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PERIO I > perio dx as a manifestation of systemic dx > Flashcards

perio dx as a manifestation of systemic dx Flashcards

1
Q

how do systemic dx affect periodontium

A

Diseases and conditions that can affect the periodontal tissues by influencing the course of periodontitis.

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2
Q

major impacts of sys dx on perio

A

Severe/early-onset
periodontitis

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3
Q

moderate impacts of sys dx on perio dx

A

Increase prevalence
No otherwise different clinical presentations of chronic periodontitis

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4
Q

what can sys dx influence regarding perio dx

A

Influence periodontal inflammation
Influence the pathogenesis of periodontal diseases

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5
Q

what type of sys dx influence perio inflamm

A

Genetic Disorders
Acquired Immunodeficiency Diseases
Inflammatory Diseases

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6
Q

types of Genetic Disorders

A
  1. Diseases associated with immunologic disorders
  2. Diseases affecting the oral mucosa and gingival tissue
  3. Diseases affecting the connective tissues
  4. Metabolic and endocrine disorders
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7
Q

Down Syndrome

A

Trisomy 21 or mongolism
Characteristic physical appearance
Mental deficiency and growth retardation

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8
Q

Down Syndrome perio dx

A

Moderate to severe periodontitis with rapid progression
Local factors alone failed to explain the severity of
periodontal destruction

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9
Q

DS immune affects
predisposed to?
Impaired functions?

A

Predispose to infections: intrinsic immune system defects
Poor PMN chemotaxis, phagocytosis, intracellular killing

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10
Q

Leukocyte Adhesion
Deficiency

A

Mutation in beta-2 integrin (ITGB2) gene Lack of beta-2 integrin mRNA in leukocytes
Low integrin (CD18 or CD15) expression on neutrophils
Neutrophils are confined to blood vessels and absent from the periodontium
Leukocytosis is common
History of severe recurrent infection but no pus
Disruption of neutrophil-associated homeostasis
Lack of neutrophil immune surveillance

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11
Q

Leukocyte Adhesion Deficiency perio effects

A

Severe gingival inflammation, acute gingival lesions
Early-onset and rapidly progressive alveolar bone loss
Early loss of the primary and permanent teeth

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12
Q

Papillon–Lefèvre Syndrome
what is compromised?
decreased immune function?
signs?

A

Compromised neutrophil function, not the quantity
Decreased phagocytosis
Hyperkeratotic lesions Palms, soles of the feet, elbows, knees

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13
Q

Papillon–Lefèvre Syndrome perio effects

A

Severe gingival inflammation, pocket formation
Early-onset and rapidly progressive alveolar bone loss
Early loss of the primary and permanent teeth

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14
Q

Chediak-Higashi Syndrome
defective function of cell?
oculocutaneous sign?
Defects in?
Recurrent?
Circulating leukocytes exhibit defective?
Decrease in what immune function?
neurologic problems

A

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

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15
Q

Chediak-Higashi Syndrome perio effects
gingiva?
alveolar bone loss ?
teeth?
response to dental treatment?

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

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16
Q

Congenital Neutropenia

A

Mutations in the ELANE (50%), HAX1(10%) gene 1/3 causes remain unknown
Decrease in number of neutrophils ANC < 500 cell/uL and static
Deficiency in the immune response
Severe and recurrent infections

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17
Q

Congenital Neutropenia oral effects
common perio dx form?
Higher risk for?
mucosa?

A

Severe periodontitis is common
Higher risk for tooth loss
Oral ulcerations

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18
Q

congenital Diseases Associated with
Immunologic Disorders

A

trisomy 21
LAD
Papillon–Lefèvre Syndrome
Chediak-Higashi Syndrome
Congenital Neutropenia

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19
Q

Epidermolysis Bullosa/ kindler syndrome
Imparied function?
Molecular defects where?
Reduced resistance at?
signs?

A

Imparied keratinocyte cell adhesion
Molecular defects in basement membrane zone
Reduced resistance at the junctional epithelium
Photosensitivity
Recurrent blister formation

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20
Q

Epidermolysis Bullosa/kindler syndrome oral effects
what may form?
periodontitis form?
Alveolar bone loss?
Need what to confirm diagnosis?
Skin biopsy of?

