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Risk factors
 

Risk factors

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    Risk factors Risk factors Presentation Transcript

    • Risk Factors Associated with Periodontal Disease Dr. Samjhana Kashaju Joshi
      • Periodontitis is an inflammatory condition
      • initiated by microbial plaque
      • influenced by an array of factors that affect the development and progression of the disease.
      • 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
      • Risk factors
      • Smoking
      • Diabetes
      • Stress
      • Drugs
      • Systemic disease
      • Nutrition
      • Risk determinants
      • Genetics
      • Socioeconomic status
      • Gender
    • 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
    • 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
      • 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”
    • 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
    • Drugs
      • Anticonvulsant– Phenytion
      • Immunosuppressant– Cyclosporin
      • Calcium channel–blocking drugs as Nifedipine, Amlodipine
      • Induces gingival overgrowth classically begins in the inter-dental papillae
      • 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
      • 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.
    • 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
    • Systemic conditions and periodontitis
    • 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
    • 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
    • Genetic conditions and periodontal diseases
    • Socioeconomic status
      • Complex, multi-faceted parameter
      • Higher socioeconomic status-
      • better plaque control and increased dental visits
      • decreased prevalence of periodontal disease
    • Gender
      • Higher in males
      • Related to poorer plaque control and lower dental attendance rates in males
    • 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
    • Local risk factors for periodontal disease
    • Microbial factors
      • Over 500 bacteria have
      • been identified
      • Authors categorized
      • bacterial species into
      • colour coded groups
      • based on their
      • pathogenecity :
      • Lets take “History” of every patient very carefully keeping all these probable risk factors in our mind!!!
      • Lets always think of “Risk Assessment”
      • Complexity 1
      • BPE Score 1 – 3 in any sextant
      • Complexity 2
      • BPE Score of 4 in any sextant
      • Surgery involving the periodontal tissues
      • Complexity 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:
    • 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.
      • 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.
    • Thank you!!!