Aetiology of Plaque Associated Diseases

• What vascular changes does a hyperglycaemic environment cause on the oral environment?

  • Thickening of basement membrane
  • metabolic waste elimination
  • neutrophil migration
  • diffusion of antibodies
• What result does a diabetic get on a Hba1c?

  Above 6.5%
• What is a normal result on a Hba1c test?

  4-5.6%
• What effect does a hyperglycaemic environment have on periodontisis?

  • reduced growth, proliferation and matrix synthesis by fibroblasts and osteoblasts in the periodontal ligament
• What does a Hba1c measure?

  Sugar control over 3 months
• How does diabetes affect PMN function?

  • Impair chemotaxis, adherence and phagocytosis
  • impairs apoptosis
• What are multiple lateral periodontal abscesses a sign of?

  Poorly controlled or undiagnosed diabetes
• When is diabetes a risk factor for periodontitis?

  When it is uncontrolled/ undiagnosed
• Why do organ transplant recipients have increased effects of periodontisis?

  Take long term corticosteroids to prevent rejection
• Why might stressed patients have increased periodontitis?

  • Pathogens utilize stress hormones for growth
  • flow rate of saliva changes,
  • cortisol suppresses immune system
  • habits alter
  • parafunctional activity causes occlusal trauma
• Why does postmenopausal osteoporosis increase effects of periodontitis?

  Bone density reduces affecting its mass and strength
• Why are hormonal contraceptive users more at risk of gingivitis?

  Mimics a state of pregnancy
• Why do people think gingivitis increases during pregnancy?

  • increased growth of microorganisms
  • increased inflammatory response
  • decreased immune response
• What effect does puberty have on gingivitis?

  Increase in gingival inflammation with no change in plaque levels
• What effect does cortisol have on the body?

  • Reduces bone formation
  • inhibits collagen formation
  • affects electrolyte balance
• What conditions cause the production of corticosteroid hormones?

  Stress, depression, surgery, fear and pain
• What do corticosteroid hormones do in the body?

  Control inflammation and metabolism of glucose, protein and fat
• How do steroid sex hormones influence progression of periodontitis?

  Regulate activity of immune cells and influence bacterial metabolism and growth
• What is cyclic neutropenia?

  rare hematologic disorder to occurs every three weeks and lasting for few days at a time due to changing rates of neutrophil production by the bone marrow.
• What is a qualitative haematological disorder?

  Difference in the function of leukocytes
• What is a quantitative haematological disorder?

  Difference in the number of leukocytes
• What are the two haematological disorders?

  Quantitative and qualitative
• Why does obesity cause chronic subclinical inflammation?

  Adipose tissue-derived pro-inflammatory cytokines
• What role does vitamin E play in the body?

  • Stabilises membrane structures
  • deficiency causes haemolytic anaemia and neurological effects
• What role does vitamin C play in the body?

  Collagen synthesis, deficiency can cause scurvy
• How do antioxidants reduce oxidative stress?

  Donate electrons to mop up free radicals
• How are free radicals introduced or produced by the body?

  Smoking, Increased glucose and lipid intake, Ways of cooking food, Sunlight, Alcohol, Exercise
• Why are reactive oxygen species important for health?

  • Necessary for hormone production
  • kills bacteria and engulfs pathogens
  • required for cell signalling
• What is oxidative stress?

  The imbalance between free radicals and antioxidants in the body
• How long after giving up smoking does blood flow increase?

  3 days
• How long does it take after giving up smoking to have the same risk profile as a non-smoker?

  13 years
• How much more likely are maintenance patients who smoke to lose their teeth?

  2 x
• What is the microbiological effect of smoking on the mouth?

  More anaerobic pathogens, reduced GCF, higher calcium concentration increasing calculus production
• What is found in the gingival crevicular fluid of smokers that impairs healing?

  Cotinine and nicotine
• How does smoking impair healing?

  Decreased fibroblast growth, attachment and function and heat is an irritant during healing
• Which inflammatory mediators does smoking alter the production of?

  IL-1, IL-6, TNF-alpha and PGE2
• How does decreased immunoglobulin production due to smoking affect the body?

  Decreased helper T cells, decreased B cell function, decreased salivary IgA and decreased serum IgG
• How does smoking affect PMN function?

  Decreased chemotaxis, vascular transmigration and phagocytosis
• What are some of the effects smoking has on the periodontium?

  Increased probing pocket depths, more pocket sites, greater bone loss, more furcation involvement, greater gingival recession, greater calculus formation, more recurrence in step 4, poorer response to treatment and increased risk of oral cancer
• What is classified as a heavy smoker?

  1 or more packs a day