A

Oral blisters formation
Severe periodontitis
Alveolar bone loss that progress rapidly
Need immunofluorescence to confirm diagnosis
Skin biopsy of an included blister

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21
Q

Diseases Affecting the Oral
Mucosa and Gingival Tissue

A

Epidermolysis Bullosa

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22
Q

Ehlers-Danlos Syndrome

A

Mutations in genes encoding fibrillar collagens or
enzymes involve in the biosynthesis of these proteins
Affecting collagen production and composition Mainly involves joint, skins and walls of the blood vessels
Joint hypermobility, skin extensibility, and tissue fragility

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23
Q

Ehlers-Danlos Syndrome types

A

EDS type VIII/IV/I

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24
Q

EDS type VIII perio effects

A

EDS type VIII have gingival recession and generalized
severe periodontitis that often leads to loss of all teeth.

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25
Q

EDS type IV/I perio effects

A

EDS type IV and, to a lesser extent, in EDS type I may
also demonstrate the periodontitis as oral manifestation

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26
Q

Ehlers-Danlos Syndrome perio dx

A

Generalized, early-onset severe periodontitis and gingival recession
Early loss of the primary and permanent teeth

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27
Q

Hypophosphatasia
mutation?
forms?
affects on dentin/cementum?

A

Alcaline phosphatase (ALPL) gene mutation
Mild form and severe form
Dentin is not affected with defective cementum

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28
Q

Hypophosphatasia oral effects:
Impaired?
Defects in?
Compromised? result?
The teeth are not?
Alveolar bone/teeth loss?

A

Impaired bone/tooth mineralization
Defects in root cementum Compromised periodontal attachment, reduction in alveolar bone height
The teeth are not adequately anchored to the alveolar bone via the PDL
Alveolar bone loss and premature loss of teeth

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29
Q

Osteoporosis

A

Postmenopausal women with osteoporosis or osteopenia exhibit greater loss of periodontal attachment compared with women with normal bone mineral density.

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30
Q

Osteoporosis flow chart

A
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31
Q

osteoperosis and periodontitis relation

A

Both are bone resorptive diseases

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32
Q

osteoperosis and periodontitis relation radiographs

A

Higher prevalence and severity of radiographic alveolar bone loss
No clear association with probing depth or clinical attachment loss

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33
Q

Diabetes Mellitus

A

An important risk factor for periodontal diseases
Associated with significantly higher prevalence and
severity of periodontitis.
A disorder of glucose metabolism

34
Q

DM I vs II

A
35
Q

what is accumulated in DM? result of this?

A

Accumulation of AGEs (advanced glycation end products)
AGEs - RAGE (Receptor of AGEs) interaction

36
Q

Diabetes Mellitus and perio dx

A

Diabetes as a risk factor for periodontal disease Increased prevalence and severity of attachment loss

37
Q

DM perio abcesses

A

Periodontal abscess may be a common complication 58.6% of patients having periodontal abscesses had HbA1c ≥6.5%

38
Q

DM and perio dx relation

A

Periodontal disease as a complicating factor for Diabetes Periodontitis ALSO affects glycemic control

39
Q

Obesity
Metabolic syndrome including:
Adipose tissue effect
key factor of pathophys?

A

Metabolic syndrome: Hypertension, Hyperglycemia,
Obesity, and dyslipidemia
Adipose tissue is a complex organ secrets numerous
endocrine mediators
Rather than the amount of fat mass, adipose tissue
dysfunction may be the key factor in pathophysiology

40
Q

obesity immune effects:
* Cross-talk?
* release of?
* Decreased activity?
* Impaired function?

A
  • Cross-talk between T cells and adipose tissue
  • Increased releasing myriad proinflammatory cytokines and chemokines
  • Decreased phagocytic activity
  • Impaired antigen presentation
41
Q

Obesity and inflammation progression

A
42
Q

Obesity factors

A

Environmental Factors (Eg. smoking, nutrition, physical activity)
Genetic Factors

43
Q

what is eleveated in synthesis in obesity. perio dx

A

Elevated synthesis of inflammatory cytokines TNF-a, IL-1, IL-6

44
Q

chronic dx associated with obesity (and perio dx)

A

Eg. Type-2 DM, Coronary heart disease (CHD)

45
Q

Acquired
Immunodeficiency
Diseases

A

Acquired neutropenia
HIV infection

46
Q

Acquired Neutropenia mechanism

A

*Caused by autoimmune disease, cytotoxic chemotherapy or other drug or idiopathic etiology
*Due to decreased production or increased destruction of granulocytes

47
Q

Acquired Neutropenia risk for perio dx

A

increased risk for infections and periodontitis
correlated with severity of neutropenia

48
Q

acquired neutropenia possible forms of diagnosis

A

ANC
< 1500 cell/uL: mild
< 1000 cell/uL: moderate
< 500 cell/uL: severe

49
Q

HIV mechanism

A

Deficiency of the immune system due to infection with the HIV virus

50
Q

HIV increased risk for?

