perio risk factors Dr R

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periodontal disease is a ............ susceptibility varies from person to person....what are the 3 things which vary
disease of dysbiosis. genetics, inflammatory drive, biofilm
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what inflammatory. mediators cause breakdown of the periodontium and also cause bone resorption
PMNs, cytokines, IL1, PGE2, osteoclast activation
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how is nutrition linked to perio disease
affects the immune response, microbiome and ultimately dysbiosis
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what happens when we have over nutrition
Higher circulating glucose • More adipose tissue, • Greater inflammatory drive? • Treatment becomes more complicated.
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people that are obese have diverse microbiome and have more adipose tissue which produces ....
cytokines, TnF alpha IL6, pro inflammatory mediators, adipokines- leptin etc which are pro inflammatory
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what do bacteria use as a source of energy and what does this mean
bacteria use cytokines as energy source which increase proteolytic activity and increase anaerobes
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what results in dysbiosis
aerobic pathways that become fermentation
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how does poorly controlled diabetes increase the risk of periodontitis
high HbA1c affects the microbiome, loose good bacteria, destabilises immune system.
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what is the role of refined food/sugar in the inflammatory process
Oxidative stress, bacterial burden, low grade systemic inflammation IL6 significantly higher • Advanced Glycation End products (AGE) increase oxidative stress, these products are found in almost all ‘bad’ foods
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what is diabetes mellitus
chronic hyperglycaemia results in varying degrees of dysfunction of the carbohydrate, lipid and protein metabolism causing widespread cellular and molecular dysfunction. this causes sig disturbance of the immune response, angiogenesis and wound heal
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continued
wound healing leading to microvascular and macrovascular systemic pathology
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what are the 5 major complications of DM
Atherosclerosis, retinopathy, nephropathy and neuropathy
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what is the key factor that determines the association between DM and. chronic periodontitis
the degree of blood glucose
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how is long term blood glucose control assessed
by measuring the glycated haemoglobin (HbA1c) score from a blood sample
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what is the recommended target level of control for the glycated haemoglobin
less than 48 mol/mol (6.5%)
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what does it mean if the score is above 48mmol/mol
the higher the risk of developing the long term complications of diabetes
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what would recurrent periodontal abscesses and or exaggerated periodontal inflammation indicate
undiagnosed diabetes especially if the oral hygiene and periodontal treatment. appears to have been adequate
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wha is prediabetes
abnormally high blood sugar levels (hyperglycaemia) but below threshold for a diagnosis of diabetes
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how does the perio treatment turn out in people with controlled and uncontrolled diabetes
controlled: have a similar positive response to perio treatment as non diabetics. uncontrolled: simnifically impaired because of altered immune cell function, altered fibroblast function, poor wound healing and increased formation of AGE
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Diabetes causes altered immune cell function .. expand what type of cells are affected and what is the impact
Reduced Neutrophil (PMN) function: • Impaired adherence, chemotaxis & phagocytosis. • Postulated that this results in the persistent bacterial infection & tissue damage found in DM.Hyper-responsive monocytes & macrophages:
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continued
Results in increased secretion of pro-inflammatory mediators such as cytokines (IL-1 & TNFα) & prostaglandins (PGE2):Leads to the pronounced chronic inflammatory response found in DM: • Increased tissue damage. • Contributestotheimpairedwoundhealing.
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continued
Pro-inflammatory mediators leak into the bloodstream leading to increased systemic inflammation: • Causes liver to release acute phrase proteins (e.g. C-Reactive Protein (CRP)) which further amplifies systemic inflammation.
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how could periodontitis negatively affect glycaemic control
periodontal pocket is filled with a pathogenic anaerobic biofilm resulting in an inflammatory reaction in the adjacent gingival tissues resulting in the pocket wall being ulcerated & leaky.
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what are the adverse effects of alcohol
Defective neutrophil function, Altered clotting mechanism. (Defective Prothrombin and Vitamin K activity), Increased bone resorption & decreased bone formation, Reduced healing,Direct toxic effect on periodontal tissues.
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what is the role of vitamin C
Essential for collagen! • Additionally important immune functions • Defends against oxidative stress and free radicles. Promotes chemotaxis • Also essential for iron absorption.
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what is the role of Vitamin D
Essential for skeletal development • Modulation of immune system • Deficiency of vitamin D associated with reduced immunity and increased autoimmunity .
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what inflammatory. mediators cause breakdown of the periodontium and also cause bone resorption

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PMNs, cytokines, IL1, PGE2, osteoclast activation

Card 3

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how is nutrition linked to perio disease

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Card 4

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what happens when we have over nutrition

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Card 5

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people that are obese have diverse microbiome and have more adipose tissue which produces ....

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