RISK ! RISK ! RISK ! RISK p.p.presentaion.ppt

PERIO

1. BY
DR.P.THEAGARAYAN
RISK ! RISK ! RISK !
FOR PERIODONTAL DISEASES

2. RISKFACTORS , INDENTIFICATION OF RISK AND MANAGEMENT

IDENTIFICATION
OF
RISK FACTORS
ASSESMENT OF
LEVELS OF RISK AS,
LOW, MODERATE
OR HIGH
MANAGING AND MODFYING RISK FACTORS FOR
TREATMNT AND PREVENTION OF RECCURENCE OF
PERIODONTAL DISEASE AND POSTPONEMENT OF
RECCURENCE

3. RISK FACTORS
•RISK FACTORS ARE CHARACTERISTICS THAT HAVE A CAUSAL
RELATIONSHIP WITH THE DEVELOPMENT OF A DISEASE, BECK 1994.
•THE REPORTED RISK FACTORS FOR PERIODONTAL DISEASE
PROGRESSION ARE
•AGE,
•SMOKING AND
•PERIODONTAL PATHOGENS
•MORE RECENTLY, THE POSSIBLE ROLE OF PERIODONTAL INFECTIONS AS
RISK FACTORS FOR SYSTEMIC DISEASES SUCH AS
•DIABETES AND
•CORONARY HEART DISEASE HAS ATTRACTED SPECIAL ATTENTION,GENCO
1996,PAPAPANOU 1996

4. OTHER RISK FACTORS TO BE COSIDERED
•ORAL ENVIRONMENT
•Abnormal Oral Environmental Risk is one of the most difficult risk factors to
control on a day-to-day basis but can be the easiest to implement if the
patient is willing to accept responsibility for his or her own oral health.
•FREQUENCY OF TOOTH BRUSHING.
•TIME SPENT FOR TOOTH BRUSHING.
•CHANGING OF TOOTH BRUSH.
•POORLY CONTOURED RESTORATIONS
•Proximal fillings or crowns that provide traps for debris and plaque can also
contribute to its risk for periodontitis.
•ANATOMICAL TOOTH ABNORMALITIES
•Abnormal tooth structure can increase the risk for periodontitis.
•WISDOM TEETH.
•Third molars, can be a major breeding ground for the bacteria that cause
periodontal disease.

5. THINK TO YOUR SELF AND INK
1. Tom -Brushes his teeth once a day
- Consumes 2 minutes to brush
- Changes the brush once in 3 months
2. Dick - Brushes his teeth twice a day
- Consumes 2 minutes to brush once
- Changes the brush once in 3 months
3. Hary - Brushes his teeth once a day
- Consumes 5 minutes to brush once
- Changes the brush once in 3 months
Who will have good plaque control?
Who will have good teeth ?
Who will have dental problums if so what problum and why?

6. AGE AND GENDER
•CHILDREN AND ADOLESCENTS.
Gingivitis, in varying degrees, is nearly a universal finding in children and
adolescents. In rare genetic cases, children and adolescents are subject to
destructive forms of the disease. children, however, do not generally
harbor two primary periodontal bacteria, P. gingivalis and T. denticola.
•ADULTS.
•As people age, the risk for periodontal disease increases. Elderly
populations in many countries often show high rates of edentulousness
and the dentate often has only a few functional teeth. Miyazaki et al.
1995.As people age, their risk for developing PD increases . While the age
of a patient cannot be altered, the other major risk factors can be
controlled.
•FEMALE HORMONES
•Affect the gums, and women are particularly susceptible to periodontal
problems. Hormone-influenced gingivitis appears in some adolescents, in
some pregnant women, and is occasionally a side effect of birth control
medication.

7. MENSTRUATION AND PREGNANCY.
MENSTRUATION
Gingivitis may flare up in some women a few days before they
menstruate, when progesterone levels are high. Gum inflammation
may also occur during ovulation. Progesterone dilates blood
vessels causing inflammation, and blocks the repair of collagen, the
structural protein that supports the gums.
PREGNANCY.
Hormonal changes during pregnancy can aggravate existing
gingivitis, which typically worsens around the second month and
reaches a peak in the eighth month. Pregnancy does not cause gum
disease, and simple preventive oral hygiene can help maintain
healthy gums. Any pregnancy-related gingivitis usually resolves
within a few months of delivery. Periodontal disease can increase
the risk for premature low-weight infants.-OFFENBACKER

