This document discusses risk assessment for periodontal disease. It begins by defining risk assessment and identifying its importance in clinical decision making. It then describes various risk factors that can increase one's risk of developing periodontal disease, including age, tobacco use, diabetes, stress, genetics, pregnancy, cardiovascular disease, and poor oral hygiene. The document outlines approaches to performing risk assessment at the patient, mouth, tooth, and site levels. It discusses some tools that can aid in risk assessment, such as the Oral Health Information Suite and Periodontal Risk Calculator.
Role of Lifestyle, Compliance and Dental care Habits in Causation of Periodon...Dr. Ankit Mohapatra
Lifestyle,
ROLE OF SOCIOECONOMIC STATUS.
Periodontal disease
periodontitis
Physical Activity and Periodontal disease
Dietary Habits and periodontitis
Alcohol and periodontal disease
Substance abuse and Periodontal disease
COMPLIANCE and periodontal disease
Dental Care habits and periodontal disease
Dental visits
Dr. Hamed Mousa Bakri is from Al-Arda, Jazan in southern Saudi Arabia near the Yemen border. The region has a problem with oral cancer and periodontal disease due to widespread chewing of smokeless tobacco among elderly residents. Since childhood, Dr. Bakri has been troubled by these issues and motivated to study periodontics to help educate and treat his community. He is currently working as a general dentist in Jazan city while pursuing advanced training in periodontics through the postgraduate program at Riyadh Colleges to better address the oral health needs of his region.
This document discusses risk assessment in periodontal disease. It defines key terms like risk, risk factors, risk determinants, and risk markers. It categorizes different types of risk elements and describes several risk assessment tools that use various clinical and historical parameters to provide a risk score. The document concludes that while identification of risk factors has furthered understanding of periodontitis, predicting individual risk remains limited.
This document discusses risk assessment in periodontics. It defines key terminology like risk factors, risk determinants, risk indicators, and risk markers. It then describes the process of risk assessment, including assessing risk at the subject, tooth, and site levels. Several risk assessment tools and models are presented, including the Periodontal Risk Calculator, Periodontal Risk Assessment hexagonal diagram, and functional Periodontal Pentagon diagram. Risk factors for dental implants are also discussed. Overall the document aims to explain the importance of risk assessment for targeting periodontal treatment and providing proactive care for at-risk patients.
Awareness regarding the systemic effects- PERIO SYSTEMIC RELATIONSHIPNagarajan Srini
For decades, physicians and dentists have paid close attention to their own respective fields, specializing in medicine pertaining to the body and the oral cavity, respectively. However, recent findings have strongly suggested that oral health may be indicative of systemic health. Currently, this gap between allopathic medicine and dental medicine is quickly closing, due to significant findings supporting the association between periodontal disease and systemic conditions such as cardiovascular disease, type 2 diabetes mellitus, adverse pregnancy outcomes, and osteoporosis. Significant effort has brought numerous advances in revealing the etiological and pathological links between this chronic inflammatory dental disease and these other conditions. Therefore, there is reason to hope that the strong evidence from these studies may guide researchers towards greatly improved treatment of periodontal infection that would also ameliorate these systemic illnesses. Hence, researchers must continue not only to uncover more information about the correlations between periodontal and systemic diseases but also to focus on positive associations that may result from treating periodontal disease as a means of ameliorating systemic diseases.
Association between periodontal pathogens & systemic diseasesKyaw Htoo Lwin
This document discusses the association between periodontal pathogens and various systemic diseases. It begins with an introduction on the prevalence of periodontal disease and its potential links to non-oral systemic diseases. It then examines several specific diseases and conditions in more detail, including cardiovascular disease, cerebrovascular disease, respiratory infections, various cancers, diabetes, Alzheimer's disease, adverse pregnancy outcomes, osteoporosis, and rheumatoid arthritis. For each condition, it explores the potential pathways and mechanisms through which oral bacteria and the inflammatory response to periodontal disease may influence or contribute to the development and progression of the systemic condition.
This document summarizes risk factors for periodontal disease. It discusses several different types of risk factors including risk, risk factors, risk indicators, risk predictors/markers, and risk determinants. Major risk factors covered include tobacco smoking, diabetes, pathogenic bacteria, microbial tooth deposits, genetic factors, age, gender, socioeconomic status, and stress. For each risk factor, the document summarizes several studies that have examined the relationship between the risk factor and periodontal disease.
Role of Lifestyle, Compliance and Dental care Habits in Causation of Periodon...Dr. Ankit Mohapatra
Lifestyle,
ROLE OF SOCIOECONOMIC STATUS.
Periodontal disease
periodontitis
Physical Activity and Periodontal disease
Dietary Habits and periodontitis
Alcohol and periodontal disease
Substance abuse and Periodontal disease
COMPLIANCE and periodontal disease
Dental Care habits and periodontal disease
Dental visits
Dr. Hamed Mousa Bakri is from Al-Arda, Jazan in southern Saudi Arabia near the Yemen border. The region has a problem with oral cancer and periodontal disease due to widespread chewing of smokeless tobacco among elderly residents. Since childhood, Dr. Bakri has been troubled by these issues and motivated to study periodontics to help educate and treat his community. He is currently working as a general dentist in Jazan city while pursuing advanced training in periodontics through the postgraduate program at Riyadh Colleges to better address the oral health needs of his region.
This document discusses risk assessment in periodontal disease. It defines key terms like risk, risk factors, risk determinants, and risk markers. It categorizes different types of risk elements and describes several risk assessment tools that use various clinical and historical parameters to provide a risk score. The document concludes that while identification of risk factors has furthered understanding of periodontitis, predicting individual risk remains limited.
This document discusses risk assessment in periodontics. It defines key terminology like risk factors, risk determinants, risk indicators, and risk markers. It then describes the process of risk assessment, including assessing risk at the subject, tooth, and site levels. Several risk assessment tools and models are presented, including the Periodontal Risk Calculator, Periodontal Risk Assessment hexagonal diagram, and functional Periodontal Pentagon diagram. Risk factors for dental implants are also discussed. Overall the document aims to explain the importance of risk assessment for targeting periodontal treatment and providing proactive care for at-risk patients.
Awareness regarding the systemic effects- PERIO SYSTEMIC RELATIONSHIPNagarajan Srini
For decades, physicians and dentists have paid close attention to their own respective fields, specializing in medicine pertaining to the body and the oral cavity, respectively. However, recent findings have strongly suggested that oral health may be indicative of systemic health. Currently, this gap between allopathic medicine and dental medicine is quickly closing, due to significant findings supporting the association between periodontal disease and systemic conditions such as cardiovascular disease, type 2 diabetes mellitus, adverse pregnancy outcomes, and osteoporosis. Significant effort has brought numerous advances in revealing the etiological and pathological links between this chronic inflammatory dental disease and these other conditions. Therefore, there is reason to hope that the strong evidence from these studies may guide researchers towards greatly improved treatment of periodontal infection that would also ameliorate these systemic illnesses. Hence, researchers must continue not only to uncover more information about the correlations between periodontal and systemic diseases but also to focus on positive associations that may result from treating periodontal disease as a means of ameliorating systemic diseases.
Association between periodontal pathogens & systemic diseasesKyaw Htoo Lwin
This document discusses the association between periodontal pathogens and various systemic diseases. It begins with an introduction on the prevalence of periodontal disease and its potential links to non-oral systemic diseases. It then examines several specific diseases and conditions in more detail, including cardiovascular disease, cerebrovascular disease, respiratory infections, various cancers, diabetes, Alzheimer's disease, adverse pregnancy outcomes, osteoporosis, and rheumatoid arthritis. For each condition, it explores the potential pathways and mechanisms through which oral bacteria and the inflammatory response to periodontal disease may influence or contribute to the development and progression of the systemic condition.
