Risk factors in Periodontal Disease
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Risk factors in Periodontal Disease



Risk factors in Periodontal Disease

Risk factors in Periodontal Disease



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Risk factors in Periodontal Disease Risk factors in Periodontal Disease 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!!!