Manifestation of Systemic Diseases Flashcards
1
Q
What is the definition for periodontitis as a manifestation of systemic disease?
A
Diseases and conditions that can affect the periodontal tissues by influencing the course of periodontitis
2
Q
What is the definition for systemic diseases and conditions affecting the periodontal supporting tissues?
A
Diseases and conditions that can affect the periodontal tissues by affecting the periodontal supporting tissues independently of dental plaque biofilm‐induced inflammation
3
Q
What is a major impact?
A
Severe/early-onset periodontitis
4
Q
What is a moderate impact?
A
- Increase prevalence
- No otherwise different clinical presentations of chronic periodontitis
5
Q
Systemic disorders that have a major impact on the loss of periodontal tissue by influencing periodontal inflammation:
A
- Genetic Disorders
- Acquired Immunodeficiency Diseases
- Inflammatory Diseases
6
Q
What types of genetic disorders have major impacts on periodontal inflammation?
A
- Diseases associated with immunologic disorders
- Diseases affecting the oral mucosa and gingival tissue
- Diseases affecting the connective tissues
- Metabolic and endocrine disorders
7
Q
What are examples of genetic diseases associated with immunologic disorders?
A
- down syndrome
- leukocyte adhesion deficiency
- papillon-lefevre syndrome
- chediak-higashi syndrome
- congential neutropenia
8
Q
What is down syndrome?
A
- Trisomy 21
- Characteristic physical appearance
- Mental deficiency and growth retardation
9
Q
How does down syndrome affect the periodontium?
A
- Moderate to severe periodontitis with rapid progression
- Local factors alone fail to explain the severity of periodontal destruction
- Intrinsic immune system defects
10
Q
How does patients with down syndrome recieve periodontal treatment?
A
- Scaling & root planing and flap surgery have been shown to be equally effective in improving CAL and in reduction of PD’s.
- Patients have impaired PMN function, but this does not appear to affect how they respond to periodontal therapy.
- Frequent periodontal maintenance and oral hygiene are vital in maintaining periodontal health
11
Q
What is leukocyte adhesion deficiency?
A
- 3 types of Leukocyte Adhesion Deficiency
— LAD -1: CD11/18 gene mutation
— LAD-2: FUT8 gene mutation
— LAD-3: ITGA4 gene mutation - Deficiency in integrins
— Neutrophils cannot adhere to blood vessel walls at site of infection
— Neutrophils cannot migrate into affected tissues - History of severe recurrent infection but no purulence
- Diagnosis based on clinical symptoms, family history, and laboratory tests
12
Q
How does leukocyte adhesion deficiency affect the periodontium?
A
- Severe gingival inflammation, acute gingival lesions
- Early-onset and rapidly progressive alveolar bone loss
- Early loss of the primary and permanent teeth
- Systemic treatment by physician with bone marrow or stem cell transplant helps in periodontal treatment outcome
13
Q
What is papillon-lefevre syndrome?
A
- Mutations in the cathepsin C gene (CTSC)
— Chromosome 11q14 - Compromised neutrophil function
— Decreased phagocytosis (Rathi, 2002) - Hyperkeratotic lesions
— Palms, soles of the feet, elbows, knees
14
Q
How does papillon-lefevre syndrome affect the periodontium?
A
- Severe gingival inflammation
- Early-onset and rapidly progressive alveolar bone loss
- Early loss of the primary and permanent teeth
15
Q
What is chediak-higashi syndrome?
A
- Mutations in CHS1, LYST gene
— Lysosomal trafficking defect - Partial oculocutaneous albinism
— Defects in melanin granules - Recurrent pyogenic infections
— Circulating leukocytes exhibit defective lysosomes
—Decrease in phagocytosis - Varying neurologic problems
— Intellectual deficit and dementia
16
Q
How does chediak-higashi syndrome affect the periodontium?
A
- Severe gingival inflammation
- Early-onset and rapidly progressive alveolar bone loss
- Early loss of the primary and permanent teeth
- Poor response to dental treatment
- Patients who undergo bone marrow transplant early in life are less susceptible to aggressive periodontitis
17
Q
What is congential neutropenia (kostmann disease)?
A
- Mutations in the ELANE (50%), HAX1(10%) gene
— 1/3 causes remain unknown - Decrease in number of neutrophils
— ANC < 500 cell/uLand static - Deficiency in the immune response
— Severe and recurrent infections - Treated with Granulocyte Colony-Stimulating Factor (G-CSF)
— Patients still can have gingivitis and periodontal disease when taking this, but they do not get severe systemic infections
18
Q
How does congenital neutropenia affect the periodontium?
A
- Severe periodontitis is common
- Higher risk for tooth loss
- Oral ulcers
19
Q
What is the example of genetic disease affecting the oral mucosa and gingival tissue?
