Periodontal Instruments and Periodontal Surgical Instruments.
Stress and nutritional factors on periodontal disease april 12013
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Transcript of Stress and nutritional factors on periodontal disease april 12013
Stress and Nutritional Deficiencies on Periodontium
What is Stress
An inharmonious fit between the person and the
environment, one in which the person’s resources are taxed
or exceeded, forcing the person to struggle, usually in
complex ways to cope.”
Richard S. Lazarus. Puzzles in the study of daily hassles. J Behavioral Med. 1984; 7(4): 375-389
A reasonable amount of researches indicate the
association of psychosocial stress, financial
stress, occupational stress, distress, the negative
impact of life-events and depression with
Periodontitis
Linden GJ, Mullally BH, Freeman R. Stress and the progression ofperiodontal disease. J Clin Periodontol. 1996;
23(7): 675-680.
Stress can be viewed as a process with both
psychological and physiological components
Reners M, Brecx M. Stress and periodontal disease. Int J Dent Hyg.2007;5(4):199-204.
DIRECT Alteration of Resistance
of Periodontium to
infection
INDIRECT
Psychological aspect of a
person with health
impairing behaviour like
• Poor Oral Hygiene• Smoking• Alcohol Consumption• Poor Nutrition
Stress affects the periodontium directly or indirectly
• The most documented example between
stress and Periodontal disease is NUG
• NUG in soldiers during wartime in
trenches lead to diagnostic term Trench
mouth
Chronic or long term stress is more like be
associated with Periodontal destruction than
acute stress
Individual with Problem focussed (Practical
coping) skills fared better than individuals with
emotion-focussed (avoidance) coping skills
with respect to periodontal disease
Chronic stress and inadequate coping could
lead to changes in daily habits, such as
– Poor oral hygiene
– Clenching & Grinding
– Decreased salivary flow
– Suppressed Immunity
Stress induced Immunosuppression
• Stress and psychosomatic disorder impact the periodontal health
• Complex Interaction among
Stress Implications
Pshychiatric influence or Self induced injury
Self-induced or Factitious Injury
Neurotic Habits:
Grinding, Clenching Teeth, Nibbling on
Foreign Objects(pens etc),Nail Biting, excessive
use of tobacco
Self-inflicted injuries such as Gingival
Recession have been described both in children
and adults
Nutritional Influences
• No Nutritional defencies that by themselves may cause
Gingivitis or Periodontitis
• There are Nutritional defencies that produce changes in
oral cavity.
– Changes include alterations of tissue of lips, oral
mucosa,gingiva and bone
Vitamin Deficiency
• Fat soluble : A,D,E,K
• Water soluble: B,C
Vitamin A
• Major function is to maintain health of epithelial cells of skin & mucous membrane
• Prevent microbial invasion by maintaining epithelial integrity
• Deficiency in experimental animals– Hyperkeratosis, Hyperplasia of gingiva,
increased pocket formation, proliferation of Junctional epithelium, Retardation of wound healing
Vitamin D
• Essential for absorption of Ca from GIT and maintenance of Ca- P balance
• Deficiency Rickets in children, osteomalcia in adults
• Animals– Osteoporosis of alveolar bone
Vitamin E
• Serves an Antioxidant to prevent free radical
reactions
• Protect cells from Lipid Peroxidation
• Cell membranes which contain highest content of
Polyunsaturated Fatty Acids are major site of
Vitamin E deficiency
• No direct relation have been found between
Vitamin E deficiency and Oral Disease
• Systemic Vitamin E have been shown to
accelerate gingival wound healing in rats
Oral Changes associated Gingivitis Glossitis Glossodynia Angular Cheilitis Inflammation of entire oral mucosa
Oral disease is rarely caused by a deficiency
in just one component of the B-complex
group, the deficiency is generally multiple
Vitamin B Complex Deficiencies
Gingivitis in Vitamin Deficiencies is non-
specific because it is caused by bacterial
plaque rather than by deficiency but
deficiency can have modifying effect
B1 or Thiamine Deficiency
Characterised by• Paralysis• CVS symptoms including Edema• Loss of ApetiteOral symtoms-• Hypersenstivity of Oral Mucosa,• Minute vesicles on oral mucosa, buccal vesicles on buccal
mucosa, under the tongue or on palate
• Called Berberi
B2 Riboflavin Deficiency
• Glossitis-Magenta Discoloartion
• Angular Cheilitis
• Seborrheic Dermatitis
• Superficial Vascularising Keratitis
• Atrophy of Papillae
• Angular Chelitis-Perleche
B3 Niacin Deficiency
• Pellagra characterised by • 3Ds
– Dermatitis– Diarrhea– Dementia
• 3Gs– Glossitis– Gingivitis– Generalised Stomatitis
• Glossitis and Stomatitis are the earliest
signs of Niacin Deficiency
• Gingiva may be involved with or without
tongue changes
• MC finding is NUG in areas of
irritation
Folic acid Deficiency