This document summarizes risk factors for periodontal disease. It discusses several different types of risk factors including risk, risk factors, risk indicators, risk predictors/markers, and risk determinants. Major risk factors covered include tobacco smoking, diabetes, pathogenic bacteria, microbial tooth deposits, genetic factors, age, gender, socioeconomic status, and stress. For each risk factor, the document summarizes several studies that have examined the relationship between the risk factor and periodontal disease.
In this presentation, we answer two questions about the mouth-body connection. Why can the health of your mouth affect your whole body. And why are simple habits like daily brushing and flossing more important than you might think.
Systemic diseases, or conditions themselves do not cause periodontitis but alter host tissues to increase the progression of periodontal disease. Systemic diseases and conditions can influence the course of periodontitis or affect the periodontal supporting tissues independent of the presence of dental plaque. Most commonly affecting diseases are diabetes, neoplasms.
influence of oral environment on general healthBhargavi Vedula
Oral infections and inflammation can influence general health through several pathways. Gram-negative bacteria and pro-inflammatory cytokines from the oral cavity can spread through bacteremia and influence many body systems. Periodontitis has been associated with increased risk of cardiovascular disease, diabetes, preterm birth and low birthweight, respiratory infections, Alzheimer's disease, rheumatoid arthritis, renal transplant rejection, prostate health issues and potentially pancreatic cancer. While connections have been established, more research is still needed to fully understand the relationships and minimal interventions required to reduce health risks. The oral cavity represents an entry point for pathogens and inflammation that can impact overall wellness through multiple complex mechanisms.
This article reviews the relationship between oral health and diabetes mellitus. It discusses how diabetes can cause various oral health issues such as periodontitis, dental caries, oral mucosal diseases, and salivary dysfunction. Periodontitis is characterized by chronic inflammation and breakdown of tissues around the teeth. It affects 50-90% of adults and is considered the 6th complication of diabetes. Patients with diabetes are also more susceptible to dental caries, opportunistic fungal infections like candidiasis, and have reduced salivary flow that increases oral dryness. The review concludes that diabetes has adverse effects on oral health and dental care should be an important part of managing diabetes to improve patients' well-being and quality
External modifying factors of periodontal diseasesMonika
Terminologies
Periodontitis
Risk indicator, risk factor & risk predictor
Socioecological model of periodontal diseases
Introduction
External modifying factors
a. Role of tobacco products
Evidence from cross sectional studies
Evidence from longitudinal studies involving periodontal attachment loss & periodontal healing
Role of low socioeconomic status
Evidence from cross sectional studies
Evidence from longitudinal studies
c. Role of lifestyle & dental care habits
Evidence from cross sectional studies
Evidence from longitudinal studies
Role of Acquired Systemic & Infectious disease
Role of psychosocial stress
Effect of Allergies
Effect of epilepsy & phenytoin therapy
Effect of Human immunodeficiency virus
e. Conclusion
f. References.
Background: The COVID-19 pandemic and control measures taken by countries around the worldcause stress and anxiety. The outbreak of corona virus not onlyhas a major impact on the physical health of the community, but also has a foremosteffect on thementalhealth of the public.Investigating the coping strategies to deal with this unique crisis is essential. Objective: The aim of this study was to assess the impact of covid-19 on stress and coping responses among general population. Methods: A descriptive cross-sectional study is adapted among 100 general populations. A convenient sampling technique was applied. The demographic data were collected using a structured questionnaire via interview method. The level of stress was measured by the perceived stress scale (PSS) and coping responses was evaluated by the brief cope scale. Result: The study outcomesdisplaysthat 53 (53%) had moderate stress, 28 (28%) had mild stress and 19 (19%) had severe stress during Covid-19. In respect to level of coping strategies among general population, 96% of the participants used planning coping strategy, 93% of them used religion coping strategy followed by 92% used self-distraction coping strategy. Conclusion: In our study, general population presented a moderate level of stress, in addition avoidance coping strategies was mostly used.Aiding the mental health care needs of public during these difficult times (pandemic) should be the top priority soadequate measures must be taken to promote the mental health of general public.
This document summarizes various risk factors associated with periodontal disease. It discusses both modifiable and non-modifiable risk factors such as smoking, diabetes, stress, drugs, systemic diseases, nutrition, genetics, socioeconomic status, and gender. Specific conditions like type 1 and type 2 diabetes are explained in more detail. The relationship between periodontal disease and various systemic conditions is also covered briefly.
This document reviews the issue of HIV and aging, noting that people living with HIV are experiencing age-related conditions at earlier ages than normal due to factors like persistent inflammation and immune system defects caused by HIV and long-term antiretroviral treatments. Some of the key points discussed include the links between inflammation, premature aging, and increased risk of diseases like heart and kidney disease. More research is needed to understand how to better manage comorbidities and support quality of life as the HIV population continues to age. Advocacy, education, and improved clinical care guidelines that address complex chronic disease management are areas that require focus.
This document discusses the influence of systemic conditions on the periodontium. It begins by introducing periodontitis as a chronic bacterial infection and how host responses can vary between individuals. Systemic disorders can impair the host's immune defenses, creating opportunities for more severe periodontal disease. Several specific systemic factors are then examined in more detail, including hormonal changes, diabetes mellitus, and female sex hormones. The effects of these conditions on the periodontium are explored through their impact on factors like subgingival microbiota, polymorphonuclear leukocyte function, collagen metabolism, and wound healing. Treatment considerations for periodontal disease in systemic disease patients are also briefly addressed.
The document discusses the role of pediatricians in preventing chronic noncommunicable diseases. It outlines several factors that can impact childhood health and development with long-term consequences, including maternal smoking during pregnancy, preterm birth, maternal obesity, and environmental exposures. Maternal smoking during pregnancy is associated with increased risks of preterm birth, asthma, cardiovascular issues, and neurological and behavioral problems in children. Both undernutrition and overnutrition during pregnancy can also influence the health of offspring and increase risks of chronic diseases later in life. The document emphasizes the importance of pediatricians educating parents about modifiable risk factors and promoting healthy prenatal environments and lifestyles to reduce the future disease burden from noncommunicable diseases.
Sinusitis and Immunodeficiency - IDF Conferencesinusblog
This is Dr. Andrew Pugliese's powerpoint on the connection between chronic sinusitis and immunodeficiencies. This was specifically for an educational conference for the Immune Deficiency Foundation.
Diabetes and periodontal disease ,at two way relationshipLobna El Khatib
The document discusses the bidirectional relationship between diabetes and periodontal disease. It begins by providing overviews of diabetes and periodontal disease. It then explains how diabetes can increase the risk and severity of periodontal disease by altering oral microorganisms, the host immune response, blood vessels, and wound healing. Conversely, periodontal disease can negatively impact blood sugar control in diabetes by increasing systemic inflammation. Maintaining good oral hygiene and treating periodontal disease may help manage diabetes and reduce complications.
1.Comparism between Margot L. Van Dis and Edwin T. Parks Article and Tahrir ...MohammedAbdulhammed
Comparison prove that Tahrir N. Aldelaimi ( dean of college of dentistry / Anbar University ) have plagiarized 60% from a article belong to Margot L. Van Dis and Edwin T. Parks it under his name
This document provides an overview of current approaches in periodontal care. It discusses initial cause-related therapy including scaling and root planing as well as adjunctive use of antimicrobials. It also covers corrective therapy such as surgical procedures and regenerative techniques. Supportive therapy including ongoing maintenance is also emphasized. Modification of the biofilm using approaches like antimicrobial peptides and probiotics as well as modification of the host response through diet are presented as potential novel therapies. The roles of lasers in non-surgical periodontal therapy are also summarized.
This study reviewed the literature on the health effects of cooking with solid fuels in developing countries. It found that solid biomass fuel use is associated with increased risk of respiratory diseases. However, the effectiveness of improved cookstove interventions in reducing health risks is unclear as most studies only measured symptoms rather than objective health outcomes. Future research with reliable exposure biomarkers is still needed to determine the impact of improved cookstoves on health.
