9 - Influence of Systemic Conditions on the Periodontium Flashcards
___ host immune response may lead to more severe forms of periodontitis
___ alter host tissues and physiology, impairing immune defense
altered, deficient, or exaggerated;
systemic diseases
do systemic diseases initiate periodontitis
they DO NOT
systemic disorders may ___ periodontal disease
predispose/accelerate
can perio infection affect systemic health
yes
1 and #2 most frequent factor as modifable contributor to systemic inflammatory burden
1: obesity
2: periodontitis
how does periodontitis contribute directly to pathogenesis of atherosclerosis?
thru bacterial challenges to arterial endothelium -> inflammation -> atheromatosis
what hypothesis:
synthesis of inflammatory molecules caused by periodontitis, increasing the cerebral inflammation state
inflammatory mechanism hypothesis
what hypothesis:
bacteria involved in periodontitis pathogenesis could also be involved in Alzheimer’s disease pathogenesis (A. actinomycetemcomitans, P. gingivalis, T. denticola, and F. nucleatum can invade the CNS, triggering neurodegenerative disease)
bacterial mechanism hypothesis
periodontitis is the ___th complication of diabetes
6th
poorly controlled diabetics lead to what
- severe inflammation
- deep periodontal pockets
- rapid bone loss
- frequent perio abscess
effects of diabetes on periodontium
- greater loss of attachment
- increased BOP
- increased tooth mobility (compared to non-diabetics)
etiology of perio in diabetic patients
- increased glucose in gingival fluid and blood
- PMN deficiencies
- macrophage deficiencies
- altered collagen metabolism
- advanced glycation end products (AGEs)
do uncontrolled diabetics have a good or poor respons to periodontal therapy? why?
POOR! due to delayed post-surgical healing
what should you avoid in uncontrolled diabetic patient? what is HbA1c percent
elective periodontal surgery on an uncrontrolled diabetic patient
HbA1c >7%
what is used to monitor a patient’s overall glycemic control? at what percent do you diagnose DM
HbA1C at greater or equal to 6.5%
how does HbA1c test work
- Glycohemoglobin forms continuously as a reaction between glucose and the hemoglobin protein, which carries oxygen.
- Binding of glucose to hemoglobin remains stable for lifespan of RBC.
HbA1c estimates average blood glucose levels over preceding ___ days
30-90 days
what HbA1c level is prediabetes
5.7-6.4%
what is the linear relationship between A1c and average daily blood glucose?
estimated average glucose (EAG)
how does periodontitis affect the diabetic state?
improved glycemic control following scaling and root plaining (found ~10% reduction in HbA1c levels)
scaling and root planing in diabetic patients lead to what
- Decreased IL-1B and TNF-a in GCF.
- May decrease HbA1c values.
- Wide inter-individual variability (some worsened glycemic control)
what is a metabolic syndrome
Obdominal obesity + 2 or more of: Hypertension, dyslipidemia, hyperglycemia
is there significant association between obesity and periodontitis
yes
how does obesity result in inflammation
- adipose tissue dysfunction -> increased macrophages, B cells, T cells, eosinophils, neutrophils, mast cells
- proinflammatory cytokine production: IL-6 and TNF-alpha -> recirculate and contribute to systemic inflammation
examples of when change of hormones occur
puberty, pregnancy, and hyperparathyroidism
explain gingivitis in puberty and pregnancy treatment?
- exaggerated response to plaque
- treat by removing local factors (plaque)
does pregnancy/puberty CAUSE gingivitis?
NO!
