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Periodontal Disease In The Elderly arthritis

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Periodontal Disease In The Elderly arthritis Powered By Docstoc
					Periodontal Disease in
    the Older Adult



   Kimberly Manz, DMD



  Medical University of South Carolina/SC-Geriatric Education Center
                     Objectives
 Aftercompletion of the module, the
 participant will be able to:
     Recognize the signs and symptoms
      of periodontal disease.
     Identify the factors that increase
      patients susceptibility to
      periodontitis.
     Be aware of the fundamental goals of
      periodontal therapy and how
      successful therapy can improve
      quality of life.
     Understand the effects of chronic oral
      infections on systemic health.
          Medical University of South Carolina/SC-Geriatric Education Center
       Word Documents

The Opening Activity, Glossary,
References, Evaluation Form and
Pre-Post test are found in a separate
MS Word document.




      Medical University of South Carolina/SC-Geriatric Education Center
         Opening Activity

 Define periodontal disease.
 List three symptoms.
 Will it affect the rest of the body?
 What happens if it is not corrected?
 Does it occur because of age?




        Medical University of South Carolina/SC-Geriatric Education Center
       Periodontal Disease
 Is chronic bacterial infection
  affecting the gingiva and underlying
  bone.
 Begins as gingivitis when plaque is
  not adequately removed from the
  tooth surface.
 If untreated, can progress causing
  bone destruction and eventual tooth
  loss.
 Can be localized or generalized.
        Medical University of South Carolina/SC-Geriatric Education Center
        Facts About Periodontal
        Disease in the Elderly1,2
 Itis associated with increasing age, but
  is not a direct consequence of aging.

 Researchhas shown a gradual
  breakdown of the periodontium with age.

 The  periodontal ligaments contain less
  fiber and cellular constituents reducing
  healing and regenerative capabilities.

           Medical University of South Carolina/SC-Geriatric Education Center
    Facts About Periodontal
     Disease in the Elderly
 Cellsin the aging periodontium
 demonstrate higher production of
 inflammatory mediators which may
 affect the severity of the disease.

 Changes   in connective tissue
 structure including epithelial thinning
 and a decrease in keratinized tissue
 may result in increased susceptibility
 to infection.
          Medical University of South Carolina/SC-Geriatric Education Center
    Diagnosis of Periodontal
           Disease
 Review   of medical and dental history
 Clinical examination:
   Probing depths
   Radiographs
      Panoramic

      Periapical

      Bitewings


 Follow-upevaluations to determine
 disease progression
         Medical University of South Carolina/SC-Geriatric Education Center
     Impact on Quality of Life3
 Pain
           chewing food
 Difficulty
 Decreased caloric intake and weight
  loss
 Root caries due to recession
 Tooth loss
 Speech impairment
 Decreased self-esteem
 Impact of chronic oral infection on
  health
        Aspiration Pneumonia
            Medical University of South Carolina/SC-Geriatric Education Center
    Diagnosis of Periodontal
           Disease
 Clinical   Examination:
   Color and quality of soft tissues
   Contours of hard tissues
   Probing depths
   Tooth mobility
   Areas of recession
   Furcation involvement/root exposure


         Medical University of South Carolina/SC-Geriatric Education Center
      Diagnosis of Periodontal
             Disease
 Probing Depths:
   Probe is placed
    between gingiva and
    tooth structure.
   Measures
    periodontal pockets
    surrounding each
    tooth.
   Greater probing
    depths indicate
    varying degrees of
    bone destruction.
           Medical University of South Carolina/SC-Geriatric Education Center
   Diagnosis of Periodontal
          Disease
 Panoramic        Radiograph:




       Medical University of South Carolina/SC-Geriatric Education Center
   Diagnosis of Periodontal
          Disease
 Panoramic        Radiograph:




       Medical University of South Carolina/SC-Geriatric Education Center
    Diagnosis of Periodontal
           Disease
 Periapical     Radiographs:




        Medical University of South Carolina/SC-Geriatric Education Center
   Diagnosis of Periodontal
          Disease
 Bitewing    Radiographs:




        Medical University of South Carolina/SC-Geriatric Education Center
Stages of Periodontal Disease

                         Health
                                
                     Gingivitis
                                
                  Periodontal
                   Disease
     Medical University of South Carolina/SC-Geriatric Education Center
Stages of Periodontal Disease4

 Health:
   Soft tissues are coral-pink in color
   Contour and alignment of teeth
    determine shape and position of
    gingiva
   Scalloped borders following
    contours of teeth
   Flat, knife-edged margins
   Smooth or stippled texture

       Medical University of South Carolina/SC-Geriatric Education Center
Stages of Periodontal Disease
 Health:




      Medical University of South Carolina/SC-Geriatric Education Center
Stages of Periodontal Disease
 Gingivitis:
   Earliest stage of disease
   Inflammation of the gingiva
   Gingiva appears red and swollen and
    may be tender
   May bleed when probed, brushed or
    flossed
   Bone and periodontal ligament not
    affected yet
   REVERSIBLE