Non-communicable diseases cannot be spread from person to person and some are chronic, meaning they are present continuously or intermittently over a long period. Multiple sclerosis is an example of a degenerative disease that causes breakdown in body cells, tissues, and organs as it progresses. Some congenital diseases are caused by heredity while others are caused by a mother's lifestyle choices during pregnancy. Heredity passes traits from parents to children like eye color or sickle cell anemia. Factors you cannot control include heredity, age, gender, and ethnicity while factors you can control involve diet, exercise, weight, sleep, stress management, and avoiding tobacco, alcohol and other drugs. Environmental factors and substances can
There has been an increase in the predominance of diabetes mellitus over the past 40 years worldwide. The worldwide occurrence of diabetes in 2000 was approximately 2.8% and is estimated to grow to 4.4% by 2030. This data interprets a projected rise of diabetes from 171 million in 2000 to well over 350 million in 2030. The presence of hypertension in diabetic patients substantially increases the risks of coronary heart disease, stroke, nephropathy and retinopathy. Indeed, when hypertension coexists with diabetes, the risk of CVD is increased by 75%, which further contributes to the overall morbidity and mortality of an already high risk population. Patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality, and are disproportionately affected by cardiovascular disease. Most of this excess risk is associated with high prevalence of well-established risk factors such as hypertension, dyslipidaemia and obesity in these patients. Hypertension plays a major role in the development and progression of microvascular and macrovascular disease in people with diabetes. Lifestyle Modifications and pharmacotherapy are the choice for the Management of Hypertension in Patients with Diabetes.
The document provides World Gastroenterology Organisation global guidelines on celiac disease from April 2012. It was reviewed by an international team and covers definitions, epidemiology, diagnosis, and management of celiac disease. Key points include that celiac disease affects genetically predisposed individuals and is triggered by ingestion of gluten. Diagnosis requires histological changes in intestinal biopsy and positive celiac disease serology or response to gluten-free diet. Management involves strict lifelong gluten-free diet to avoid complications.
This study aimed to determine the prevalence of diabetes and diabetic retinopathy among patients attending a retina clinic in Dehradun, India, and to examine epidemiological factors associated with diabetic retinopathy. The study found that 20.3% of patients had known diabetes, and of those, 67.1% showed signs of diabetic retinopathy. Variables significantly linked to diabetic retinopathy included older age, female sex, income levels, education, high blood pressure, cholesterol, longer diabetes duration, insulin use, irregular eye screenings, and uncontrolled blood glucose. Tight control of associated risk factors can help reduce the progression of diabetic retinopathy.
El documento describe las diferentes playas del norte de Perú, incluyendo Playa Huanchaco en Trujillo, Puerto Pacasmayo, Playa Pimentel en Chiclayo, Playa Tortuga en Chimbote y Playa Máncora en Piura. Estas playas se caracterizan por tener arena blanca y aguas tibias, en contraste con las playas grises y frías del sur de Perú.
This document discusses how words contain "bundles" of meaning components and concepts that a translator must be able to unpack in order to properly translate between languages. Words can have different meanings combined in different ways across languages, so the translator must analyze the central concept and meaning components of each word. Concepts and meaning components are classified semantically as things, events, attributes, and relations. Skewing can occur when the grammatical categories do not match the semantic categories. Restating text in terms of semantic structure can help translators identify meanings and eliminate skewing to facilitate accurate translation.
In this presentation, we answer two questions about the mouth-body connection. Why can the health of your mouth affect your whole body. And why are simple habits like daily brushing and flossing more important than you might think.
Systemic diseases, or conditions themselves do not cause periodontitis but alter host tissues to increase the progression of periodontal disease. Systemic diseases and conditions can influence the course of periodontitis or affect the periodontal supporting tissues independent of the presence of dental plaque. Most commonly affecting diseases are diabetes, neoplasms.
influence of oral environment on general healthBhargavi Vedula
Oral infections and inflammation can influence general health through several pathways. Gram-negative bacteria and pro-inflammatory cytokines from the oral cavity can spread through bacteremia and influence many body systems. Periodontitis has been associated with increased risk of cardiovascular disease, diabetes, preterm birth and low birthweight, respiratory infections, Alzheimer's disease, rheumatoid arthritis, renal transplant rejection, prostate health issues and potentially pancreatic cancer. While connections have been established, more research is still needed to fully understand the relationships and minimal interventions required to reduce health risks. The oral cavity represents an entry point for pathogens and inflammation that can impact overall wellness through multiple complex mechanisms.
This article reviews the relationship between oral health and diabetes mellitus. It discusses how diabetes can cause various oral health issues such as periodontitis, dental caries, oral mucosal diseases, and salivary dysfunction. Periodontitis is characterized by chronic inflammation and breakdown of tissues around the teeth. It affects 50-90% of adults and is considered the 6th complication of diabetes. Patients with diabetes are also more susceptible to dental caries, opportunistic fungal infections like candidiasis, and have reduced salivary flow that increases oral dryness. The review concludes that diabetes has adverse effects on oral health and dental care should be an important part of managing diabetes to improve patients' well-being and quality
External modifying factors of periodontal diseasesMonika
Terminologies
Periodontitis
Risk indicator, risk factor & risk predictor
Socioecological model of periodontal diseases
Introduction
External modifying factors
a. Role of tobacco products
Evidence from cross sectional studies
Evidence from longitudinal studies involving periodontal attachment loss & periodontal healing
Role of low socioeconomic status
Evidence from cross sectional studies
Evidence from longitudinal studies
c. Role of lifestyle & dental care habits
Evidence from cross sectional studies
Evidence from longitudinal studies
Role of Acquired Systemic & Infectious disease
Role of psychosocial stress
Effect of Allergies
Effect of epilepsy & phenytoin therapy
Effect of Human immunodeficiency virus
e. Conclusion
f. References.
Background: The COVID-19 pandemic and control measures taken by countries around the worldcause stress and anxiety. The outbreak of corona virus not onlyhas a major impact on the physical health of the community, but also has a foremosteffect on thementalhealth of the public.Investigating the coping strategies to deal with this unique crisis is essential. Objective: The aim of this study was to assess the impact of covid-19 on stress and coping responses among general population. Methods: A descriptive cross-sectional study is adapted among 100 general populations. A convenient sampling technique was applied. The demographic data were collected using a structured questionnaire via interview method. The level of stress was measured by the perceived stress scale (PSS) and coping responses was evaluated by the brief cope scale. Result: The study outcomesdisplaysthat 53 (53%) had moderate stress, 28 (28%) had mild stress and 19 (19%) had severe stress during Covid-19. In respect to level of coping strategies among general population, 96% of the participants used planning coping strategy, 93% of them used religion coping strategy followed by 92% used self-distraction coping strategy. Conclusion: In our study, general population presented a moderate level of stress, in addition avoidance coping strategies was mostly used.Aiding the mental health care needs of public during these difficult times (pandemic) should be the top priority soadequate measures must be taken to promote the mental health of general public.
This document summarizes various risk factors associated with periodontal disease. It discusses both modifiable and non-modifiable risk factors such as smoking, diabetes, stress, drugs, systemic diseases, nutrition, genetics, socioeconomic status, and gender. Specific conditions like type 1 and type 2 diabetes are explained in more detail. The relationship between periodontal disease and various systemic conditions is also covered briefly.
This document reviews the issue of HIV and aging, noting that people living with HIV are experiencing age-related conditions at earlier ages than normal due to factors like persistent inflammation and immune system defects caused by HIV and long-term antiretroviral treatments. Some of the key points discussed include the links between inflammation, premature aging, and increased risk of diseases like heart and kidney disease. More research is needed to understand how to better manage comorbidities and support quality of life as the HIV population continues to age. Advocacy, education, and improved clinical care guidelines that address complex chronic disease management are areas that require focus.