A
- epidermolysis bullosa
20
Q
What is epidermolysis bullosa (kindler syndrome)?
A
- Mutation in the fermitin family homologue 1 gene
— (kindlin-1; FERMT1) - Lack of integrin activation
— Affect keratinocyte cell adhesion
— Lead to molecular defects in basement membrane zone - Photosensitivity
- Recurrent blister formation
21
Q
How does the epidermolysis bullosa affect the periodontium?
A
- Oral blisters formation
- Severe periodontitis
— Alveolar bone loss that progresses rapidly - Need immunofluorescence to confirm diagnosis
— Skin biopsy of an included blister
22
Q
What is the example of genetic disease affecting the connective tissues?
A
ehlers-danlos syndrome
23
Q
What is ehlers-danlos syndrome?
A
- Mutations in genes encoding fibrillar collagens or enzymes involvedin the biosynthesis of these proteins
- Affecting collagen production and composition
— Mainly involves joint, skin, and walls of the blood vessels - Joint hypermobility, skin extensibility, and tissue fragility
24
Q
How does the ehlers-danlos syndrome affect the periodontium?
A
- Generalized, early-onset severe periodontitis and gingival recession
- Early loss of the primary and permanent teeth
25
What is the example of genetic diseases involving metabolic and endocrine disorder?
- hypophosphatasia
- diabetes mellitus
- obesity
- osteoporosis
26
What is hypophosphatasia?
* Alkaline phosphatase (ALPL) gene mutation
* Mild form and severe form
* Defective cementum, alveolar bone loss, and premature loss of teeth
27
How does the hypophosphatasia affect the periodontium?
* Impaired bone/tooth mineralization
* Defects in root cementum
28
What is diabetes mellitus?
* Disorder of glucose metabolism
* Accumulation of AGE’s
--- Collagen repair and replacement is decreased
--- Tissue integrity is impaired as a result of the damaged collagen
* Chronic status of elevated blood glucose level
29
How does the diabetes mellitus affect the periodontium?
Diabetes as a risk factor for periodontal disease
* Increased prevalence and severity of attachment loss
* Multiple periodontal abscesses
* In Type I patients, periodontal disease can start as early as 12 years of age
* Function of WBC’s is impaired with poor control of glucose levels
30
Periodontitis also affects _________ control
glycemic
31
What is body mass index?
Body Mass Index = Weight (kg) / Height (m)^2
32
How does obesity lead to increased risk for periodontal issues?
33
What are the shared risk factors between osteoporosis and periodontitis?
Age, vitamin D & calcium deficiency, and smoking
34
What are the features of osteoporosis?
* Estrogen withdrawal
* Increased bone turnover
* Net systemic bone loss
* Decrease in bone mineral density
* Weakenedbone microarchitecture
* High risk of bone fracture
35
Both osteoporosis and periodontitis are _______________ diseases
bone resorptive
36
Osteoporosis with periodontitis lead to higher prevalence and severity of radiographic...
alveolar bone loss
37
What are the types of acquired immunodeficiency diseases?
- Acquired neutropenia
- HIV infection
38
What is the mechanism of acquired neutropenia?
* Caused by autoimmune disease, cytotoxic chemotherapy or other drug or idiopathic etiology
* Due to decreased production or increased destruction of granulocytes
* Increased risk for infections and periodontitis correlated with severity of neutropenia
39
What is the mechanism of HIV infection?
* Deficiency of the immune system due to infection with the HIV virus
* Increased risk for opportunistic infections, neoplasms (i.e., Kaposi's sarcoma)
40
What are the types of inflammatory diseases (autoimmune)?
- Epidermolysis Bullosa Acquisita
- Inflammatory bowel disease
- Rheumatoid arthritis
41
What is epidermolysis bullosa acquisita?
* Pathogenic autoantibodies bind to target antigens
--- Mechanobullous type
--- Inflammatory form (mimic pemphigoid)
* Recurrent blister formation
* Generalized gingival inflammation, severe alveolar bone loss
* Immunofluorescence on basement membrane zone -split skin
42
What is inflammatory bowel disease?
* Hypersensitivity of immune response
* Inflammation and alveolar bone loss in a susceptible host
* Increased prevalence and severity of periodontitis
43
What is rheumatoid arthritis?
* Chronic auto-inflammatory disease
* Increased risk for loss of periodontal attachment, alveolar bone
* Biological link between rheumatoid arthritis and periodontitis
44
Other systemic disorders that may contribute to periodontal tissue loss by influencing the pathogenesis of periodontal diseases:
* Stress/depression
* Smoking
* Medications: For malignancies, anti-inflammatory agents, bisphosphonates
45
How does stress affect the periodontium?
