Periodontal Disease Aetiology

• Aetiology of periodontal disease involves non-microbial factors
• Systemic diseases/conditions can modify the host response to periodontal pathogens.
• Factors can contribute to periodontal disease or disorders.

Videos to Watch

• Link to video: https://youtu.be/bHMTgMKPFG8
• Link to video: https://youtu.be/RhrLOVN5_8E
• Link to video: https://youtu.be/br-iMGi6fYI

Useful Websites

• Link to website: https://www.efp.org/gum-disease-general-health/perio-diabetes/
• Link to website: https://www.efp.org/gum-disease-general-health/oral-health-pregnancy/

Periodontal Disease

• More in depth discussion in Year 2 of study
• Includes Applied Clinical Practice and Dental Specialities

BSP Periodontal Diagnosis Flowchart

• See the diagram for full details on:
• Staging
• Grading
• Radiographic Assessment
• Interproximal bone loss

Susceptibility to Periodontal Disease

• Increase in susceptibility to periodontal disease if the host response is modified or amplified

Risk Factors

• Non-modifiable risk factors include; ethnicity, gender, age & family history
• Modifiable risk factors include; abdominal obesity, high blood pressure, smoking, diabetes, psychosocial factors & high cholesterol

Non-Microbial Factors

• Non-microbial factors include:
• Genetic factors
• Systemic disorders
• Sex hormones
• Stress
• Smoking, own topic
• Medications

Common Risk Factor Approach to Oral Health (Sheilman and Watt 2000)

• Common risk factor approach to oral health involving factors such as, obesity, cancer, alchohol, periodontal disease & trauma

Factors affecting Periodontal Disease

• Diagram includes factors such as; stress, down syndrome, diabetes mellitus, pregnancy, HIV/AIDS, osteoporosis & DiGO

Diabetes

• Linked to Endocrine Disease lecture
• Should be considered during taking a medical history

Diabetes Prevalence

• Approximately 8.5 out of 100 people have diagnosed or undiagnosed diabetes
• Data from PHE available: https://fingertips.phe.org.uk/profile/diabetes-ft/data

Diabetes and Oral Health

• Understand what you can see in the mouth, the medical emergencies risk and the impacts of poor control
• Consider management of appointments and patient motivation

How Diabetes Affects Oral Health

• Control of oral & general health
• Predicting risk now & in future or family members
• Diabetes and periodontal disease have a two-way relationship which can be found here: https://doi.org/10.1038/sj.bdj.2014.907

Pregnancy & Hormone-Related Factors

• Sex hormones linked to puberty, contraception, pregnancy, menopause & HRT
• Pregnancy has certain factors such as hard tissues, hormones, inflammatory mediators, adverse pregnancy outcomes & appointment management
• Study on the relationship between periodontal disease and pregnancy complications available: https://doi.org/10.14219/jada.archive.2006.0403

Impact of Sex Hormones

• Puberty/Contraception
• Menopause
• Depot medroxyprogesterone acetate use and periodontal health in 15- to 44-year-old females: J Periodontal. 2012;83:1008–1017.

HIV

• Periodontal disease associated with HIV infection: Oral Surg Oral Med Oral Pathol. 1992 Feb;73(2):145-50. doi: 10.1016/0030-4220(92)90186-t. PMID: 1532235.

Immune Disorders

• Examples for this includes: Angular cheilitis, Herpes Simplex Virus (HSV), Candidiasis, Human Papilloma Virus (HPV), Leukoplakia, Oral Hairy, Periodontitis and Gingivitis, Ulcer, Varicella Zoster Virus, Ecchymosis vs. Kaposi's Sarcoma and more

Leukocyte Adhesion Deficiency (LAD) & Diabetes

• Leukocyte adhesion deficiency (LAD) is a rare inherited immunodeficiency that leads to immune cells that fail to bind to blood vessel walls
• Diabetes can also be associated

HIV Associated & DiGo

• DiGo can be associated

Differential Diagnosis

• Medicines which factor in differential diagnosis include; amlodipine, diltiazem, cyclosporine, phenytoin and felodipine

Stress

• Stress can causes immuno-suppression, leading to increased clenching and altered diet, decreasing motivation

Osteoporosis

• Consider the impact of age, gender and diet

Hyperlipidaemia

• Consider the impact of hyperlipidaemia

Patient Interaction

• The role of the dental professional involves detection, assessing, communication/education, motivation & coaching
• This leads to delivery, re-assessment, support, and monitoring to improve the patients health

Supporting Material

• Includes guidance for Public Health England and delivering better oral health

Making Every Contact Count (MECC)

• Making Every Contact Count (MECC) uses day-to-day interactions to support people in making positive changes to physical and mental health

Recommended Reading

• Casanova, L., Hughes, F. & Preshaw, P. Diabetes and periodontal disease: a two-way relationship. Br Dent J 217, 433–437 (2014). https://doi.org/10.1038/sj.bdj.2014.907 • Bobetsis YA, Barros SP, Offenbacher S. Exploring the relationship between periodontal disease and pregnancy complications. J Am Dent Assoc. 2006 Oct;137 https://doi.org/10.14219/jada.archive.2006.0403 • Winkler JR, Robertson PB. Periodontal disease associated with HIV infection. Oral Surg Oral Med Oral Pathol. 1992 Feb;73(2):145-50. doi: 10.1016/0030-4220(92)90186-t. PMID: 1532235. • Taichman LS, Sohn W, Kolenic G, Sowers M. Depot medroxyprogesterone acetate use and periodontal health in 15- to 44-year-old U.S. females. J Periodontal. 2012;83:1008-1017

Helpful links

• Useful links include the following; sanofi.com, parents.com, everydayhealth.com, irishtimes.com, womenshealth.gov, osmosis.org, diabetesjournals.org, zavamed.com, gnhindia.com, canr.msu.edu & Chance To Change stock image