(cardiovascular/cerebrovascular/peripheral vascular)
altered wound healing
diabetes and biological effects
bact. pathogens- inc ___in GCF
effects on subging. bact unclear
impaired function of PMNs, monocytes/macrophages
___alteration in antibody production
Altered Collagen Metabolism
Glycosylation ---- AGEs (advanced glycation end-products)
Interferes with collagen turnover
Casual plasma glucose ≥
Fasting plasma glucose ≥
2hr post-prandial pl. glucose ≥
HbA1c (less than ___ to 6.5%) (7.0 for Perio Staging and Grading)
___ is a global concern with serious health consequences including diabetes mellitus and cardiovascular disease. It is believed that the condition of excess adipose tissue contributes to an___systemic proinflammatory response in these individuals.
a condition of abdominal obesity combined with two or more of the following metabolic disturbances: hypertension, dyslipidemia, and hyperglycemia.
t/f Individuals diagnosed with metabolic syndrome are at increased risk for developing type 2 diabetes mellitus, and cardiovascular disease.
t/f The association between periodontitis and metabolic syndrome is thought to be the result of systemic oxidative stress and an increased inflammatory response.
leukemia causes (3)
gingival bleeding and enlargement and oral ulceration
NUG is found in (3)
soldiers trench mouth/ students/ smoking
OHI, Clenching/Grinding, smoking
Cortisol suppresses immune response
t/f Nutritional Deficiencies do not cause Gingivitis/Periodontitis
t/f Nutritional Deficiencies do produce oral tissue changes
Bisphosphonate-related osteonecrosis of the jaw
uses-Actonel (Risedronate)¡ Boniva (Ibandronate)¡ Fosamax (Alendronate)
uses Zometa (Zoledronate) ¡ Aredia (Pamidronate)
provides relatively weak retrospective anecdotal evidence
may suggest that further study is needed
compares groups of subj. at a single point in time
stronger than case report
fairly easy to conduct
relatively inexpensive to conduct
follows groups of subj. over time
stronger than cross sec study
studies with a control group much stronger than studies without controls
more diff and exp to conduct
examines the effects of some intervention
studies with a control group much stronger than studies without controls
strongest form of evidence is the randomized controlled intervention trial
diff and exp to conduct
systematically evaluates evidence from mult studies esp rand cont trials
uses clearly defined guidelines for the selection of evidence to be inc. or excluded from the review
examines for heterogeneity in the overall data to indicate variations in study design sample pop and assessment methodologies
The ___ microbiota in patients with periodontitis provides a significant and persistent gram-negative bacterial challenge to the host that is met with a potent immunoinflammatory response. These organisms and their products, such as lipopolysaccharides (LPSs), have ready access to the periodontal tissues and to the circulation via the ___ epithelium, which is frequently ulcerated and discontinuous
___ are common after mechanical periodontal therapy, and they also occur frequently during normal daily function and oral hygiene procedures.
The total surface area of pocket epithelium in contact with subgingival bacteria and their products in a patient with generalized moderate periodontitis has been estimated to be approximately the size of the ___ of an adult hand, with even larger areas of exposure in cases of more advanced periodontal destruction.
The ultimate medical outcome measure is ___. A number of studies suggest that an increased mortality rate from various causes is associated with inflammatory periodontal diseases.
Dietrich et al. showed that for those subjects with the most alveolar bone loss (>21% alveolar bone loss at baseline), the risk of dying during the follow-up period was __% higher than for all other subjects, due to a CHD related event such as MI.
___ susceptibility factors that place individuals at risk for periodontitis may also place them at risk for systemic diseases such as cardiovascular disease.
In a prospective longitudinal study of subjects with type 2 diabetes, those with severe periodontitis had ___ times the risk of death from ischemic heart disease or kidney disease as subjects without periodontitis or with only slight periodontitis. (Saremi et al.)
___-related events are a major cause of death. MI has been associated with acute systemic bacterial and viral infections and is sometimes preceded by influenza-like symptoms.
Localized infection that results in a ___ inflammatory reaction (like periodontal disease) has been suggested as a mechanism underlying CHD in these individuals.
Because ___ is a major determinant of CHD-related events, dental health has also been related to coronary atheromatosis.
There is evidence that the extent of periodontal disease may be associated with CHD. For example, there may be a ___ risk for CHD-related events, such as MI, in subjects who have periodontitis affecting a greater number of teeth in the mouth compared with those who have periodontitis involving fewer teeth.
¡ Periodontal disease is a risk factor for CHD!