what bacterium can increase in pregnancy? what does this substitute
prevotella intermedia
substitues estradiol and progesterone for Vitamin K
whaat this:
Parathyroid hypersecretion
Generalized demineralization of skeleton
Proliferation of connective tissue in enlarged marrow spaces
von Recklinghausen’s disease of bone
hyperparathyroidism
oral changes in hyperparathyroidism
- tooth mobility (first clue)
- widened PDL
- lamina dura absent
- brown tumors
what are hematologic disorders
Neutropenia
Agranulocytosis
Leukemia
Thrombocytopenia
Leukocyte Disorders
Antibody Deficiency Disorders
what this:
Low levels circulating neutrophils
Caused by: Disease, Medications (chemotherapy), Infections, Idiopathic, Hereditary
May result in severe periodontal destruction
PMN is first line of defense
neutropenia
what this:
Gingival changes recur with recurrent exacerbation of neutropenia
Periodontitis as a manifestation of systemic diseases
cyclic neutropenia
what this:
Absolute neutrophil count <100 cells/ul
Low levels Basophils and eosinophils
Drug-induced or idiopathic
Gingival bleeding, necrosis, severe infections
agranulocytosis
oral manifestations of leukemia
- leukemic infiltration
- BLEEDING in absence of gingivitis
- oral ulcerations
- infections
what this:
Reduced platelet count
Spontaneous gingival bleeding
Gingiva is edematous and friable
Removal of local factors (plaque) reduces severity
thrombocytopenia purpura
what this:
Increased susceptibility to periodontitis
NG, NP, NS
acquired immunodeficiency syndrome
what are genetic disorders that cause perio
- chediak-higashi syndrome
- leukocyte adhesion deficiency
- papillon-lefere syndrome
- down syndrome
- aggamaglobulinemia
what this:
Affects melanocytes, platelets, phagocytes
Leading to: partial albinism, bleeding disorders, bacterial infections
Impaired killing of microorganisms by neutrophils
Periodontitis as a manifestation of systemic diseases
chediak-higashi syndrome
what this:
Failure to express CD18 necessary for leukocyte adhesion to vessel wall at site of infection (No transendothelial migration)
Absence of neutrophils in gingival tissues
Rapid destruction of periodontal bone
Early tooth loss of primary and permanent dentition
leukocyte adhesion deficiency
what this:
Autosomal recessive
Hyperkeratotic skin lesions on palms, soles, knees, elbows
Periodontal inflammation, increased osteoclastic activity, thin cementum
Severe destruction of periodontium
Periodontitis as a Manifestation of Systemic Disease
Severe bone loss
Early tooth loss of primary and permanent dentitions
papillon-lefevre syndrome
prevalence of periodontal disease is almost 100% in what
down syndrome
waht this:
Almost 100%
Deep periodontal pockets
Generalized periodontitis
Poor PMN chemotaxis, phagocytosis, and killing
Poor oral hygiene
down syndrome
what this:
Inadequate antibody production due to deficiency in B cells
Increased susceptibility to severe, rapidly progressing periodontitis
agammaglobulinemia
is stress capable to potentiate periodontal breakdown
yes
can stress lead to poorer oral hygiene and suppressed immunity
yes
do nutritional deficiences cause gingivitis or periodontitis?
NO! alone do not cause gingivitis or perio
do nutritional deficiencies accentuate plaque-induced inflammation
yes
vitamin c deficiency leads to what
bleeding, swollen gingiva
is gingivitis caused by vitamin c deficiency
no
what medication cause periodontitis
bisphosphonates
what bisphosphonates for osteoporosis/osteopenia
Fosamax ® (Alendronate)
Actonel ® (Risedronate)
Boniva ® (Ibandronate)
Reclast ® (Zoledronate) (IV)
what are IV bisphosphonates for bone cancer
Zometa ® (Zoledronate)
Aredia ® (Pamidronate injection)
how does medication-related osteonecrosis of jaw occur
Exposure of bone in mandible or maxilla persisting for more than 8 weeks in a patient who has taken or is taking a bisphosphonate or similar medication and who has no history of radiation therapy to the jaws.
May be spontaneous.
May occur following invasive surgery.
T/F: ONJ from oral bisphosphonates differs from ONJ from IV bisphosphonates.
true
Longer period of exposure to oral drug required.
Smaller amount of exposed bone.
Discontinuation of oral bisphosphonate may lead
to improvement and spontaneous healing.
continuous oral bisphosphonate therapy of ___ years associated with increased risk of ONJ
3 or more years
how do the drugs linked to osteonecrosis of the jaws lead to osteonecrosis
Inhibits maturation of osteoclasts
Binds to and inhibits RANKL
Mimics action of osteoprotegerin
osteoprotegarin and denosumab prevent binding of what
RANKL to RANK
sites with active periodontitis have [increased/decreased] RANKL and [increased/decreased] OPG
increase RANKL
decrease OPG
what systemic disease causing perio is associated with menopause
osteopenia/osteoperosis
Estrogen Deficiency and Osteopenia/Osteoporosis associated with what
Increased attachment loss
Increased crestal bone density loss
Increased bone loss when combined with smoking
what have links to periodontitis for systemic diseases
CVD, stroke, diabetes, PTLBW (preterm low bith weight), infants, respiratory disease, alzheimer’s
is diabetes and important contributing factors to perio
yes
gingival enlargement and bleeding in the absence of inflammation can be an early sign of what
leukemia
T/F: Nutritional deficiencies may be minor contributing factors to gingival inflammation. Plaque biofilm is primary etiology.
TRUE