This document discusses the influence of systemic conditions on the periodontium. It begins by introducing periodontitis as a chronic bacterial infection and how host responses can vary between individuals. Systemic disorders can impair the host's immune defenses, creating opportunities for more severe periodontal disease. Several specific systemic factors are then examined in more detail, including hormonal changes, diabetes mellitus, and female sex hormones. The effects of these conditions on the periodontium are explored through their impact on factors like subgingival microbiota, polymorphonuclear leukocyte function, collagen metabolism, and wound healing. Treatment considerations for periodontal disease in systemic disease patients are also briefly addressed.
The document discusses the role of pediatricians in preventing chronic noncommunicable diseases. It outlines several factors that can impact childhood health and development with long-term consequences, including maternal smoking during pregnancy, preterm birth, maternal obesity, and environmental exposures. Maternal smoking during pregnancy is associated with increased risks of preterm birth, asthma, cardiovascular issues, and neurological and behavioral problems in children. Both undernutrition and overnutrition during pregnancy can also influence the health of offspring and increase risks of chronic diseases later in life. The document emphasizes the importance of pediatricians educating parents about modifiable risk factors and promoting healthy prenatal environments and lifestyles to reduce the future disease burden from noncommunicable diseases.
Sinusitis and Immunodeficiency - IDF Conferencesinusblog
This is Dr. Andrew Pugliese's powerpoint on the connection between chronic sinusitis and immunodeficiencies. This was specifically for an educational conference for the Immune Deficiency Foundation.
Diabetes and periodontal disease ,at two way relationshipLobna El Khatib
The document discusses the bidirectional relationship between diabetes and periodontal disease. It begins by providing overviews of diabetes and periodontal disease. It then explains how diabetes can increase the risk and severity of periodontal disease by altering oral microorganisms, the host immune response, blood vessels, and wound healing. Conversely, periodontal disease can negatively impact blood sugar control in diabetes by increasing systemic inflammation. Maintaining good oral hygiene and treating periodontal disease may help manage diabetes and reduce complications.
1.Comparism between Margot L. Van Dis and Edwin T. Parks Article and Tahrir ...MohammedAbdulhammed
Comparison prove that Tahrir N. Aldelaimi ( dean of college of dentistry / Anbar University ) have plagiarized 60% from a article belong to Margot L. Van Dis and Edwin T. Parks it under his name
This document provides an overview of current approaches in periodontal care. It discusses initial cause-related therapy including scaling and root planing as well as adjunctive use of antimicrobials. It also covers corrective therapy such as surgical procedures and regenerative techniques. Supportive therapy including ongoing maintenance is also emphasized. Modification of the biofilm using approaches like antimicrobial peptides and probiotics as well as modification of the host response through diet are presented as potential novel therapies. The roles of lasers in non-surgical periodontal therapy are also summarized.
This study reviewed the literature on the health effects of cooking with solid fuels in developing countries. It found that solid biomass fuel use is associated with increased risk of respiratory diseases. However, the effectiveness of improved cookstove interventions in reducing health risks is unclear as most studies only measured symptoms rather than objective health outcomes. Future research with reliable exposure biomarkers is still needed to determine the impact of improved cookstoves on health.
Non-communicable diseases cannot be spread from person to person and some are chronic, meaning they are present continuously or intermittently over a long period. Multiple sclerosis is an example of a degenerative disease that causes breakdown in body cells, tissues, and organs as it progresses. Some congenital diseases are caused by heredity while others are caused by a mother's lifestyle choices during pregnancy. Heredity passes traits from parents to children like eye color or sickle cell anemia. Factors you cannot control include heredity, age, gender, and ethnicity while factors you can control involve diet, exercise, weight, sleep, stress management, and avoiding tobacco, alcohol and other drugs. Environmental factors and substances can
There has been an increase in the predominance of diabetes mellitus over the past 40 years worldwide. The worldwide occurrence of diabetes in 2000 was approximately 2.8% and is estimated to grow to 4.4% by 2030. This data interprets a projected rise of diabetes from 171 million in 2000 to well over 350 million in 2030. The presence of hypertension in diabetic patients substantially increases the risks of coronary heart disease, stroke, nephropathy and retinopathy. Indeed, when hypertension coexists with diabetes, the risk of CVD is increased by 75%, which further contributes to the overall morbidity and mortality of an already high risk population. Patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality, and are disproportionately affected by cardiovascular disease. Most of this excess risk is associated with high prevalence of well-established risk factors such as hypertension, dyslipidaemia and obesity in these patients. Hypertension plays a major role in the development and progression of microvascular and macrovascular disease in people with diabetes. Lifestyle Modifications and pharmacotherapy are the choice for the Management of Hypertension in Patients with Diabetes.
The document provides World Gastroenterology Organisation global guidelines on celiac disease from April 2012. It was reviewed by an international team and covers definitions, epidemiology, diagnosis, and management of celiac disease. Key points include that celiac disease affects genetically predisposed individuals and is triggered by ingestion of gluten. Diagnosis requires histological changes in intestinal biopsy and positive celiac disease serology or response to gluten-free diet. Management involves strict lifelong gluten-free diet to avoid complications.
This study aimed to determine the prevalence of diabetes and diabetic retinopathy among patients attending a retina clinic in Dehradun, India, and to examine epidemiological factors associated with diabetic retinopathy. The study found that 20.3% of patients had known diabetes, and of those, 67.1% showed signs of diabetic retinopathy. Variables significantly linked to diabetic retinopathy included older age, female sex, income levels, education, high blood pressure, cholesterol, longer diabetes duration, insulin use, irregular eye screenings, and uncontrolled blood glucose. Tight control of associated risk factors can help reduce the progression of diabetic retinopathy.
El documento describe las diferentes playas del norte de Perú, incluyendo Playa Huanchaco en Trujillo, Puerto Pacasmayo, Playa Pimentel en Chiclayo, Playa Tortuga en Chimbote y Playa Máncora en Piura. Estas playas se caracterizan por tener arena blanca y aguas tibias, en contraste con las playas grises y frías del sur de Perú.
This document discusses how words contain "bundles" of meaning components and concepts that a translator must be able to unpack in order to properly translate between languages. Words can have different meanings combined in different ways across languages, so the translator must analyze the central concept and meaning components of each word. Concepts and meaning components are classified semantically as things, events, attributes, and relations. Skewing can occur when the grammatical categories do not match the semantic categories. Restating text in terms of semantic structure can help translators identify meanings and eliminate skewing to facilitate accurate translation.
El documento presenta un plan de acción para mejorar el liderazgo del personal directivo de la Unidad Educativa Estadal John F. Kennedy. El plan propone objetivos como capacitar al personal docente y fortalecer la práctica pedagógica, actualizar los acuerdos de convivencia, y obtener recursos para techado de la cancha deportiva. El plan incluye metas, acciones, actividades, responsabilidades, recursos y tiempos para cada objetivo.
Este documento discute los bloques de ingresos, recursos clave y actividades clave del modelo de negocios Canvas. Explica diferentes mecanismos para generar ingresos como precios fijos y dinámicos, pago por uso de servicio, suscripción y anunciantes. También analiza recursos como físicos, intelectuales, humanos y financieros, así como actividades clave como producción, solución de problemas y creación de plataformas. El documento provee casos y preguntas para analizar cada bloque.
Mango allows users to declaratively define and query Apache CouchDB indexes. Mango leverages Lucene not only to perform text search, but also to enable ad-hoc querying capabilities.
The concept of data movement lies at the heart of Apache CouchDB. CouchDB’s replication protocol lets developers synchronize copies of their data to remote CouchDB-based systems – including Cloudant – at the push of a button. Replication jobs can also run continuously, and in both directions.