         Medical University of South Carolina/SC-Geriatric Education Center
Stages of Periodontal Disease
 Gingivitis:




         Medical University of South Carolina/SC-Geriatric Education Center
Stages of Periodontal Disease

 Periodontal         Disease:
   Primary cause is bacterial plaque
   Chronic inflammatory response caused
    by bacterial toxins
   Attachment loss
   Recession
   Tooth mobility
   Tooth loss
   Common patient complaints
        Medical University of South Carolina/SC-Geriatric Education Center
  Stages of Periodontal Disease

 Periodontal      Disease:




         Medical University of South Carolina/SC-Geriatric Education Center
 Types of Periodontal Disease

 Gingivitis
 Aggressive  Periodontitis
 Chronic Periodontitis
 Periodontitis as a Manifestation of
  Systemic Disease
 Necrotizing Periodontal Diseases




        Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
     to Periodontal Disease

 Systemic   Diseases                   Tobacco  Use
 Arthritis/Poor                        Poor Nutrition
  Dexterity                             Stress/Depression
 Cancer Therapy                        Removable Partial
 Medications                            Dentures
 Genetics                              Microorganisms


          Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
    to Periodontal Disease 5
   Systemic         Diseases:
       Diabetes Mellitus
       Osteoporosis

       Cardiovascular Disease




          Medical University of South Carolina/SC-Geriatric Education Center
        Systemic Diseases5
 Diabetes Mellitus (DM):
   Duration of diabetes and severity of
    periodontal disease are directly
    proportional.
   Uncontrolled/poorly controlled DM
    associated with increased susceptibility
    to oral infections.
   Related to PMN dysfunction.
   Elevated glucose concentration in
    gingival secretions may cause altered
    plaque bacteria.
         Medical University of South Carolina/SC-Geriatric Education Center
       Systemic Diseases5

 Diabetes    Mellitus (DM):
   Hyperglycemia adversely affects
    collagen synthesis and maturation.
   Diabetics have less favorable response
    to therapy than non-diabetics.




        Medical University of South Carolina/SC-Geriatric Education Center
       Systemic Diseases6,7,8

 Osteoporosis:
   Age-related changes in bone mass are
    greater in women than men.
   Patients greater than 50 years of age
    demonstrate increased porosity of
    mandibular bone and an overall decrease
    in bone mass.




         Medical University of South Carolina/SC-Geriatric Education Center
       Systemic Diseases8

 Osteoporosis:
   Post-menopausal women with
    osteoporosis appear to be at greater
    risk for developing periodontal disease.
   Estrogen supplementation in early post-
    menopausal women with evidence of
    osteoporosis has shown to reduce
    gingivitis and attachment loss.



        Medical University of South Carolina/SC-Geriatric Education Center
         Systemic Diseases

 Cardiovascular Disease:
   Associated with periodontal disease, but
    exact mechanism not established

   Theories Include:

      Bacteria from the oral cavity gain access to
       vasculature causing systemic inflammation.
      Bacteria in the circulation attach to plaques
       along vessel walls and release agents that
       affect clotting.


          Medical University of South Carolina/SC-Geriatric Education Center
       Systemic Diseases3
 Theories Include:

     Periodontal disease as a source of
      inflammatory mediators, reaching systemic
      levels.

 Risk of infective endocarditis as a result
 of oral plaque bacteria.



         Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
   to Periodontal Disease9-10

 Arthritis/Poor Dexterity:
   Increased plaque accumulation
        Arthritis, injury, stroke
   In contrast, a study found no difference in
    plaque levels between rheumatoid arthritis-
    periodontitis patients and healthy controls.




               Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
    to Periodontal Disease10
  Arthritis/Poor Dexterity:
    Research indicates patients with
     rheumatoid arthritis have increased
     levels of inflammatory products in
     association with periodontal bone loss.
    Periodontal disease and rheumatoid
     arthritis thought to have similar
     pathologies.
       Damage from immune system response
       Chronic inflammation




          Medical University of South Carolina/SC-Geriatric Education Center
 Factors Increasing Susceptibility
    to Periodontal Disease11-12
 Cancer   Patients:
     Certain malignancies, such as acute and
      chronic leukemias, often present with oral
      manifestations.
     Radiation, chemotherapy and bone
      marrow transplants may have adverse
      effects on the oral cavity.



            Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
    to Periodontal Disease12
  Cancer    Patients:
      Cytotoxic effects of the various cancer
       treatments may result in increased
       susceptibility to infection from fungal,
       viral and bacterial organisms.
      Potential sources of oral infections
       should be eliminated prior to cancer
       therapy.


           Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
    to Periodontal Disease13
 Medications:
   Xerostomia
      Anticholinergics

      Antihypertensives

      Antidepressants

      Antianxiety medications
                               13

   Gingival Hyperplasia
      Calcium channel blockers

      Cyclosporine

      Dilantin
          Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
     to Periodontal Disease
 Gingival Hyperplasia
  From Medication:




        Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
   to Periodontal Disease14-16
 Genetics:
   Genetic studies have found significant
    heritable components in adult
    periodontitis.
        Gingivitis, probing depths, attachment loss
         and bone height
   Other studies have investigated
    abnormalities in immune system
    components.
      Immunoglobulins
      Interleukins


              Medical University of South Carolina/SC-Geriatric Education Center
 Factors Increasing Susceptibility
     to Periodontal Disease17
 Tobacco Use:
   Significant risk factor in the development
    and progression of periodontitis.
   Associated with deeper probing depths,
    greater attachment , alveolar bone loss and
    increased calculus formation.
   Related to cigarettes per day and number of
    years patients have smoked.




            Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
    to Periodontal Disease17

  Tobacco Use:
    Considered an important predictive
     variable in patient response to therapy.
    Results in defective neutrophil function.
    Possible relationship between
     smokeless tobacco and periodontal
     disease, primarily localized attachment
     loss.


          Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
    to Periodontal Disease13

  Poor   Nutrition:
    Age-related decline in nutrient
     absorption.
    Poor nutrition may result in decreased
     cellular activity.




          Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility to
      Periodontal Disease18
   Stress/Depression:
    Stress:
       Increased production of inflammatory

        mediators
    Depression:
       May cause decreased immune function and
        wound healing
       Decreased response to therapy




          Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
    to Periodontal Disease13

  Poor   Nutrition:
    Age-related decline in nutrient
     absorption.
    Poor nutrition may result in decreased
     cellular activity.




          Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
    to Periodontal Disease18
  Stress-Depression:
   Stress:
      Increased production of inflammatory

       mediators
   Depression:
      May cause decreased immune function and
       wound healing
      Decreased response to therapy




         Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
    to Periodontal Disease19
 Removable           Partial Dentures:
   Associated with increased gingivitis,
    periodontal disease and tooth mobility.
   Increases plaque accumulation.
   Causes pressure on natural teeth
    transmitting stress to periodontal
    structures.


         Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
     to Periodontal Disease
 Removable      Partial Dentures:




        Medical University of South Carolina/SC-Geriatric Education Center
Factors Increasing Susceptibility
    to Periodontal Disease20
  Microorganisms:
    Types and primary location:
       Supragingival: Gram positive, aerobic,
        facultative anaerobic species
       Subgingival: Gram negative, strictly
        anaerobic
    Mechanism of pathology:
       Endotoxin, lipopolysaccharides and
        collagenases
    Species of bacteria associated with
     specific forms of periodontal disease
          Medical University of South Carolina/SC-Geriatric Education Center
     Treatment Options For
      Periodontal Disease

 Personal/Professional Debridement
 Chlorhexidine Mouth Rinse (Peridex)
 Surgical Procedures
 Treatment for Refractory Periodontitis




        Medical University of South Carolina/SC-Geriatric Education Center
        Treatment Options For
         Periodontal Disease

 Personal    and Professional Debridement:
   Personal Debridement:
      Maintenance of daily oral hygiene regimen.

      Goal is prevention of gingival inflammation

       through plaque removal.




            Medical University of South Carolina/SC-Geriatric Education Center
        Treatment Options For
         Periodontal Disease

 Personal   and Professional Debridement:
   Professional Debridement:
      Removal of deposits by hygienist or dentist

      Recommended intervals based on oral hygiene
       status
      Effective technique instruction




           Medical University of South Carolina/SC-Geriatric Education Center
        Treatment Options for
         Periodontal Disease
 Surgical    Procedures:
     Pocket Reduction Procedures
     Regenerative Procedures

     Crown Lengthening

     Soft Tissue Grafts




         Medical University of South Carolina/SC-Geriatric Education Center
     Treatment Options For
      Periodontal Disease
 Chlorhexidine              Gluconate 0.12%:
   Brand Names: Periguard, Peridex
   Advantages:
      Decreases gingival inflammation

      Binds to tissues and has lasting effect

      Convenient for patients who cannot brush
       after surgical procedures
   Disadvantages:
      May cause increased calculus deposition

      Stains teeth

   Dosing Information:
         Medical University of South Carolina/SC-Geriatric Education Center
        Treatment Options For
        Periodontal Disease21-22
 Treatment    for Refractory Periodontitis:
     Those who respond poorly to initial
      treatment
     Specific bacterial species associated with

      refractory periodontal disease
     Emergence of antibiotic resistance

     Alternatives to systemic antibiotic

       therapy

          Medical University of South Carolina/SC-Geriatric Education Center
                          Summary
   Multifactorial disease from bacterial
    infections causing chronic inflammation of
    the periodontium.
   Numerous adverse outcomes of untreated
    disease.
   Known age-related changes can increase
    susceptibility to developing periodontitis.
   Health care providers and their role in
    recognition and knowledge of disease
    processes.
   Prevention of disease or timely treatment
    can improve health and quality of life for
    patients.
             Medical University of South Carolina/SC-Geriatric Education Center
                  Biography

Kimberly Manz, DMD, graduated from
the University of Arizona in 1999,
with a BS in microbiology. She
graduated from the College of Dental
Medicine in 2005, at the Medical
University of South Carolina and is
currently pursuing a residency in
periodontics.

      Medical University of South Carolina/SC-Geriatric Education Center

				
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