8. ORAL CONTRACEPTIVES AND MENOPAUSE.
•ORAL CONTRACEPTIVES.
•Some studies report that oral contraceptives containing the
synthetic progesterone desogestrel increase the risk for periodontal
disease.
•MENOPAUSE.
•Estrogen deficiency after menopause reduces bone mineral
density, which can lead to bone loss. Bone loss is associated with
both periodontal disease and osteoporosis. Bone loss in the
alveolar bone which holds the tooth in place may be a major
predictor of tooth loss in postmenopausal women. Periodontal
disease is the main cause of alveolar bone loss. During menopause,
some women may also develop a rare condition called menopausal
gingivostomatitis, in which the gums are dry, shiny, and bleed
easily. Women may also experience abnormal tastes and sensations
such as salty, spicy, acidic, and burning in the mouth.

9. FAMILY AND GENETIC FACTORS
•FAMILY FACTORS
•Periodontal disease often occurs in members of the same family as
Genetics, intimacy, hygiene, or a mixture of factors may be responsible for
the disease process . Studies have found that children of parents with
periodontitis are 12 times more likely to have the bacteria thought to be
responsible for causing plaque and, eventually, periodontal disease
•GENETIC FACTORS.
•Genetic factors may play the critical role in half the cases of periodontal
disease. Up to 30% of the population may have some genetic
susceptibility to periodontal disease.

10. SMOKING AND NICOTINE
Smoking is the
•Single major preventable risk factor for periodontal disease. The
habit can cause
•Bone loss and gum recession even in the absence of periodontal
disease. when nicotine combines with oral bacteria, such as P.
gingivalis, the effect produces even greater levels of cytokines and
eventually leads to periodontal connective tissue breakdown. The
risk of periodontal disease increases with the number of cigarettes
smoked per day. Smoking cigars and pipes carries the same risks as
smoking cigarettes. . Smoking habit and baseline attachment level
of 6mm more may be considered risk factors for further attachment
loss among healthy individuals with cigaret smoking habit.

11. NICOTINE AND C.V.S. SYSTEM
•Nicotine, the chief noxious substance found in cigarettes, and
its byproducts have a vasoconstrictive effect, not only on
peripheral circulation, but also on
•CORONARY,
•PLACENTAL, AND
•GINGIVAL BLOOD VESSELS -GONZA´LEZ ET AL. 1996.
•NICOTINE MAY REDUCE THE FUNCTIONAL ACTIVITY OF
•LEUKOCYTES AND
•MACROPHAGES IN SALIVA AS WELL AS
•CREVICULAR FLUID, AND IT DECREASES
•CHEMOTAXIS AND
•PHAGOCYTOSIS OF BLOOD AND TISSUE POLYMORPHONUCLEAR
LEUKOCYTES.
 

12. DIABETES AND OBISITY
DIABETES.
Much evidence exists on the link between type 1 and 2 diabetes
and periodontal disease. Diabetes causes changes in blood vessels,
and high levels of specific inflammatory chemicals such as
interleukins, that significantly increase the chances of periodontal
disease. High levels of triglycerides, which are common in type 2
diabetes also appear to impair periodontal health.
OBISITY
Obesity, common in people with type 2 diabetes, may also
predispose a person to periodontal disease. Controlling both type 1
and 2 diabetes may help reduce periodontal problems. For children
with diabetes, good oral hygiene should begin at a young age.

13. BLOODSUGAR LEVELS IN DIABETES
•BLOOD SUGAR LEVELS-
•Fasting blood sugar -70mgs/dl to 110mgs/dl
•Post prandial blood sugar-140mgs/dl
•Random blood sugar -80mgs to 120mgs/dl
•HbA1C-Non diabetic up to -6%-
•Well controlled diabetic -6.1% to 6.8%
•Poorly controlled diabetic-6.9% to 7.8%
•Uncontrolled diabetic >7.8%

14. OSTEOPOROSIS AND OSTEONECROSIS
OSTEOPOROSIS AND OSTEONECROSIS
Osteoporosis,loss of bone density has been associated with periodontal
disease in postmenopausal women. Osteoporosis may result from
disease, dietary or hormonal deficiency, or advanced age. Regular exercise
, vitamin and mineral supplements can reduce and may even reverse loss
of bone density.
BISPHOSPHONATES
However, almost all cases of osteonecrosis of the jaw associated with
bisphosphonate drugs occur during or after the use of intravenous
bisphosphonates, usually given as part of treatment for bone cancer or
other cancers that have spread to the bone.