La Ilustración fue una corriente intelectual que dominó Europa en el siglo XVIII, especialmente Francia e Inglaterra. Se basó en el racionalismo, empirismo, y las leyes naturales descubiertas por Newton para transformar todos los aspectos de la vida a través de la razón. Los ilustrados criticaron el Antiguo Régimen por su absolutismo monárquico, intolerancia religiosa, y desigualdad social. Fue impulsado por la imprenta, el descubrimiento de América, y el apoyo de los reyes a los
Este documento proporciona información sobre los componentes de una computadora, sistemas operativos y tipos de licencias de software. Explica los conceptos clave de hardware, software, sistemas operativos como Mac OS, DOS, UNIX y sus clasificaciones. También cubre los tipos de licencias como de software libre, de fuente abierta y dominio público.
Hepatitis B and C infection and it's clinical implication in Dental practice, how to management patients of hepatitis and what clinical features patients with hepatitis show in oral cavity.
¿Cómo influenciar positivamente a tu hijo?lisbeth Reyes
Taller para padres que orienta cómo a través del efecto pigmalión y las expectativas de fe sobre tus hijos pueden llevarlos a tener exito en su vida personal, académica y en todas las áreas de su vida.
This document outlines the social media strategy for a business called Sweets & Sayings. The objectives are to increase followers on Instagram by 300 in 6 months and grow the Facebook page to 150 likes in 3 months. The strategy involves increasing video and photo content while encouraging customer shares on social media. Key dates involve holidays and seasons. Responsibilities include managing social media in-house. Metrics will track traffic, followers, and posts.
Creatividad e innovación en estudiantes universitariosAlejandra Mora
El documento discute la creatividad e innovación en estudiantes universitarios. Explica que la creatividad y la innovación son elementos naturales en los seres humanos pero que han adquirido un nuevo significado en el contexto del cambio global. También describe la creatividad como la generación de nuevas ideas mientras que la innovación es la implementación exitosa de esas ideas. Finalmente, señala que aunque son conceptos distintos, la creatividad y la innovación trabajan juntos para mejorar los resultados y desarrollar las habilidades de los estudiantes.
Dylan Courtney's industrial design portfolio showcases 6 projects from 2015-2016. The portfolio includes [1] the Acrobat chair, inspired by the Adirondack chair; [2] Wild Tiles, a chess set with magnetic tiles that alter gameplay; and [3] Fly-By-Light, a luminaire made from recycled frisbees. The portfolio demonstrates Dylan's skills in sketching, modeling, prototyping, and applying sustainable design practices to create innovative product designs.
Modernizing Dept of Homeland Security for CFAA investigationsDavid Sweigert
This thesis examines the U.S. government's evolving focus on cyber security threats following 9/11, from international terrorism to risks to critical infrastructure. It analyzes the Department of Homeland Security's (DHS) technology-centric approach and argues it has underutilized the investigative capabilities of the U.S. Secret Service (USSS). The research questions consider how to develop a comprehensive national cyber security strategy using agencies' lawful authorities, and how law enforcement methods could augment DHS's defensive methods to secure critical infrastructure.
Nguyen Duc Viet has over 15 years of experience in health, safety, and environment roles on construction projects in Vietnam. His current role is as an HSE Supervisor for a joint venture project constructing an expressway in Ho Chi Minh City. Previously, he held safety officer and supervisor positions on industrial and infrastructure projects. He has a background in first aid and emergency health and safety.
This document discusses risk factors, determinants, indicators, and predictors for periodontal disease. It identifies the major risk factors as smoking, diabetes, and pathogenic bacteria. It also discusses genetic factors, age, gender, socioeconomic status, and stress as risk determinants. HIV/AIDS, osteoporosis, and infrequent dental visits are provided as examples of risk indicators. Previous history of periodontal disease and bleeding on probing are given as examples of risk predictors. The document concludes by noting that clinical risk assessment involves collecting data on a patient's medical history, dental history, and clinical presentation and analyzing this using a computer-based tool to identify patients at risk of periodontal disease.
This document discusses risk assessment in periodontal disease. It defines risk factors, determinants, indicators, and markers. Major risk factors discussed include smoking, diabetes, pathogenic bacteria, genetic factors, age, gender, and socioeconomic status. It also covers risk indicators like HIV/AIDS, osteoporosis, and infrequent dental visits. Recent advances in risk assessment tools are introduced, including the Oral Health Information Suite, Periodontal Risk Calculator, and the Hexagonal Risk Diagram for Periodontal Risk Assessment. Risk is assessed at the patient, mouth, tooth, and site levels.
Periodontal risk & making risk assessmentibrahimaziz15
Periodontal risk and risk assessment is very importnant in monitoring periodontally affected patients, this seminar will give you an idea about periodontal risk factors and how to make a periodontal risk assessment for patients.
This document provides an overview of risk assessment for periodontal disease. It defines key terms like risk factors, risk indicators, and risk predictors. It discusses several accepted risk elements for periodontal disease like tobacco smoking, diabetes, pathogenic bacteria, tooth deposits, and genetic factors. For each risk element, it provides details on how they increase the risk of periodontal disease based on clinical studies and biological mechanisms. The goal of risk assessment is to help predict a patient's risk and allow early identification and targeted treatment.
This document provides information on risk assessment for periodontal disease. It defines risk assessment and identifies various elements of risk, including risk factors, determinants, indicators, and predictors. Major risk factors discussed include tobacco use, diabetes, and specific pathogenic bacteria. Other risk determinants addressed are genetic factors, age, gender, socioeconomic status, and stress. The document also discusses models for clinical risk assessment, including assessing risk at the patient, mouth, tooth, and site levels. Current methods for risk assessment mentioned are the Periodontal Risk Calculator, Health Information Suite, Periodontal Assessment Tool, and Hexagonal Risk Diagram for Periodontal Risk Assessment.
This document discusses factors that are considered when determining a prognosis for periodontal disease. It outlines different types of prognoses from excellent to hopeless based on factors like bone loss and furcation involvement. Overall clinical factors like age, disease severity, plaque control, and patient compliance are discussed. Systemic factors like smoking and genetic factors are also outlined. Local factors like plaque, calculus, and subgingival restorations are covered. The relationship between prognosis and restorative and prosthetic needs is also summarized.
This document discusses factors involved in determining the prognosis of periodontal disease. It defines prognosis as the prediction of the probable course and outcome of a disease. Prognosis is determined after diagnosis and before treatment planning. It is influenced by the patient's history, risk factors, response to previous treatment, and the clinician's experience. The document outlines various factors to consider like patient age, disease severity, plaque control, systemic conditions, smoking, stress, anatomic factors, mobility, restorations, and response to initial therapy. Both overall prognosis for the dentition and individual tooth prognosis are important. The prognosis can be reevaluated after treatment.
This document provides information on key concepts and terms related to gingivitis and periodontitis. It discusses the epidemiology, etiology, risk factors, and management of gingivitis. Regarding periodontitis, it discusses the epidemiology and etiology. Gingivitis is very common and affects 50-90% of adults worldwide. It is caused by bacterial plaque. Risk factors include poor oral hygiene, tobacco use, diabetes, older age, decreased immunity, certain medications, infections, dry mouth, and hormonal changes. Management involves improving oral hygiene habits such as using a power toothbrush and antimicrobial mouthwash. Periodontitis is also common, affecting 35% of those ages 30+.
This document provides information on key concepts and terms related to gingivitis and periodontitis. It discusses the epidemiology, etiology, risk factors, and management of gingivitis. Regarding periodontitis, it discusses the epidemiology and etiology. Gingivitis is very common and affects 50-90% of adults worldwide. It is caused by bacterial plaque. Risk factors include poor oral hygiene, tobacco use, diabetes, older age, decreased immunity, certain medications, infections, dry mouth, and hormonal changes. Management involves improving oral hygiene habits such as using a power toothbrush and antimicrobial mouthwash. Periodontitis is also common, affecting 35% of those ages 30+.
This document provides information on key concepts and terms related to gingivitis and periodontitis. It discusses the epidemiology, etiology, risk factors, and management of these conditions. Some key points include:
- Gingivitis is the mildest form of periodontal disease and affects 50-90% of adults worldwide. It is caused by dental plaque.
