Influence of Systemic Conditions on the Periodontium

7/27/2019 Influence of Systemic Conditions on the Periodontium

1/31

D E N T 3 7 1

D R . H I S H A M A L - S H O R M A N

INFLUENCE OF SYSTEMIC

CONDITIONS ON THE

PERIODONTIUM


2/31

Endocrine disorderso Diabetes Mellitus

o Female sex hormones

o Corticosteroid hormones

o Hyperparathyroidism Hematological disorders

o Leukemia

o Anemia

o Thrombocytopenia

o Leukocytes disorderso Antibody deficiency disorders

Stress and psychosomatic disorders

Nutritional influences

Other systemic conditions

RELEVANT CONDITIONS


3/31

DIABETES MELLITUS

The diseaseComplex group of metabolic disorders with a

common feature of impaired CARBOHYDRATEand

LIPIDmetabolism

Classes Type I

Type II Gestational

Others due to cancer, trauma ,etc..


4/31

DIABETES MELLITUS

Diagnosis

oClinical picture

oBlood glucose levels

ComplicationsoMicrovascular

Retinopathy

Nephropathy

NeuropathyoMacrovascular

Cardiovascular

Cerebrovascular

o

Periodontal disease (the sixth complication!)


5/31

DIABETES MELLITUS

DM pts (especially the un-controlled ) more

frequently have :

oMucosal drying and cracking

oBurning mouth and tongueoReduced salivary flow

oAlteration of the oral flora and predominance of

candida albicansangular cheilitis

They are at higher risk of developing periodontaldisease

Destruction is more severe in type I pts

Controlled pts have better periodontal health


6/31

Mechanisms (1):

1. High levels of glucose in GCF and blood resultin change in oral flora and increasedperiodontal pathogens:oPorphyromonag gingivalis

oProvetella intermediaoAggrigatibacter actinomyceemcomitans

oCapnocytophaga

o

2. Defective PMN function in:oChemotaxis

oAdherence

oPhagocytosis


7/31

3. Altered collagen metabolism and reduced woundhealing (chronic uncontrolled pts) :

o Increased collagenase activity

oDecreased collagen synthesis

o reduced fibroblast cell proliferation and growth

o reduced collagen and glycoseaminoglycansand other matrix components

4. Advanced Glycation Endproducts (AGEs)

oReduce collagen turn-over rateoCause hyperresponsive cellular state of

monocytes, macrophages and endothelial cells

o Increase production of interleukin-1 , TNF-,PG-E2 and other cytokines

Mechanisms(2):


8/31

As a general rule:

Hormonal changes by themselves do NOTcause periodontal disease, they justaggravate the condition

Periodontal disease occurs only in thepresence of local factors and causativemicroorganisms

FEMALE SEX HORMONES


9/31

PUBERTY

Exaggerated response to dental plaque

preventable condition

Clinically :

oMarked inflammation

oBluish red discoloration

o Edema

oGingival enlargement

Not always present

Reduced with age

Complete resolution requires removal of the local

factors


10/31

MENSTRUAL CYCLE

Generally, menstrual cycle is NOT accompanied

by gingival disease

However, some patients may complain of

bleeding gums and tense feeling of the gums a few

days before the cycle


11/31

PREGNANCY

Generally, pregnancy does not cause gingivitis

It accentuates the gingival response to plaque andits clinical picture.

Peak at first and third trimesters

Reduction of the inflammation starts 2 months

postpartum. After 1 year, the gingival health is

similar to other women who never had pregnancy


12/31

Pregnancy tumor

PREGNANCY


13/31

PREGNANCY

Pregnancy gingivitis

Linked to Prevotella intermedia


14/31

ORAL CONTRACEPTIVES

They affect the periodontium in a way

similar to pregnancy, i.e. accentuates the

gingival response to dental plaque

When taken for more than 1.5 year, it

increases periodontal destruction


15/31

MENOPAUSE

Menopausal gingivostomatitisnot common

Due to the end of hormonal cycles in the body

Signs : gingiva and other oral mucosadry, shiny,

varies in color and bleeds easily. Fissuring in the

mucobuccal fold may be noticed

Symptoms :pt complains of dry burning sensation

of the oral mucosa associated with extreme

sensitivity to thermal changes, abnormal taste and

difficulty with removable partial dentures


16/31

CORTICOSTEROID HORMONES

Cortisone and ACTH have NO effect on

gingiva

Exogenous hormones have negative effect

on boneosteoporosis of alveolar bone and

bleeding in the periodontal ligament and CT

Stress increases circulating cortisol

reduced immune response to periodontal

bacteria


17/31

PARATHYROIND HORMONE

Hyperparathyroidism produces:

oGeneralized bone demineralization

o Increased osteoclastic activity

oFormation of bone cysts

Oral changes include:

o Malocclusion and tooth mobility

o Radiographic evidence of alveolar osteoporosiso Widening of periodontal ligaments

o Absence of lamina dura

o Radiolucent cyst-like space


18/31

HEMATOLOGIC DISORDERS

The importance of blood in the general well

being of humans

Functions :

oRBCsoxygenation of tissues and nutrition

oWBCsinflammatory reactions and body defense

oPlateletshemostasis and recruitment of cells

during wound healing

You may be the first to discover blood

disorders!


19/31

HEMATOLOGIC DISORDERS -

LEUKEMIA

Malignant neoplasms of WBCs

Leukemic WBCs are abnormal and high innumber, therefore, the condition results in:

oReduced RBCsanemia and poor tissue

oxygenation

oNormal WBCs - infectionsoPlateletsbleeding disorders

Classified into: lymphocytic and myelocytic


20/31

HEMATOLOGIC DISORDERS -

LEUKEMIA

Periodontal manifestations:

leukemic gingival infiltration

(enlargement), bleeding,

ulcerations and infectionsHighest incidence in acute-

monocytic leukemia (67%),

followed by acute-

myelocytic-monocytic (19%)and acute myelocytic

leukemia

Not seen in chronic leukemia


21/31


ANEMIA

Reduced RBCs and hemoglobin

Results from:

oBlood loss

oDefective formation

o Increased RBCs destruction

Types:

oPernicious anemia (impaired gastric absorption)o Iron-deficiency anemia (chronic bleeding)

oSickle-cell anemia (in blacks)

oAplastic anemia


22/31


ANEMIA

Clinical features:

o Red, smooth and shiny tongue.

o Increased pallor of the gingivao Ulceration of the oral mucosa


23/31


THROMBOCYTOPENIA

Petechiae and hemorrhage in the mouth

Spontaneous bleeding

Gingivae are swollen and fragile


24/31


LEUKOCYTE DISORDERS

Neutropeniasevere infections

Agranulosytosissevere infections

ChediakHigashi Syndromeaggressive

periodontitis

Lazy Leukocyte Syndromesevere infections -

aggressive periodontitis

Leukocyte Adhesion Deficiencysevere

infections and loss of teeth

Papillon-Lefevre Syndromeloss of teeth

Down Syndromeperiodontal pocket formation

and recession


25/31

HEMATOLOGICAL DISORDERS

Cyclic nuetropenia


26/31

STRESS AND PSYCHOSOMATIC

DISORDERS

NUG trench mouth

The effect of stress on periodontium is

related to the type of stress and the ability of

the patient to cope, i.e. the more the patient

feels helpless, the more the periodontal

destruction

Examples: financial crises, divorce, loss of

family member, etc


27/31

STRESS AND PSYCHOSOMATIC

DISORDERS

Stressed patients may :

oHave poor oral hygiene

oHave clenching and grinding

o Smoke more frequently

o Less likely seek professional care

Stress also affects the immune response:

o Production of cortisol, resulting in reduced immune

response by inhibiting:

o Neutrophil activity

o IgG production

o Salivary IgA

o Increased secretion of neurotransmitters which

leads to increased tissue destruction


28/31

NUTRITIONAL INFLUENCES

Vitamin A : dermatological and mucosal health

Vitamin B complex (especially B12, Folic Acid)

Vitamin C (ascorbic acid) deficiency and scurvy

Ascorbic acid is essential for collagen

synthesis

Periodontal manifestation: hemorrhagic

lesions, impaired healing, gingival edema andincreased tooth mobility

Vitamin D

Vitamin E


29/31

OTHER CONDITIONS

Protein deficiency

Hypophosphatasia

Congenital heart disease

Metal intoxication


30/31

WHAT IS THE FINAL CONCLUSION?

The mouth could be a true mirror of the general

health

You may be the first to discover medical conditions

You need to learn how to cooperate with colleaguesin other specialties in dental and medical

professions

You may play a major role in educating patients and

helping them control their conditionsWhat if we improve the periodontal condition of

patients? Will this reduce the effect of systemic

conditions? SERARATE LECTURE


31/31

Influence of Systemic Conditions on the Periodontium

Documents

Transcript of Influence of Systemic Conditions on the Periodontium