Term
What is the number one cause of dental malpractice lawsuits?
What is the second? |
|
Definition
failure to diagnose and treat periodontal disease
Failure to diagnose Oral Cancer |
|
|
Term
True or false
Periodontal disease is connected to many medical conditions and dental care providers cannot afford to ‘watch it’. |
|
Definition
|
|
Term
True or false
It is not necessary to document all conversations pertaining to dental care. |
|
Definition
False
It is important that all conversations pertaining to dental care be documented. If you fail to document, it could be assumed you fail to diagnose.” |
|
|
Term
| The biofilm of complex plaque (>400 bacterial species, toxic products) causes what kinds of host-mediated destruction to initiate? |
|
Definition
Cytokines and inflammatory mediators
IL-1, IL-6,IL-8, TNF-α, PGE2 |
|
|
Term
| What happens in the periodontal pocket that causes systemic disease susceptibility? |
|
Definition
| Inside of periodontal socket is nonkeratinized-in diseased it becomes ulcerated (ulcerated periodontal pocket epithelium); becomes a pathway for disease to get into systemic circulation |
|
|
Term
| How does the sub gingival biofilm cause systemic disease susceptibility? |
|
Definition
A Reservoir of Gram- Negative Bacteria
-Bacteremia
-Major vascular responses |
|
|
Term
True or false
Mastication can cause bacteremias. Oral hygiene does not cause bacteremias. |
|
Definition
True to first, false to second.
Every time you chew or perform oral hygiene we develop bactermia. |
|
|
Term
Bacteremias is related to severity of _____________?
It is greater in patients with _________. |
|
Definition
gingival inflammation
periodontitis |
|
|
Term
True or false:
Bacteremias must be cured with surgical periodontal therapy. |
|
Definition
False
Prevention maintenance of periodontal health (can be cured with non-surgical perio therapy) |
|
|
Term
| What was the theory in which extreme therapies involved removal of oral tissue in the absence of evidence of infection, and many healthy teeth were indiscriminately removed. |
|
Definition
focal infection theory ("foci" of sepsis from oral cavity)
evidence did not support theory |
|
|
Term
| Flossing adds ___ years to your life |
|
Definition
|
|
Term
True or false:
Smoking is not a systemic disease but it relates to periodontitis because it is extremely pro-inflammatory |
|
Definition
|
|
Term
| What all (4) does smoking affect in periodontitis? |
|
Definition
Immunosuppression (T-cell ratios)
Impaired osteablast function (Reduction in skeletal bone mineral content)
Impaired neutrophil function
Local cytotoxic and vasoactive substances (nicotine) - vasoconstriction locally to the sites |
|
|
Term
| *What is the #1 modifiable risk factor of perio disease? |
|
Definition
|
|
Term
*True or false
If you smoke and are over 25, you very likely to have periodontitis. |
|
Definition
False
if you smoke and over 35!! |
|
|
Term
True or false:
30% 19-40 year olds periodontitis is associated with smoking |
|
Definition
|
|
Term
True or false:
100% of heavy smokers of 30-40 have periodontitis |
|
Definition
|
|
Term
| What do surgeon general warning labels on cigarettes fail to mention? |
|
Definition
| may cause gum disease and tooth loss |
|
|
Term
| What is the increase in likelihood of developing perio disease you smoke? |
|
Definition
|
|
Term
| How do we calculate dose-dependent relationship of smoking? |
|
Definition
| # of year x # packs/day (20 cigs in one pack) |
|
|
Term
| How many years does it take for the risk of a former smoker to have risks of a non-smoker? |
|
Definition
|
|
Term
| What does smoking increase and decrease in terms of periodontitis? |
|
Definition
Smoking increases the risk of developing periodontal disease
Smoking decreases the effectiveness of surgical and nonsurgical periodontal treatments |
|
|
Term
True or false
Smokers may have an increase in pathogenic bacteria or more pathogenic bacteria at shallower sites than nonsmokers |
|
Definition
|
|
Term
| Why has there been in an increase in smokeless tobacco use in the past decade? |
|
Definition
Smoking bans
“Dual use”
(200% increase in smokeless tobacco use in females since 1999) |
|
|
Term
Smokeless tobacco more or less detrimental than cigarette smoking in the systemic system?
