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