- Stress/Anxiety/Depression + Negative Life Event
- Increased Serum Cortisol
--- Activates the limbic-hypothalamic-pituitary-adrenal axis
- Immune System Depression
- Change in behavior/mood/physiological markers
- Risk factor for necrotizing periodontal disease
46
How does smoking affect the periodontium?
- Chronic nicotine exposure
- Impairment of antigen-mediated T cell signaling
- Inhibits antibody-forming cell response
- Immunosuppression
- The inflammation in response to plaque accumulation is reduced
47
How does cannabis affect the periodontium?
* Increased risk of oral cancer
* Leukoedema seen more often in cannabis users
* Periodontitis
o Gingival enlargement/hyperplasia
o Alveolar bone loss
* Increased risk for
o Xerostomia
o Caries
o Missing teeth
o Candidiasis
o Stomatitis
48
What are the features of bisphosphonates?
* Treat cancer (IV administration), osteoporosis (oral administration)
* Inhibit osteoclast activity, interfere with bone turnover
* Reduce alveolar bone loss but increase the risk of oral osteonecrosis
* Not currently used to prevent further alveolar bone loss
49
What are the types of systemic disorders that can result in loss of periodontal tissue independent of periodontitis?
* Neoplasms
* Other disorders that may affect periodontal tissue
50
Neoplastic diseases of periodontal tissue:
* Oral squamous cell carcinoma
* Odontogenic tumors
* Other primary neoplasms of periodontal tissue
| These lesions require a biopsy to determine if malignant
51
oral squamous cell carcinoma
52
odontogenic tumors
53
Secondary metastatic neoplasms of periodontal tissue include...
* Metastatic tumors of the oro-facial region are uncommon
* Clinical manifestation of metastatic tumors can be variable
* Oral metastasis is considered a late complication of the disease, and often other organ metastasis is involved
* Most common site of metastasis in males:
--- Lungs, kidneys, prostate, liver, bone, thyroid, and skin
* Most common site of metastasis in females:
--- Breasts and, less commonly, female genital organs, bone, and kidneys
54
Giant cell granuloma includes...
Peripheral giant cell granuloma
Central giant cell granuloma
* No systemic features
* Reactive proliferation, benign lesion
* Biopsy to confirm diagnosis
55
What are the features of peripheral giant cell granuloma?
* Expanding epulis-like gingival swelling
* Occasional loss of periodontal supporting tissue
56
What are the features of central giant cell granuloma?
* Loss of periodontal supporting tissue
* May expand toward marginal periodontal tissue
* Can present as a honeycomb or soap bubble lesion radiographically
* Histology shows osteoclast-like giant cells
57
What is langerhans cell hisiocytosis?
* Peripheral small vessel necrotizing vasculitis
* Respiratory and renal impairment
* Characteristic fiery and hyperplastic gingival inflammation
* Alveolar bone loss
58
What is primary hyperparathyroidism?
* Rare
* Excess secretion of PTH due to benign or malignant neoplasm of the parathyroid glands
* >60 years old typically
* Females are more affected than males
59
What is secondary hyperparathyroidism?
* Excess secretion of PTH
* Parathyroid hyperplasia compensating for a metabolic disorder that has resulted in retention of phosphate, depletion of serum calcium levels, or decreased active vitamin D
* Increased calcium in blood due to PTH acting on bones, intestines, and kidneys.
60
What is tertiary hyperparathyroidism?
Parathyroid hypertrophy with excess PTH secretion following secondary type
61
What are the oral changes associated with hyperparathyroidism (osteitis fibrosa cystica or von Recklinghausen bone disease)?
* Malocclusion and tooth mobility
* Radiographic evidence of alveolar osteoporosis with closely meshed trabeculae
* Widening of the periodontal ligament space
* Absence of the lamina dura (this does not always occur and is not diagnostic)
* Radiolucent cyst-like spaces
--- Brown tumors made of reparative giant cell
granulomas
62
_______% of patients with hyperparathyroidism have associated oral changes
25-50
63
How do you diagnose hyperparathyroidism?
* Biopsy is recommended
--- Not definitive for a diagnosis
* Test serum PTH levels to check for elevation
64
What is systemic sclerosis (scleroderma)?
* Autoimmune disease of the connective tissues
* Many different systemic presentations
--- Affects skin, GI tract, lungs, heart, and kidneys
* Raynaud’s phenomenon
--- Extreme sensitivity to cold, affecting extremities
* Autoantibody screening
--- ANA test (Antinuclear Antibody)
65
What are the oral changes associated with systemic sclerosis (scleroderma)?
* Widening PDL and higher prevalence of periodontitis
* Chronic fibrosis and alterations of the gingival microvasculature of the periodontal tissues may be responsible for greater periodontal breakdown, despite less acute periodontal inflammatory signs