What type of oral disease would you expect to see in smokeless tobacco users? |
|
Definition
Smokeless is less detrimental than cigarette smoking in systemic (There is still decreased blood flow and pro-inflammatory.)
Oral cancer, localized recession factor at site |
|
|
Term
| What does nicotine cause in the systemic system |
|
Definition
| vasoconstriction and pro-inflammatory (electronic cigs are still detrimental) |
|
|
Term
| If you’re a woman over 65, if you fall and break your hip, what’s the likelihood of mortality rate within the year? |
|
Definition
|
|
Term
What is NOT a risk factor for osteoporosis?
Older age
Being male
Family history of osteoporosis or broken bones
Being Caucasian
Being small and thin
Low sex hormones (estrogen, testosterone)
inactive lifestyle
smoking |
|
Definition
|
|
Term
What low intake is an osteoporosis risk factor?
What excessive intake is an osteoporosis risk factor? |
|
Definition
Low calcium intake
Low vitamin D intake
Excessive intake of protein, sodium and caffeine |
|
|
Term
How many post menopausal women have osteoporosis?
How many men? |
|
Definition
1 in 3 post menopausal women
1 in 12 Men |
|
|
Term
| What is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration with a consequent increase in bone fragility and susceptibility to fracture |
|
Definition
|
|
Term
True or false:
There is not a link between osteoporosis and tooth loss |
|
Definition
False
Link between osteoporosis and bone loss in the jaw
May lead to tooth loss
-density of the supporting bone decreased
-teeth no longer have a solid foundation |
|
|
Term
| What age will you see peak bone mass lost? |
|
Definition
| 20-40 (mainly due to carbonated beverages) |
|
|
Term
| In the calcium depletion phase there is a similar loss of ________ bone and ________ bone |
|
Definition
|
|
Term
True or false:
the calcium depletion phase does not have similar rates in men and women |
|
Definition
false
Similar rates in men and women |
|
|
Term
| Do men or women have higher bone mass throughout their lives? |
|
Definition
|
|
Term
| When is bone loss accelerated in women? |
|
Definition
| circummenopausal (females get to fracture threshold quicker than males) |
|
|
Term
| There is a strong association between _________ consumption and bone fractures in teenage girls. |
|
Definition
|
|
Term
| In a healthy individual, up to ___% of all bone mass may be undergoing remodeling |
|
Definition
|
|
Term
| Bone is resorbed by _________ cells after which newly formed bone is deposited by _________ cells |
|
Definition
|
|
Term
How long can bone resorption at one site take?
How long can bone deposition at the same site take? |
|
Definition
|
|
Term
| What factors can uncouple bone resorption and deposition? |
|
Definition
age
infection/disease
forces or function |
|
|
Term
| Bone resorption is upregulated by ________ cascades that ultimately upregulate receptor activator for nuclear factor- κβ ligand (________) |
|
Definition
| Bone resorption is upregulated by cytokine cascades that ultimately upregulate receptor activator for nuclear factor- κβ ligand (RANKL) |
|
|
Term
True or false:
Proinflammatory cytokines that are elevated in osteoporotic bone resorption are also elevated with periodontal disease |
|
Definition
|
|
Term
| Basal bone mineral density is related to ____________ over time. |
|
Definition
| bone loss (loss of bone height) |
|
|
Term
| What are some ways to manage osteoporosis? |
|
Definition
Diet
Calcium supplements
Estrogen replacement (Cost benefit analysis)
Weight baring exercise
Bisphosphonates (Alendronate, Fosamax)
Regeneration? |
|
|
Term
| What type of therapy decreases bone resorption and increases apposition to increase bone density but the remaining bone is old. |
|
Definition
|
|
Term
| Why do people get taken off of bisphosphate therapy after 10-15 years? |
|
Definition
| it doesn't have any additional benefit because bisphosphate has an extremely long half life |
|
|
Term
| What are the 2 categories of bisphosphates? |
