Risk factors in Periodontal Disease


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Risk factors in Periodontal Disease

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Risk factors in Periodontal Disease

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