perio dx as a manifestation of systemic dx Flashcards
how do systemic dx affect periodontium
Diseases and conditions that can affect the periodontal tissues by influencing the course of periodontitis.
major impacts of sys dx on perio
Severe/early-onset
periodontitis
moderate impacts of sys dx on perio dx
Increase prevalence
No otherwise different clinical presentations of chronic periodontitis
what can sys dx influence regarding perio dx
Influence periodontal inflammation
Influence the pathogenesis of periodontal diseases
what type of sys dx influence perio inflamm
Genetic Disorders
Acquired Immunodeficiency Diseases
Inflammatory Diseases
types of Genetic Disorders
- Diseases associated with immunologic disorders
- Diseases affecting the oral mucosa and gingival tissue
- Diseases affecting the connective tissues
- Metabolic and endocrine disorders
Down Syndrome
Trisomy 21 or mongolism
Characteristic physical appearance
Mental deficiency and growth retardation
Down Syndrome perio dx
Moderate to severe periodontitis with rapid progression
Local factors alone failed to explain the severity of
periodontal destruction
DS immune affects
predisposed to?
Impaired functions?
Predispose to infections: intrinsic immune system defects
Poor PMN chemotaxis, phagocytosis, intracellular killing
Leukocyte Adhesion
Deficiency
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
Leukocyte Adhesion Deficiency perio effects
Severe gingival inflammation, acute gingival lesions
Early-onset and rapidly progressive alveolar bone loss
Early loss of the primary and permanent teeth
Papillon–Lefèvre Syndrome
what is compromised?
decreased immune function?
signs?
Compromised neutrophil function, not the quantity
Decreased phagocytosis
Hyperkeratotic lesions Palms, soles of the feet, elbows, knees
Papillon–Lefèvre Syndrome perio effects
Severe gingival inflammation, pocket formation
Early-onset and rapidly progressive alveolar bone loss
Early loss of the primary and permanent teeth
Chediak-Higashi Syndrome
defective function of cell?
oculocutaneous sign?
Defects in?
Recurrent?
Circulating leukocytes exhibit defective?
Decrease in what immune function?
neurologic problems
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
Chediak-Higashi Syndrome perio effects
gingiva?
alveolar bone loss ?
teeth?
response to dental treatment?
Severe gingival inflammation
Early-onset and rapidly progressive alveolar bone loss
Early loss of the primary and permanent teeth
Poor response to dental treatment
Congenital Neutropenia
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
Congenital Neutropenia oral effects
common perio dx form?
Higher risk for?
mucosa?
Severe periodontitis is common
Higher risk for tooth loss
Oral ulcerations
congenital Diseases Associated with
Immunologic Disorders
trisomy 21
LAD
Papillon–Lefèvre Syndrome
Chediak-Higashi Syndrome
Congenital Neutropenia
Epidermolysis Bullosa/ kindler syndrome
Imparied function?
Molecular defects where?
Reduced resistance at?
signs?
Imparied keratinocyte cell adhesion
Molecular defects in basement membrane zone
Reduced resistance at the junctional epithelium
Photosensitivity
Recurrent blister formation
Epidermolysis Bullosa/kindler syndrome oral effects
what may form?
periodontitis form?
Alveolar bone loss?
Need what to confirm diagnosis?
Skin biopsy of?
Oral blisters formation
Severe periodontitis
Alveolar bone loss that progress rapidly
Need immunofluorescence to confirm diagnosis
Skin biopsy of an included blister
Diseases Affecting the Oral
Mucosa and Gingival Tissue
Epidermolysis Bullosa
Ehlers-Danlos Syndrome
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
Ehlers-Danlos Syndrome types
EDS type VIII/IV/I
EDS type VIII perio effects
EDS type VIII have gingival recession and generalized
severe periodontitis that often leads to loss of all teeth.
EDS type IV/I perio effects
EDS type IV and, to a lesser extent, in EDS type I may
also demonstrate the periodontitis as oral manifestation
Ehlers-Danlos Syndrome perio dx
Generalized, early-onset severe periodontitis and gingival recession
Early loss of the primary and permanent teeth
Hypophosphatasia
mutation?
forms?
affects on dentin/cementum?
Alcaline phosphatase (ALPL) gene mutation
Mild form and severe form
Dentin is not affected with defective cementum
Hypophosphatasia oral effects:
Impaired?
Defects in?
Compromised? result?
The teeth are not?
Alveolar bone/teeth loss?
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
Osteoporosis
Postmenopausal women with osteoporosis or osteopenia exhibit greater loss of periodontal attachment compared with women with normal bone mineral density.
Osteoporosis flow chart
osteoperosis and periodontitis relation
Both are bone resorptive diseases
osteoperosis and periodontitis relation radiographs
Higher prevalence and severity of radiographic alveolar bone loss
No clear association with probing depth or clinical attachment loss
Diabetes Mellitus
An important risk factor for periodontal diseases
Associated with significantly higher prevalence and
severity of periodontitis.
A disorder of glucose metabolism
DM I vs II
what is accumulated in DM? result of this?
Accumulation of AGEs (advanced glycation end products)
AGEs - RAGE (Receptor of AGEs) interaction
Diabetes Mellitus and perio dx
Diabetes as a risk factor for periodontal disease Increased prevalence and severity of attachment loss
DM perio abcesses
Periodontal abscess may be a common complication 58.6% of patients having periodontal abscesses had HbA1c ≥6.5%
DM and perio dx relation
Periodontal disease as a complicating factor for Diabetes Periodontitis ALSO affects glycemic control
Obesity
Metabolic syndrome including:
Adipose tissue effect
key factor of pathophys?