|
Definition
Bisphosphonate used to treat osteoporosis and osteopenia
Bisphosphonate used to treat metastatic bone cancer (zometia-100-500x more potent) |
|
|
Term
True or false
The clinical efficacy of oral bisphosphonates for the treatment of osteopenia/osteoporosis is not well established |
|
Definition
false
is well established (why so many scripts are written for oral bisphosphonates) |
|
|
Term
| What is exposed bone in the maxillofacial area occuring spontaneously or after routine therapy with no evidence of healing for 8 weeks despite appropriate therapy |
|
Definition
Osteonecrosis of the Jaw
ONJ, BRONJ (bisphosphonate related osteonecrosis of the jaw) |
|
|
Term
| Is BRONJ more likely to occur in patients receiving IV bisphosphonates or oral? |
|
Definition
|
|
Term
| Where are the risk factors in the mandible and maxilla for BRONJ? |
|
Definition
Mandible- Lingual tori, Mylohyoid ridge
Maxilla-Palatal tori |
|
|
Term
| Are BRONJ lesions more commonly found in the mandible or maxilla? |
|
Definition
| Lesions are found more commonly in the mandible than the maxilla (2:1 ratio) |
|
|
Term
True or false:
BRONJ is more commonly found in areas with thin mucosa overlying bony prominences such as tori, bony exostoses, and the mylohyoid ridge |
|
Definition
|
|
Term
| Patients with a history of ___________ have a 7-fold increased risk for developing BRONJ |
|
Definition
| inflammatory dental disease, eg, periodontal and dental abscesses |
|
|
Term
| List some risk factors for BRONJ. |
|
Definition
Corticosteroid therapy
Diabetes
Smoking
Alcohol use
Poor oral hygiene
Chemotherapeutic drugs |
|
|
Term
True or false:
Intervention is necessary prior to oral bisphosponate therapy. |
|
Definition
False
No intervention necessary at that time
No end point for therapy, therefore explain and reinforce the importance of good OH/routine dental care |
|
|
Term
| How would you treat a patient prior to IV bisphosponate therapy? |
|
Definition
| Treat like a patient who is beginning head and neck radiation therapy (do exam and identify potential problems) |
|
|
Term
| What should you do with an asymptomatic patient on IV bisphosphonates? |
|
Definition
Avoid invasice dental procedures
Routine cleanings/visits are important
Monitor |
|
|
Term
| What should you do with an asymptomatic patient on oral bisphosphonates for less than 3 years and over 3 years? |
|
Definition
No immediate modifications to therapy (< 3 years)
If > 3 years exposure or + chronic steroid treatment Consider a drug holiday with their physician (approx 3 mos) |
|
|
Term
| In a recent study conducted in the netherlands, __________ was associated with hypertension, diabetes, and rheumatoid arthritis |
|
Definition
|
|
Term
True or false
There is increased prevalence of co-disease with increasing severity of periodontitis |
|
Definition
|
|
Term
| Is periodontal disease more prevalent in patients with rheumatoid arthritis or osteoarthritis? |
|
Definition
| Periodontal disease is nearly 2x as prevalent in patients with RA (51%) versus OA (26%) |
|
|
Term
| The presence of periodontitis in RA patients was highly associated with _____ and ______, which are both associated with RA progression and severity |
|
Definition
rheumatoid factor (RF)
anti-cyclic citrullinated peptide (anti- CCP) |
|
|
Term
| What is the one bacteria that possesses peptidylarginine deiminase (PAD), which is able to citrullinate proteins which is highly indicative for RA disease progression? |
|
Definition
|
|
Term
Rheumatoid arthritis is mainly in females in the ____ to ___ decade of life.
Prevalence increases with ______ |
|
Definition
|
|
Term
| Rheumatoid arthritis often clusters with other ______ disorders. |
|
Definition
|
|
Term
| 70-90% of patients with RA demonstrate _________. |
|
Definition
| rheumatoid factor (antibodies to the Fc portion of IgG) |
|
|
Term
In Perio-RA interaction human studies, _________ treatment of RA patients reduced periodontal indices and GCF TNF-α levels.