- Periodontitis is inflammation of the tissues that support the teeth, caused by dental plaque and subgingival microorganisms. It leads to progressive bone loss if left untreated.
- Risk factors for both conditions include poor oral hygiene, smoking, diabetes, older age, decreased immunity, and certain medications.
- Management
This document summarizes periodontal diseases and their causes. It discusses that periodontal diseases are primarily caused by bacterial biofilms (plaque) on teeth, which leads to a dysbiotic shift in the oral microbiome toward gram-negative anaerobic bacteria. Key pathogens involved are Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. P. gingivalis in particular is seen as a "keystone pathogen" that is able to trigger changes to the oral microbiome even at low levels to promote periodontal disease through its virulence factors and ability to disrupt the host immune response. The document provides an overview of risk factors, diagnosis, progression of
This document discusses factors that affect the incidence and prevalence of periodontal diseases. It identifies three main categories of factors: host factors, agent factors, and environmental factors. Some key host factors discussed include age, sex, oral hygiene, socioeconomic status, tobacco use, general health conditions like diabetes, and nutrition. Agent factors refer mainly to bacteria and calculus. Environmental factors examined include geographic distribution, fluoride concentration in water, and aspects of the oral environment like prosthetic restorations and dental caries.
This document discusses risk factors for periodontitis. It identifies smoking, diabetes, and certain pathogenic bacteria as risk factors. Genetics, age, gender, osteoporosis, and a history of periodontal disease are described as risk determinants or indicators. The document provides details on how each of these factors increases the risk of periodontal disease, noting their effects on inflammation, bone loss, and disease progression. It emphasizes that eliminating or reducing modifiable risk factors can help improve prevention and treatment outcomes for periodontitis.
Diabetic patients knowledge, attitude and practice toward oral healthAlexander Decker
This study assessed the knowledge, attitudes, and practices of 612 diabetic patients in Abha City, Saudi Arabia regarding their oral health. The results showed that over half of patients were unaware of their increased risk of oral diseases as diabetics. Less than half knew that diabetes can cause dental caries and gingivitis. While patients' oral hygiene practices were generally good, their knowledge about the oral health risks of diabetes was deficient. The study highlights the need for better patient education on maintaining oral health and the link between diabetes and oral diseases.
Essentials of Periodontal Medicine in Preventive MedicineMinkle Gulati
Influence of systemic disorders on periodontal diseases is well established. However, of growing interest is the effect of periodontal diseases on numerous systemic diseases or conditions like cardiovascular disease, cerebrovascular disease, diabetes, pre‑term low birth weight babies, preeclampsia, respiratory infections and others including osteoporosis, cancer, rheumatoid arthritis, erectile dysfunction, Alzheimer’s disease, gastrointestinal
disease, prostatitis, renal diseases, which has also been scientifically validated. This side of the oral‑systemic link has been termed Periodontal Medicine and is potentially of great public health significance, as periodontal disease is largely preventable and in many instances readily treatable, hence, providing many new opportunities for preventing and improving prognosis of several systemic pathologic conditions. This review article highlights the importance of prevention and treatment of periodontal diseases as an essential part of preventive medicine to circumvent its deleterious effects on general health.
This document discusses various risk factors and determinants for periodontal disease, including smoking, diabetes, pathogenic bacteria, dental deposits, genetic factors, and age. It provides details on how each of these can increase the risk of developing periodontal disease, such as by inhibiting immune response, altering inflammation, or increasing exposure to risk factors over a lifetime. The rationale for assessing risk is to help predict disease development, focus on early identification and treatment of at-risk patients, and inform clinical decision making.
The document summarizes common dental problems seen in old age, including tooth loss, denture stomatitis, dental caries, periodontal disease, dry mouth, and oral cancer. It provides details on the causes and risk factors for each problem, potential symptoms, and prevention strategies like proper brushing and a healthy diet low in sugars and acids. Maintaining good oral hygiene and regular dental checkups are important for oral health in senior years when dental issues tend to increase.
This document provides a review of the relationship between diabetes and dental health. It discusses several key points:
1) Diabetes can cause various oral manifestations due to hyperglycemia leading to changes in metabolism. This includes dry mouth, tooth decay, gum disease, oral infections, and delayed wound healing.
2) Gum (periodontal) disease is especially common among people with diabetes. High blood sugar levels make it harder to fight infections like gingivitis.
3) Other oral issues related to diabetes include dry mouth, taste changes, increased risk of tooth decay and oral infections, and slower healing of mouth sores or wounds. Managing blood sugar levels can help reduce these risks.
4)
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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1. 324 Journal of Indian Society of Periodontology - Vol 16, Issue 3, Jul-Sep 2012
Review Article
Address for
correspondence:
Dr. Elizabeth Koshi,
Professor and Head of
Department, Department
of Periodontics, Sree
Mookambika Institute
of Dental Sciences,
Kulasekharam,
Kanyakumari,
Tamil Nadu, India.
E‑mail: elizabethkoshi_dr@
yahoo.com
Submission: 01‑10‑2010
Accepted: 12‑12‑2011
Departments of
Periodontics and
1
Conservative
Dentistry, Sree
Mookambika Institute
of Dental Sciences,
Kulashekharam,
Kanyakumari,
Tamil Nadu,
2
Department of
Orthodontics, GDC,
Kottayam, Kerala, India
Risk assessment for periodontal disease
Elizabeth Koshi, S. Rajesh1
, Philip Koshi2
, P. R. Arunima1
Abstract:
The prevention and treatment of periodontal disease is based on accurate diagnosis, reduction or elimination
of causative agents, risk management and correction of the harmful effects of the disease. The practice of risk
assessment involves dental care providers identifying patients and populations at increased risk of developing
periodontal disease. This can have a significant impact on clinical decision making. Risk assessment reduces
the need for complex periodontal therapy, improve patient outcome and, ultimately, reduce oral health care cost.
The awareness of risk factors also helps with the identification and treatment of co‑morbidities in the general
population as many periodontal disease risk factors are common to other chronic diseases such as diabetes,
cardiovascular diseases and stroke.
Key words:
Periodontal disease, risk assessment, risk assessment tools, risk factors
INTRODUCTION
Overthelastthreedecades,ourunderstanding
on the pathogenesis and etiology
of periodontal diseases has grown greatly.
Numerous studies have demonstrated that the
host plays a major role in the pathobiology of
periodontitis and that risk varies greatly from one
individual to another.[1]
Identifying risk factors
and indicators, as well as undertaking measures
that can reduce the risk, can help in maintaining
oral health and prevent the onset of any form of
periodontal disease. Risk management involves
dental care providers to identify patients and
populations at increased risk of developing
periodontal disease. Assessing patients risk
of developing periodontal disease can have a
significant impact on clinical decision making.
Some risk factors can be modified to reduce
one’s risk of initiation or progression of disease,
such as smoking or improved oral hygiene,
while other factors cannot be modified, such as
genetic factors.[2]
Risk factors for periodontal disease
Risk can be identified in terms of risk factors,
risk indicators or risk predictors. A risk factor
is thought to be a cause for a disease. It should
satisfy two criteria: (1) it is biologically plausible
as a casual agent for disease and (2) it has been
shown to precede the development of disease
in prospective clinical studies. Risk factors
are biologically related to the occurrence of the
disease, but they do not necessarily imply cause
and effect, i.e. just because a patient possesses a
risk factor does not mean that they will definitely
develop the disease. Equally, absence of a risk
factor does not mean that the disease will not
develop. Evidence in the literature points to the
direct and significant link between several risk
factors and periodontal disease.[3]
Risk factors may be broadly categorized as:
1. Systemic risk factors – factors that affect the
host response to the plaque biofilm, upsetting
the host–microbial balance.