• Results in Macrocytic Anemia with Megaloblastic Erythropoiesis
• Oral Changes
• GI lesions
• Diarrhea
• Intestinal Malabsorption
• Ulcerative stomatitis is an early indication of toxic
effect of Folic acid antagonist (Methotrexate) used
in treatment of leukemia
• Gingival changes associated with pregnancy and
OCP may be partly related to suboptimal levels of
Folic acid in Gingiva
• Phenytoin induced gingival growth and folic acid,
based on interference of folic acid absorption and
utilization of Phenytoin
Vitamin C or Ascorbic acid Deficiency
• Defective formation and maintenance of collagen
• Impairment or cessation of Osteoid formation
• Impaired Osteoblastic function
• Increased capillary permeabilty
• Susceptiblity to traumatic hemorrhages
• Hyporeactivity of contractile element of peripheral blood
vessels
Clinical Manifestation
• Hemorrhagic lesions into muscles & extremities,joints, nail beds
• Petechial hemorrhages around hair follicles
• Susceptibilty to infections
• Impaired healing
• Bleeding, swollen gums and loosened teeth
• Gingivitis in vitamin-C deficient patient is
caused by dental Plaque
• Vitamin C deficiency may aggravate the
gingival response to dental plaque and worsen
the edema, enlargement and bleeding
• Acute vitamin C deficiency does not cause or
increase the incidence of gingival inflammation,
but it does increases its severity
Vitamin C deficiency alone does not cause
periodontal destruction, local bacterial
factors are required for increased pocket
proding depth and attachment loss to occur
Protein Deficiency
• Protein depletion reults in Hypoprotienemia
• Protein deprivation has shown changes in Periodontium
of experimental animals
– Degeneration of gingival& Periodontal connective tissue
– Osteoporosis of Alveolar bone
– Impaired deposition of cementum
– Delayed wound Healing
– Atrophy of Tongue Epithelium
• Protein deficiency accentuates the destructive
effects of Bacterial plaque and occlusal trauma on
the periodontal tissue, but initiation of gingival
inflammation and its severity depend on
bacterial plaque
• Protein deprivation results in Periodontal tissue
that lack integrity and are more vulnerable to
breakdown when challanged by bacteria
Other Systemic Deficiency
HypophosphatasiaFamilial skeletal disease characterized by• Rickets,Poor Cranial Bone Formation, Premature
loss of primary teeth particularly incisors• Low level of Serum Alkaline Phosphatase• Phosphoethanolamine present in serum and urine
• Teeth are lost with no clinical evidence of gingival
inflamation• Reduced cementum formation
Early exfoliation of primary incisors in Hypophosphatasia
Congenital Heart Disease
• Cardiac defects involve heart and adjacent vessels or combination of both
• MC feature in CHD is Cyanosis
• Shunting of deoxygenated blood from Right to Left
• Poorly oxygenated blood in circulation
Chronic hypoxia causes
• Impaired development,
• Compensatory Polycythemia
• Clubbing of toes and Fingers
• Polycythemia can result in hemorrhagic or thrombotic tendencies
Oral manifestation
• Cyanosis of Lips & Oral Mucosa• Delayed eruption of both decidious and
permanent dentition• Increased positional abnormalities• Enamel Hypoplasia• Teeth color bluish white • Increased Pulp Vascular volume
• More severe caries & Periodontal disease in
Cyanotic Congenital Heart Disease patients
Teratology of Fallot
Characterised by four Cardiac Defects
1. Ventricular Septal Defect
2. Pulmonary Stenosis
3. Malposition of Aorta to Right
4. Compensatory Right Ventricular
enlargement
C/F:
Severe Cyanosis, audible Heart Murmurs and Breathlessness
ORAL CHANGES:• Purplish Discoloration of lips and Gingiva• Severe marginal Gingivitis and Periodontal Destruction• Tongue is coated or Fissured• Extreme reddening of of Fungiform or Filiform Pappilae• Number of Subepithelial Capillaries is increased after
Heart surgeries
Eisenmenger’s Syndrome
• VSD>1.5 cm in diameter• Greater blood flow from
stronger Left ventricle to Right Ventricle(Left to Right Shunt)
• Progressive Pulmonary Fibrosis
• Blood Flow reversed• Right to left flow (Right
to Left)
Oral Manifestations:
Cyanosis of Lips, Cheeks, Buccal Mucosa
Severe Generalised Periodontitis have been reported in
Eisenmengers syndrome
Metal Intoxication
• BISMUTH
• Narrow bluish black discoloration of gingival margin
in preexisting area of inflammation
• Precipiation of Bismuth Sulphide associated with
vascular inflammation
.
LEAD
• Salivation, coated tongue, peculiar
sweetish taste,
• Gingival pigmentation is linear
(Burtonian line),steel gray associated
with local inflammation
Mercury
• Headache, CVS symptoms, Pronounced salivation
and Metallic taste
• Gingival pigmentation deposition of mercuric
sulphide
• Phosphorous, Arsenic, Chromium can
lead to necrosis of alveolar bone with
loosening and exfoliation of the teeth
• Benzene intoxication lead to Gingival
Bleeding, ulceration and destruction of
underlying bone