This suggested a common ________ mechanism and perhaps treatment. |
|
Definition
Anti-TNF-α
proinflammatory |
|
|
Term
| What peptide and antibody are critical in the initiating pathogenesis of RA? |
|
Definition
| Citrullinated peptides (CCP) and Anti-citrullinated peptide antibodies (ACPA) |
|
|
Term
True or false:
Pregnancy does not affect gingival disease. |
|
Definition
False
During pregnancy, similar levels of oral hygiene are associate with increased levels of gingival disease
As hormone levels increase, we see increased levels of gingival inflammation not related to oral hygiene |
|
|
Term
| All premature babies are at risk for health problems, but those born before about ____ weeks of gestation face the highest risk |
|
Definition
|
|
Term
| ______ and ______ rise steadily throughout pregnancy until threshold is reached to induce labor, cervical dilation, and delivery |
|
Definition
|
|
Term
| What is able to induce myometrial contractility and thought to participate in decidual/fetal membrane activation |
|
Definition
|
|
Term
Administration of _______ can induce termination of pregnancy.
Tx with _______ or ______ can delay spontaneous onset of labor (animals)
Plasma and intra-amniotic fluid levels of _______ increase during labor
Intra-amniotic injection of ___________ can induce termination of pregnancy |
|
Definition
prostaglandins
indomethacin or aspirin
prostaglandin
arachidonic acid |
|
|
Term
What cytokine can induce production prostaglandins?
Which trimester does this appear in and increases? |
|
Definition
IL-1β
2nd trimester (suggest a role of this cytokine during labor) |
|
|
Term
| What is an easy pathogenesis of preterm birth that we can treat? |
|
Definition
|
|
Term
| What do maternal infections result in (3)? |
|
Definition
preterm labor
preterm rupture of membranes
spontaneous preterm birth (SPB), which is associated with low birth weights |
|
|
Term
True or false:
Mothers with improved oral hygiene habits and knowledge have children who have significantly lower caries rates than mothers with poorer oral hygiene habits/ knowledge. |
|
Definition
True
Caries is #1 reason why children miss school |
|
|
Term
| What is the 2nd leading cause of death Worldwide |
|
Definition
|
|
Term
| What results in large to medium-sized muscular and large elastic arteries fibro-lipid lesions? |
|
Definition
|
|
Term
What is NOT a risk factor for patients with periodontal disease and cardiovascular disease?
Age
Female
lower socioeconomic status
stress
smoking |
|
Definition
female
(gender is mostly male) |
|
|
Term
Perio disease affects cardiovascular disease:
Direct bacterial effects on __________
_________ responses
Invasion and/or uptake of bacteria in _______ cells and _________
Endocrine-like effects of _________mediators |
|
Definition
Direct bacterial effects on platelets
Autoimmune responses
Invasion and/or uptake of bacteria in endothelial cells and macrophages
Endocrine-like effects of pro- inflammatory mediators |
|
|
Term
| What is the acute phase reactant that augments innate inflammatory response via induction of prothrombotic factors |
|
Definition
|
|
Term
| elevated ____ levels in asymptomatic patients were associated with a markedly increased risk of MI and stroke. |
|
Definition
CRP
(there is also more CRP serum concentrations in perio patients and a decrease in CRP after perio therapy) |
|
|
Term
True or false:
edentulous men are more likely to demonstrate a higher risk of coronary heart disease than periodontally healthy, dentate men |
|
Definition
true
(no association found with periodontal disease) |
|
|
Term
| What do current studies lack and should add for future studies (4). |
|
Definition
Baseline oral examinations
Assessing self-care behaviors
Adequate sample sizes especially for women
Intervention trials with an adequate endpoint |
|
|
Term
| Prevalence of periodontal disease among patients 18-34 years old is ____% higher in obesity subjects v. normoweight controls |
|
Definition
|
|
Term
| Adipocytes manufacture what 3 things that affect the periodontal tissues directly |
|
Definition
| pro-inflammatory cytokines, adipokines, and reactive oxygen species |
|
|
Term
True or false:
individuals who maintained a normal weight, performed regulalr exercise, and consumed a diet in conformity with the Food Pyramid are 40% less likely to have periodontitis |
|
Definition
|
|
Term
| What is the most common endocrine disorder? |
|
Definition
| diabetes (6% of population or 10.7% of adults > 20 y.o) |
|
|
Term
| What type of diabetes is an auto immune destruction of insulin producing B cells in pancreas --> severe hyperglycemia |
|
Definition
|
|
Term
What is the age of diagnosis usually for Type I diabetes?