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
obesity immune effects:
* Cross-talk?
* release of?
* Decreased activity?
* Impaired function?
- Cross-talk between T cells and adipose tissue
- Increased releasing myriad proinflammatory cytokines and chemokines
- Decreased phagocytic activity
- Impaired antigen presentation
Obesity and inflammation progression
Obesity factors
Environmental Factors (Eg. smoking, nutrition, physical activity)
Genetic Factors
what is eleveated in synthesis in obesity. perio dx
Elevated synthesis of inflammatory cytokines TNF-a, IL-1, IL-6
chronic dx associated with obesity (and perio dx)
Eg. Type-2 DM, Coronary heart disease (CHD)
Acquired
Immunodeficiency
Diseases
Acquired neutropenia
HIV infection
Acquired Neutropenia mechanism
*Caused by autoimmune disease, cytotoxic chemotherapy or other drug or idiopathic etiology
*Due to decreased production or increased destruction of granulocytes
Acquired Neutropenia risk for perio dx
increased risk for infections and periodontitis
correlated with severity of neutropenia
acquired neutropenia possible forms of diagnosis
ANC
< 1500 cell/uL: mild
< 1000 cell/uL: moderate
< 500 cell/uL: severe
HIV mechanism
Deficiency of the immune system due to infection with the HIV virus
HIV increased risk for?
Increased risk for opportunistic infections, neoplasms (eg. kaposi sarcoma)
diagnosis HIV
Depends on the stage of infection
*Test HIV antibody/p24 antigen and PCR-based HIV
Inflammatory Diseases
Epidermolysis bullosa acquisita
Inflammatory bowel disease
Reumatoid arthritis
Epidermolysis Bullosa Acquisita
The presence of autoantibodies against?
form? (mimics?)
Recurrent formation?
Immunofluorescence on?
The presence of autoantibodies against type VII collagen (Mechanobullous type)
Inflammatory form (mimic pemphigoid)
Recurrent blister formation
Immunofluorescence on basement membrane zone - split skin
Epidermolysis Bullosa Acquisita oral findings
gingiva?
Alveolar bone?
teeth?
Generalized gingival inflammation and enlargement, gingival recession, alveolar bone loss, and mobile teeth
Inflammatory Bowel Disease
Hypersensitivity of immune response
Inflammatory Bowel
Disease oral effects
Inflammation and alveolar bone loss in a susceptible host
Increased prevalence and severity of periodontitis
Rheumatoid Arthritis
Chronic auto-inflammatory disease
RA oral effects
Increased risk for?
Biological link?
Increased risk for loss of periodontal attachment, alveolar bone
Biological link between rheumatoid arthritis and periodontitis
what non-dx factors can influence perio dx by influencing pathogenesis
Stress/depression
Smoking
Medications for malignancies, anti-inflammatory agents, bisphosphonates
Stress and perio dx
smoking results
4x Attachment loss
Leukoplakia
Carcinoma
Gingival recession
Tooth loss
smoking effects flow chart
Chronic nicotine exposure effect on IS
what cells are affected?
Process affected?
result?
d
nicotine and tar effects flow chart
both from smoking
Bisphosphonates
Treat cancer (IV administration)
Treat osteoporosis (oral administration)
Inhibit osteoclast activity and interfere with bone turnover
Bisphosphonates effects on alveolar bone/osteonecrosis
Can dx affect the periodontium independent of bio-film-induced inflammation?
affecting the periodontal supporting tissues
independently of dental plaque biofilm‐induced
inflammation.
independent etiologies of perio dx
direct effect on the periodontium without regard to biofilm
possible independent etiologies
- Neoplasms
- langerhans cell histiocytosis
- giant cell granuloma,
- hyperparathyroidism
- systemic sclerosis
Neoplasms
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
Langerhans cell histiocytosis
* Peripheral small vessel effect?
* impairment where?
* gingiva?
* Alveolar bone?
- Peripheral small vessel necrotizing vasculitis
- Respiratory and renal impairment
- Characteristic fiery and hyperplastic gingival inflammation
- Alveolar bone loss
Giant cell granuloma
Reactive proliferation, benign lesion
No systemic features
Peripheral giant cell granuloma
*Expanding epulis-like gingival swelling
*Occasional loss of periodontal supporting tissue
should bne biopsy
Central giant cell granuloma
*Loss of periodontal supporting tissue
*May expand toward marginal periodontal tissue
should also be biopsy
Hyperparathyroidism forms
Primary : benign adenoma of parathyroid glands
Secondary: result of hypocalcemia
Tertiary: parathyroid hypertrophy following 2o type
hyperPTH oral effects
lesions?
PDL?
Widening PDL, single/multiple osteolytic lesions in the jaw that mimic periodontal bone loss (brown tumors)
Systemic sclerosis (scleroderma)
Autoimmune disease of the connective tissues
Many different systemic presentations
sys sclerosis oral effects
Widening PDL and higher prevalence of periodontitis
sys sclerosis
sign/ screening
Raynaud phenomenon
Autoantibody screening
bisphosphonate t1/2
10yrs