A

Increased risk for opportunistic infections, neoplasms (eg. kaposi sarcoma)

51
Q

diagnosis HIV

A

Depends on the stage of infection
*Test HIV antibody/p24 antigen and PCR-based HIV

52
Q

Inflammatory Diseases

A

Epidermolysis bullosa acquisita
Inflammatory bowel disease
Reumatoid arthritis

53
Q

Epidermolysis Bullosa Acquisita
The presence of autoantibodies against?
form? (mimics?)
Recurrent formation?
Immunofluorescence on?

A

The presence of autoantibodies against type VII collagen (Mechanobullous type)
Inflammatory form (mimic pemphigoid)
Recurrent blister formation
Immunofluorescence on basement membrane zone - split skin

54
Q

Epidermolysis Bullosa Acquisita oral findings
gingiva?
Alveolar bone?
teeth?

A

Generalized gingival inflammation and enlargement, gingival recession, alveolar bone loss, and mobile teeth

55
Q

Inflammatory Bowel Disease

A

Hypersensitivity of immune response

56
Q

Inflammatory Bowel
Disease oral effects

A

Inflammation and alveolar bone loss in a susceptible host
Increased prevalence and severity of periodontitis

57
Q

Rheumatoid Arthritis

A

Chronic auto-inflammatory disease

58
Q

RA oral effects
Increased risk for?
Biological link?

A

Increased risk for loss of periodontal attachment, alveolar bone
Biological link between rheumatoid arthritis and periodontitis

59
Q

what non-dx factors can influence perio dx by influencing pathogenesis

A

Stress/depression
Smoking
Medications for malignancies, anti-inflammatory agents, bisphosphonates

60
Q

Stress and perio dx

A
61
Q

smoking results

A

4x Attachment loss
Leukoplakia
Carcinoma
Gingival recession
Tooth loss

62
Q

smoking effects flow chart

A
63
Q

Chronic nicotine exposure effect on IS
what cells are affected?
Process affected?
result?

A

d

64
Q

nicotine and tar effects flow chart

A

both from smoking

65
Q

Bisphosphonates

A

Treat cancer (IV administration)
Treat osteoporosis (oral administration)
Inhibit osteoclast activity and interfere with bone turnover

66
Q

Bisphosphonates effects on alveolar bone/osteonecrosis

A
67
Q

Can dx affect the periodontium independent of bio-film-induced inflammation?

A

affecting the periodontal supporting tissues
independently of dental plaque biofilm‐induced
inflammation.

68
Q

independent etiologies of perio dx

A

direct effect on the periodontium without regard to biofilm

69
Q

possible independent etiologies

A
  • Neoplasms
  • langerhans cell histiocytosis
  • giant cell granuloma,
  • hyperparathyroidism
  • systemic sclerosis
70
Q

Neoplasms

A

Neoplastic diseases of periodontal tissue
* Oral squamous cell carcinoma
* Odontogenic tumors
* Other primary neoplasms of periodontal tissue
* Secondary metastatic neoplasms of periodontal tissue
biopsy when suspicious

71
Q

Langerhans cell histiocytosis
* Peripheral small vessel effect?
* impairment where?
* gingiva?
* Alveolar bone?

A
  • Peripheral small vessel necrotizing vasculitis
  • Respiratory and renal impairment
  • Characteristic fiery and hyperplastic gingival inflammation
  • Alveolar bone loss
72
Q

Giant cell granuloma

A

Reactive proliferation, benign lesion
No systemic features

73
Q

Peripheral giant cell granuloma

A

*Expanding epulis-like gingival swelling
*Occasional loss of periodontal supporting tissue
should bne biopsy

74
Q

Central giant cell granuloma

A

*Loss of periodontal supporting tissue
*May expand toward marginal periodontal tissue
should also be biopsy

75
Q

Hyperparathyroidism forms

A

Primary : benign adenoma of parathyroid glands
Secondary: result of hypocalcemia
Tertiary: parathyroid hypertrophy following 2o type

76
Q

hyperPTH oral effects
lesions?
PDL?

A

Widening PDL, single/multiple osteolytic lesions in the jaw that mimic periodontal bone loss (brown tumors)

77
Q

Systemic sclerosis (scleroderma)

A

Autoimmune disease of the connective tissues
Many different systemic presentations

78
Q

sys sclerosis oral effects

A

Widening PDL and higher prevalence of periodontitis

79
Q

sys sclerosis
sign/ screening

A

Raynaud phenomenon
Autoantibody screening

80
Q

bisphosphonate t1/2

A

10yrs

PERIO I (13 decks)

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