How do you treat it? |
|
Definition
<30
Exogenous Insulin supplementation |
|
|
Term
| What type of diabetes is 90-95% of all Diabetic cases? |
|
Definition
|
|
Term
| What type of diabetes is onset midlife and is insulin tolerance or resistant -->hyperglycemia |
|
Definition
|
|
Term
| How do you treat type 2 diabetes? |
|
Definition
| Diet, exercise, meds, insulin |
|
|
Term
| Which type of diabetes has a less strong genetic component? |
|
Definition
|
|
Term
What is the risk of a child developing Type 2 diabetes if 1 parent was diagnosed before 50?
after 50? |
|
Definition
1 in 7, if parent was diagnosed before 50 y.o.
1 in 13, if parent was diagnoses after 50 y.o. |
|
|
Term
| What are some complications associated with diabetes? |
|
Definition
Retinopathy (blindness)
Nephropathy (renal failure)
Neuropathy
Macrovascular disease (Cardiovascular, Stroke, Peripheral)
Altered wound healing |
|
|
Term
| In diabetics, tighter glycemic control resulted in a ___-____% decrease in microvascular complication and a __x increase in the risk of hypoglycemia |
|
Definition
| Tighter glycemic control resulted in a 25-75% decrease in microvascular complication and a 3x increase in the risk of hypoglycemia |
|
|
Term
What is the HbA1c (glucose level) for normal?
Target?
high? |
|
Definition
Normal < 6%
Target < 7% (only 1/3 of Diabetic population meets this target)
High >8% (ADA requires intervention!) |
|
|
Term
| What are some complications associated with diabetes? |
|
Definition
Retinopathy (blindness)
Nephropathy (renal failure)
Neuropathy
Macrovascular disease (Cardiovascular, Stroke, Peripheral)
Altered wound healing |
|
|
Term
| In diabetics, tighter glycemic control resulted in a ___-____% decrease in microvascular complication and a __x increase in the risk of hypoglycemia |
|
Definition
| Tighter glycemic control resulted in a 25-75% decrease in microvascular complication and a 3x increase in the risk of hypoglycemia |
|
|
Term
What is the HbA1c (glucose level) for normal?
Target?
high? |
|
Definition
Normal < 6%
Target < 7% (only 1/3 of Diabetic population meets this target)
High >8% (ADA requires intervention!) |
|
|
Term
True or false:
Diabetic status strongly related to prevalence and severity of periodontal disease |
|
Definition
|
|
Term
| Diabetics have a ___x greater risk for periodontal destruction |
|
Definition
|
|
Term
| What is known as “The 6th complication of Diabetes Mellitus”? |
|
Definition
|
|
Term
| In a study with the PIMA indians with both diabetes and periodontal disease, effective treatment of periodontal infection and reduction of periodontal inflammation are associated with a reduction in level of _________ |
|
Definition
|
|
Term
| What are complications involved with uncontrolled diabetes in regards to gingival health? |
|
Definition
More likely to develop periodontal disease than well-controlled diabetics
Acute multiple micro abscess
Gingival proliferative reaction
Changes in periodontal vasculature
Impaired immune function (PMN)
Impaired wound healing |
|
|
Term
True or false
Smoking increases your risk of lunger cancer higher than it increases your risk of cardiovascular disease |
|
Definition
False
increases cardiovascular disease more |
|
|
Term
What is it call when a person is 1 standard deviation below the mean on a bone density test?
2 standard deviations below? |
|
Definition
|
|
Term
| What happens when people lose all of their teeth? |
|
Definition
| we see lost of alveolar bone (not basal bone) |
|
|
Term
| The lower basal bone density, the more loss of _______ bone occurs |
|
Definition
|
|
Term
Zometia or Reclast:
Which one is used osteoporosis and osteopenia?
Which one is used for metastatic bone cancer (100-500x more potent)> |
|
Definition
Reclast-1 year injection for osteoporosis
Zometia- 100-500x more potent. used for metastatic bone cancer |
|
|