2. Localriskfactors – factorslocaltotheoralcavity,
which may influence plaque accumulation or
occlusal forces.[4]
Age
As people age, their risk for developing
periodontal disease increases. Over half of the
adult population has gingivitis, a less severe form
of periodontal disease surrounding three to four
teeth,andnearly30%havesignificantperiodontal
disease. In a study of people over 70 years old,
86% had at least moderate periodontitis or a
severe form of periodontal disease, and over
one‑fourth of this 86% had lost their teeth. The
study also showed that the disease accounted for
a majority of tooth extractions in patients older
than 35 years of age.[5,6]
Use of tobacco
A wealth of data has established the relationship
between the amount and duration of smoking
and the severity of periodontal pathology. Both
local and systemic mechanisms mediate the
negative impact of tobacco use on oral health.
Heat from smoke may enhance attachment
loss, and the increased calculus deposits that
often result from smoking can enhance plaque
retention. Nicotine can diminish collagen
synthesis and protein secretion and inhibit bone
formation. These findings result in impaired
wound healing as well as increased susceptibility
to periodontal disease, which may limit the
success of treatment interventions. Smoking
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2. Journal of Indian Society of Periodontology - Vol 16, Issue 3, Jul-Sep 2012 325
Koshi, et al.: Risk assessment
also inhibits immunological function and negatively affects
immunoglobulin levels, which may increase susceptibility to
typical and unusual microbial pathogens.[7]
A number of studies indicate that the nicotine found in
tobacco products triggers the overproduction of cytokines
in the body due to lowered oxygen levels. Cytokines are
signaling chemicals involved in the process of periodontal
inflammation. When nicotine combines with oral bacteria,
such as P. gingivalis, it results in higher levels of cytokines,
leading to breakdown of the supporting tissues of the teeth.
Studies suggest that smokers are 11‑times more likely than
non‑smokers to harbor the bacteria that cause periodontal
disease and four‑times more likely to have advanced
periodontitis. In one study, over 40% of smokers had lost their
teeth by the end of their lives. The risk of periodontal disease
increases with the number of cigarettes smoked per day. It is
important to note that smoking cigars and pipes carries the
same risk as smoking cigarettes.[8,9]
Diabetes mellitus
There is much evidence showing a link between type 1 and
2 diabetes mellitus and periodontitis. Diabetes has been
associated with a number of oral complications, including
gingivitis and periodontitis, dental caries, salivary gland
dysfunction and xerostomia, burning mouth syndrome and
increased susceptibility to oral infections. Of particular concern
are patients with diabetes who are at an increased risk of
developing periodontitis. In these patients, host responses
may be impaired, wound healing is delayed and collagenolytic
activity may be enhanced. As a result, periodontitis may be a
particular problem in patients with diabetes, especially in those
with uncontrolled disease.[10]
Diabetes may also contribute to the pathogenesis of
periodontitis via associated vascular compromise, deficits
in cell‑mediated immunity and the presence of a high
glucose content in the blood, which enhances bacterial
growth. Furthermore, active inflammation characteristics of
periodontitis generates compounds that may increase insulin
resistance. Therefore, control of periodontal disease may
help patients improve metabolic control. Obesity, which is
common in type 2 diabetes, may also predispose a person to
periodontal diseases.[11,12]
Stress
It has been strongly suggested that stress and related
body distress are important risk indicators for periodontal
disease. A recent study shows that people under physical
or psychological stress are prone to elevated biofilm plaque
levels and increased gingivitis.[13]
It also seems likely that high
levels of financial stress and poor coping abilities increase
the likelihood of developing periodontal disease two‑fold.
Furthermore, it is likely that systemic disease associated with
periodontal disease such as diabetes, cardiovascular diseases,
pre‑term delivery and osteoporosis may share psychosocial
stress as a common risk factor. However, a direct association
between periodontal disease and stress remains unproven.[14]
Genetic risk factors
In recent years, genetic markers have become available to
determine various genotypes of patients regarding their
susceptibility to periodontal diseases. Research on the
Interleukin‑1 (IL‑1) polymorphisms has indicated that IL‑1
genotype‑positive patients show more advanced periodintitis
lesion that IL‑1 genotype‑negative patients of the same age
group. Also there is a trend to higher tooth loss in the IL‑1
genotype‑positive subjects. In a retrospective analysis of over
300 well‑maintained periodontal patients, the IL‑1 genotype
yield higher BOP% during a 1‑year recall period than the
IL‑1 genotype‑negative control patients. This supports the
theory that specific environmental factors can be strong risk
factors and that they overwhelm any genetically determined
susceptibility or resistance to disease.[15,16]
Pregnancy
Periodontal disease has been shown to be associated with
pre‑term delivery and low birth weight, both of which put
infants at risk of experiencing increased medical complications.
Analysis of gingival crevicular fluid has demonstrated
significantly higher levels of the inflammatory mediator
prostaglandin E2 in women who delivered pre‑term low
birth weight infants. However, other research has failed to
demonstrate a link between pre‑term low birth weight babies
and periodontal disease.[17,18]
Cardiovascular diseases
Cardiovascular diseases affect adults, and there is evidence
that links periodontitis and cardiovascular diseases. C‑reactive
proteinisasystemicmarkerforinflammation.Theplasmalevels
of this marker are predictive of future myocardial infarct and
stroke. Patients with periodontitis have demonstrated elevated
C‑reactive protein levels. Some investigators have suggested
that the chronic inflammatory burden of periodontitis may
contribute to cardiovascular diseases.[19]
In an analysis of
4561 subgingival plaque samples collected from 657 subjects,
Desvarieux and colleagues found a direct relationship between
periodontal bacterial burden and subclinical atherosclerosis.
Other reports have noted associations between cerebrovascular
stroke and tooth loss, bone loss and poor dental status, although
the precise mechanisms that mediate these multiple pathogenic
processes have not been delineated.[20]
Poor oral hygiene as a risk factor
Many studies have demonstrated significant reductions in
probing pocket depths, attachment gains and, of course, in
gingival inflammation, with improvements in oral hygiene
alone. The lack of oral hygiene encourages bacterial build‑up
and biofilm plaque formation, and can also increase certain
species of pathogenic bacteria associated with more severe
forms of periodontal diseases.[21]
Risk indicators
A risk indicator is a factor that is biologically plausible as a
causative agent for a disease but has only been shown to be
associated with disease in cross‑sectional studies. An example
of a risk indicator of periodontal disease is the presence of
herpes viruses in subgingival plaque. A risk predictor is a
factor that has no current biological plausibility as a causative
agent but has been associated with disease on a cross‑sectional
or longitudinal basis. Example, the number of missing teeth is
a risk predictor for disease, but has little or no plausibility as a
causative agent for periodontitis.[3]
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3. 326 Journal of Indian Society of Periodontology - Vol 16, Issue 3, Jul-Sep 2012
Koshi, et al.: Risk assessment
Risk assessment
According to the American Academy of Periodontology,
risk assessment has been defined as the process by which
qualitative or quantitative assessments are made of the
likelihood for adverse events to occur as a result of exposure
to specified health hazards or by the absence of beneficial
influences.[22]
One of the problems with risk assessment in periodontal disease
is that the diseases are multifactorial and assessment should
therefore be at multiple levels. The presence of pathogenic
bacteria alone is not sufficient to cause the disease. In simple
terms, there are four levels to consider:
1. The patient level Perform at initial examination
2. The whole mouth level Performatinitialexaminationand
post‑initial therapy
3. The tooth level Perform post‑initial/definitive
therapy and maintenance
4. The site level Perform post‑definitive therapy
and during maintenance
This approach also allows the clinician to separate risk factors
that may initiate periodontal disease from those responsible for
its progression or for the failure of initial therapy.[23,24]
Patient‑level risk assessment
Patient‑level risk assessment can be determined at the initial
consultation by performing the following:
• Family history for hereditary, inborn or genetic risk factors.
Take a detailed history of gum disease or early tooth loss
in the family.
• Medical history for systemic diseases, e.g. diabetes mellitus,
cardiovascular diseases, osteoporosis
• Present dental history – Assess motivation to oral hygiene.