Occlusion vs narrowing of a coronary artery
systemic or periodontal infaction____fibrinogen, WBC count, von willebrand factor, and blood viscosity> ischemic heart disease
Routine daily activities such as mastication and oral hygiene procedures result in frequent ___ with oral organisms.
Periodontal disease may predispose the patient to an ___ incidence of bacteremia, including the presence of virulent gram-negative organisms associated with periodontitis
t/f There is a greater risk of bacteremia after toothbrushing in patients with higher levels of plaque, calculus, and gingivitis as compared with those with minimal plaque and gingival inflammation.
Subjects with generalized gingival bleeding after brushing showed an almost ____ increase in their incidence of bacteremia as compared with those with minimal gingival bleeding.
Platelet aggregation plays a major role in thrombogenesis, and most cases of acute MI are precipitated by thromboembolism. Oral organisms may be involved in coronary thrombogenesis. Platelets selectively bind some strains of Streptococcus sanguinis, which is a common component of ___ plaque, and Porphyromonas gingivalis, which is a pathogen closely associated with ____
Periodontitis-associated bacteremia with certain strains of S. sanguinis and P. gingivalis may promote acute thromboembolic events via interaction with circulating ___.
is a focal thickening of the arterial intima, the innermost layer lining the vessel lumen, and the media, the thick layer under the intima that consists of smooth muscle, collagen, and elastic fibers.
The formation of atherosclerotic plaques is precipitated by damage to vascular endothelium that results in an inflammatory response in which circulating ____ adhere to the vascular endothelium.
In animal models, ___ bacteria and associated ___ cause infiltration of inflammatory cells into the arterial wall, proliferation of arterial smooth muscle, and intravascular coagulation.
t/f There is strong evidence that periodontal bacteria disseminate from the oral cavity to the systemic vasculature, can be found within distant tissues, and can live within those affected tissues.
t/f In several studies of atheromas obtained from humans during endarterectomy, more than half of the lesions contained periodontal pathogens, and many atheromas contained multiple different periodontal species.
perio infect> gram - and LPS>endothelial damage platelet adhesion/aggregation/ monocyte infiltration/ proliferation>?> atheroma formation vessel wall thickening thromboembolic events
cytokine growth factor prod
Acute-phase proteins such as C-reactiveprotein (CRP) and fibrinogen are produced in the ___ in response to inflammatory or infectious stimuli and act as inflammatory markers.
CRP induces monocytes and macrophages to produce tissue factor, which stimulates the coagulation pathway and ___ blood coagulability. ___ fibrinogen levels may contribute to this process. CRP also stimulates the complement cascade, further exacerbating inflammation.
Periodontal diseases may have both ___ effects on the major blood vessels (e.g., atheroma formation) and ___effects that stimulate changes in the cardiovascular system (e.g., elevation of systemic inflammatory responses).
t/f Erectile dysfunction (ED) is associated with endothelial dysfunction, and elevated levels of oxidative stress and systemic inflammation are common to both periodontal disease and ED.
In a large case-control study of almost 200,000 subjects in Taiwan, those with ED were significantly more likely to have chronic periodontitis than those without ED, with an overall significant odds ratio of ___ after adjusting for confounding variables.
Ischemic cerebral infarction, or stroke, is often preceded by systemic bacterial or viral infection. Some studies show up to a ___ times likelihood of having a stroke within a week of having had a systemic infection!
t/fStroke patients with a preceding infection had slightly higher levels of plasma fibrinogen and significantly higher levels of CRP compared with those without infection.
Stroke is classified as either hemorrhagic or non-hemorrhagic. ____stroke, or ischemic stroke, is usually caused by thromboembolic events and cerebrovascular atherosclerosis, whereas ___ stroke often results from a vascular bleed such as an aneurysm.
Periodontal disease has been associated primarily with an increased risk of ___ stroke.
In a case-control study, subjects with severe periodontitis had a 4.3 times higher risk of stroke than subjects with mild or no periodontitis. In another study, subjects with >20% mean radiographic bone loss at baseline were more than ___ times as likely to have a stroke than subjects with <20% bone loss.
periodontal treatement imp.insulin sensitivity >___glycemic control
The medical history of the patient, which EVERYONE has, is vital to understanding how to manage the patient as a whole, and also their periodontal condition. There are many suggestive relationships with the various systemic conditions and diseases, but there is no "hard and fast" direct causative relationships that says that "periodontal disease ____ systemic disease".
¡ Much more research is needed!
it is what it
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