15. HERPES- HIV -ASSOCIATED GINGIVITIS AND AUTOIMMUNE DISEASE
HERPES-RELATED GINGIVITIS
Herpes virus is a common cause of gingivitis in children and has become
increasingly common in adults.
HIV-ASSOCIATED GINGIVITIS.
HIV-associated gingivitis has been reported in 15 - 50% of patients with
HIV or AIDS. HIV-positive individuals harbor larger numbers of periodontal
bacteria such as candida albicans, P. gingivalis, black-pigmented anaerobic
rods, and A. actinomycetemcomitans than people without HIV.
AUTOIMMUNE DISEASE
Autoimmune conditions like Crohn's disease, multiple sclerosis,
rheumatoid arthritis, lupus erythematosus, CREST syndrome have been
associated with a higher incidence of periodontal disease.

16. VITAMIN C DEFICIENCIES AND GEOGRAPHIC FACTORS
VITAMIN C DEFICIENCIES
Vitamin C helps the body repair and maintain connective tissue, and its
antioxidant effects are important in the presence of tissue-destroying
oxidants in periodontal disease. Eating citrus fruits high in vitamin C ,such
as grapefruit may be helpful for patients with periodontitis.
ETHNIC, SOCIOECONOMIC, AND GEOGRAPHIC FACTORS
Dental disease is most likely to affect the poor. Children and the elderly
suffer the worst oral care, and ethnic minorities follow. In the United
States, the lack of access to dental insurance is a contributing factor.

17. DRUG-INDUCED GINGIVITIS, PSYCHOLOGIC STRESS AND
ALCOHOL ABUSE.
DRUG-INDUCED GINGIVITIS
Gingival overgrowth can be a side effect of nearly 20 different drugs, most
commonly phenytoin/Dilantin, cyclosporine , and a short-acting form of
the calcium channel blocker nifedipine
PSYCHOLOGIC STRESS.
Stress can affect the immune system. Some studies suggest that stress can
influence the development of chronic inflammatory diseases, like
periodontitis.
ALCOHOL ABUSE.
Reported a higher incidence of periodontal disease, tooth decay, and
possibly precancerous areas in patients who abuse alcohol.

18. HEREDITARY GINGIVAL FIBROMATOSIS AND DESQUAMATIVE
GINGIVITIS
HEREDITARY GINGIVAL FIBROMATOSIS.
A rare genetic disease associated with both gum overgrowth and
hairiness. It is often associated with gingivitis and periodontal disease.
DESQUAMATIVE GINGIVITIS.
With this condition the outer layer of the gum tissue desquamates /peels
away, exposing an acutely red surface. It usually occurs as a result of an
allergic reaction or of skin diseases such as lichen planus, benign mucous
membrane pemphigoid, bullous pemphigoid, and pemphigus vulgaris. This
condition generally resolves when the underlying problem is treated. It is
fairly common in middle-aged women.

19. RISK ASSESMENT

20. MANAGEMENT BY CONTROLLING OR ALTERING THE RISK
FACTORS
1.As people age, their risk for developing Periodontal Disease increases. While
the age and gender of the patient cannot be altered, the other major risk
factors can be controlled.
2.Smoking can cause bone loss and gingival recession. Exposure to second-
hand smoke increases Periodontal Disease risk. Smoking is the single major
preventable risk factor. Sesation of smoking can arrest the disease.
3.Diabetes is the most common medical history found in patients. Controlling
diabetes may help reduce risk for periodontitis.
4.Abnormal Oral Environmental Risk is one of the most difficult risk factors to
control on a day-to-day basis but can be the easiest to implement if the
patient is willing to accept responsibility for his or her own oral health.

21. CONCLUSION
To conclude identification of risk factors ,assesment of level of risk
involved in the reccurence of the condition after periodontal therapy has
to be evaluated and the patient has to be councilled accordingly to get
100% compliance from the patient. Patient compliance is the one which
is capable of reducing or prolonging the recurrence of periodontitis after
periodontal therapy.

22. BIBILOGRAPHY
•Beck, J. D. Methods of assessing risk for periodontitis and developing
multifactorial models. Journal of Periodontology 1994
•Genco RJGCurrent view of risk factors for periodontal diseases. J
periodontol 1996
• Khalaf F.Al-Shammari Risk Indicators for Tooth Loss Due to Periodontal
Disease, Journal of Periodontology. 2005,
•Ogawa H, Yoshihara A, Hirotomi T, Ando Y, Miyazaki H: Risk factors
forperiodontal disease progression among elderly people. J Clin
Periodontol 2002;:
•Tomar S, Asma S. Smoking Attributableperiodontitis in theUnited States:
Findings from NHANES III. J Periodontol. 2000;