• Social history, which includes smoking – current or former
smoker
• Habits like bruxism.
Mouth‑level risk assessment
Mouth‑level risk assessment would be performed at the initial
examination, after a basic periodontal examination, and would
include:
• Examination of attachment loss relative to age
• Occlusal examination in static relationship
• Occlusal examination in dynamic relationship
• Examination of levels of oral hygiene
• Examination of levels of plaque‑retentive factors
• Presence of removable prosthesis
• Levels of recession
• Gingival inflammation and depth of pockets.
Tooth‑level risk assessment
Tooth‑level risk assessment may or may not be carried out
at the initial examination. A detailed periodontal chart and
radiographic assessment should be performed. Part of this
assessment includes:
• Individual tooth mobility (mobility index)
• Tooth movement or drifting of periodontally compromised
teeth
• Residual tooth support (radiographically). The extent
of residual radio graphic bone support helps determine
long‑term prognosis.
• Presence, location and extent of furcation lesions
• Individual tooth anatomy – Presence of “talon cusps” or
bulbous crowns
• Anatomy of tooth embrasures and contact points
• Presence of ledges or deficiencies on restorations
• Individual occlusal contacts – Prematurities
• Soft tissue contours
• Subgingival calculus.
Site‑level risk assessment
Site‑level risk assessment would include:
• Bleeding on probing
• Exudation from periodontal pockets
• Local root grooves or root concavities
• Individual probing pocket depth
• Attachment levels
• Other anatomical factors like enamel pearls, root grooves.
The clinical practice of risk assessment
Most dentists and periodontists are not trained or experienced
in risk assessment nor in using interventions aimed at risk
reduction in the prevention and management of periodontal
diseases. Manually summarizing and analyzing the risk factors
could be a complex process. Hence, a computer‑generated risk
assessment model can aid in the identification of patients at
elevated risk of developing periodontal disease, and may help
in the selection of patients who require additional education
or targeted interventions to prevent or minimize the impact
of periodontal disease. Several models like the Oral Health
Information Suite (OHIS), Periodontal Risk Calculator (PRC)
and American Academy of Periodontology self‑assessment
tool have been used to assess risk.[25]
The oral health information suite
OHISä is an information system protected under the U.S.
Patent #6,484,144. The system is comprised of a suite of
related tools for major oral health conditions including caries,
periodontal disease and oral cancer. OHIS is unique for
clinical dentistry by virtue of quantifying the risk for future
disease in addition to quantifying the current periodontal
disease state. Both clinical and radiographic examinations
are conducted including medical and dental histories,
with specific questions concerning risk factors for oral
disease. Diagnostic and demographic data and the patient
and provider objectives are entered into the assessment
tool appropriate for the disease state under consideration.
A diagnosis is made and a risk score and a disease score are
calculated. Based on these scores, treatment and interventions
are ranked and color coded as those most likely to be
successful, those less likely and those most unlikely to be
successful. The recommended treatment plan is evaluated
and modified by the dentist and patient to their satisfaction,
and the treatments and interventions are performed. On
re‑examination following treatment, post‑treatment risk
and disease assessment are performed. Change in risk and
disease state are automatically analyzed by the system and
are used to update the risk and disease scores as well as to
refine and improve the most appropriate treatments for any
given set of conditions.[26]
Periodontal risk calculator
The PRC is a web‑based tool that can be accessed through a
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Koshi, et al.: Risk assessment
dental office computer. PRC was developed using the six design
parameters on a desktop computer using Microsoft Excel.
1. PRC calculated risk is for future periodontal disease for
those patients who do not yet have it and risk for future
progression of periodontal disease for those who already
have it.
2. A risk factor is defined as a factor that is part of the causal
chain of disease or exposes the patient to the casual chain,
which, if present, directly increases the probability of
disease occurring and, if absent, reduces the probability.
3. A risk factor must have a scientific basis that is supported
by publication in refereed scientific journals.
4. The application of risk assessment information through the
development of treatment recommendations to reduce risk
must occur.
5. All requisite information must be obtained during a
traditional periodontal examination as performed by
dentists in the United States; the time required for data
collection and input must fit within the usual time these
dentists use for diagnosis.
6. A five‑point risk scale is to be used to balance the sensitivity
of risk assessment with the time and cost required to obtain
the necessary information.
The calculation of risk is a multi‑step process involving
mathematical algorithms that use nine risk factors, including:
• Patient age
• Smoking history
• Diagnosis of diabetes
• History of periodontal surgery
• Pocket depth
• Furcation involvements
• Restorations or calculus below the gingival margin
• Radiographic bone height
• Vertical bone lesions.
A three‑point scale is used to document pocket depth and
radiographic bone height. An algorithm was developed to
quantify disease severity from pocket depth and bone height
values. The base risk score is calculated using an algorithm that
correlates disease severity with age. The risk score is increased
if there is a positive history of periodontal surgery and if the
patient smokes more than 10 cigarettes per day, or the patient
has diabetes that is poorly controlled. The existence of furcation
involvements, vertical bone lesions or subgingival restorations
or calculus increase risk when the risk score is otherwise less
than four.[27]
American academy of periodontology self‑assessment tool
The web‑based self‑assessment tool available on the American
Academy of Periodontology website is a good example
of the value and limitations of how knowledge about the
role of individual periodontal risk factors may be used in
combination to educate patients, raise awareness and assist
in decision‑making. The tool’s web interface is a brief 13‑item
questionnaire that asks straightforward questions that most
persons would be able to answer easily. The items include the
person’s age (three response options: 40; 40–65; 65 years)
and their flossing behavior (daily, weekly, seldom). Other items
have simple response choices of yes or no, whereas several
items in addition to the yes/no option also include the option
of don’t know (any of your family members had gum disease,
are your teeth loose, do you currently have any of the following
health conditions, i.e. heart disease, osteoporosis, osteopenia,
high stress or diabetes) or the option of don’t remember (seen
a dentist in the last 2 years, ever been told that you have gum
problems, gum infection or gum inflammation). The answers
to the questions are combined using a proprietary algorithm
to yield one of three risk categories: low risk, medium risk or
high risk. The website informs users that by using the answers
to the questions, the self‑assessment tool will help them to see
if they are at risk for having or developing periodontal (gum)
disease.[28]
Genetic tests
Recently, a genetic test was available to test patients for
periodontal disease risk. This test determines whether
people possess a combination of alleles in two IL‑1 genes.[16]
Studies have reported an increased frequency of a different
IL‑1 genotype in people with advanced adult periodontitis
compared with those with early or moderate disease. There is
also retrospective evidence that genetic testing for the specific
IL‑1 genotype may give indication of increased susceptibility to
tooth loss in periodontal maintenance patients. A more recent
prospective study reported that this composite genotype was
not associated with progressive clinical attachment loss during
a 2‑year period after periodontal therapy. However, it may be
concluded that genetic testing has potential for the future, but
more research is needed to evaluate its utility.[3]
CONCLUSION
Risk assessment is an important part of modern day periodontal
practice. It is recommended that systemic and local risk factors
are documented alongside the diagnosis in patients’ case
records. The practice of risk assessment allows dental care
professionals the opportunity to improve dental and medical
outcomes in the general population and in specific population
groups by focusing on early identification and prevention of
dental diseases, especially periodontal disease.
The inclusion of a risk assessment tool in routine practice would
add only a small amount of time to patient visits. Signs and
symptoms targeted in risk assessment might include pocket
depth, bleeding on probing, poor oral hygiene, persistent
inflammation, loss of attachment, smoking, increasing pocket
depth, pregnancy and diabetes. Among the general public,
use of a risk assessment instrument may help identify the
20% of patients in need of intervention to prevent or minimize
development of more advanced periodontal disease.
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How to cite this article: Koshi E, Rajesh S, Koshi P, Arunima PR.
Risk assessment for periodontal disease. J Indian Soc Periodontol
2012;16:324-8.
Source of Support: Nil, Conflict of Interest: None declared.
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