Periodontitis as a Manifestation of a Systemic Disease Flashcards
periodontitis as a manifestation of a systemic disease
“Diseases and conditions
that can affect the
periodontal tissues by
influencing the course
of periodontitis.
Major impact
Severe/early-onset
periodontitis
Moderate impact
(2)
Increase prevalence
No otherwise different
clinical presentations of
chronic periodontitis
Systemic disorders
Loss of
periodontal
tissue
Influence (2)
Influence periodontal inflammation
Influence the pathogenesis of periodontal diseases
Influence periodontal inflammation
(3)
Genetic Disorders
Acquired Immunodeficiency Diseases
Inflammatory Diseases
Genetic Disorders
(4)
Diseases associated with immunologic disorders
Diseases affecting the oral mucosa and gingival tissue
Diseases affecting the connective tissues
Metabolic and endocrine disorders
Down Syndrome
(5)
Trisomy 21 or mongolism
Characteristic physical appearance
Mental deficiency and growth retardation
Moderate to severe periodontitis with rapid progression
Local factors alone failed to explain the severity of
periodontal destruction
Down Syndrome
Predispose to infections:
intrinsic immune system defects Poor PMN chemotaxis, phagocytosis, intracellular killing
Leukocyte Adhesion
Deficiency
(2)
Mutation in beta-2 integrin (ITGB2) gene Lack of
Neutrophils are confined to blood vessels and
absent from the periodontium
skipped
Mutation in beta-2 integrin (ITGB2) gene
(2)
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
(4)
Leukocytosis is common
History of severe recurrent infection but no pus
Disruption of neutrophil-associated homeostasis
Lack of neutrophil immune surveillance
Leukocyte Adhesion
Deficiency
dental (3)
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
(3)
Mutations in the cathepsin C gene (CTSC)
Compromised neutrophil function, not the quantity
Hyperkeratotic lesions
Mutations in the cathepsin C gene (CTSC)
Chromosome 11q14
Compromised neutrophil function, not the quantity
Decreased phagocytosis (Rathi, 2002)
Hyperkeratotic lesions
Palms, soles of the feet, elbows, knees
Papillon–Lefèvre
Syndrome
dental (3)
Severe gingival inflammation, pocket formation
Early-onset and rapidly progressive alveolar bone loss
Early loss of the primary and permanent teeth
Chediak-Higashi
Syndrome
(4)
Mutations in CHS1, LYST gene
Partial oculocutaneous albinism
Recurrent pyogenic infections
Varying neurologic problems
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
Chediak-Higashi
Syndrome
dental (4)
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
(3)
Mutations in the ELANE (50%), HAX1(10%) gene
Decrease in number of neutrophils
Deficiency in the immune response
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
dental
(3)
Severe periodontitis is common
Higher risk for tooth loss
Oral ulcerations
Epidermolysis Bullosa
Kindler syndrome
(3)
Mutation in the fermitin family homologue 1 gene (kindlin-1; FERMT1)
Photosensitivity
Recurrent blister formation
Kindler syndrome
Mutation in the fermitin family homologue 1 gene (kindlin-1; FERMT1)
(3)
Imparied keratinocyte cell adhesion
Molecular defects in basement membrane zone
Reduced resistance at the junctional epithelium
Epidermolysis Bullosa
Kindler syndrome
dental (3)
Oral blisters formation
Severe periodontitis
Need immunofluorescence to confirm diagnosis
Severe periodontitis
Alveolar bone loss that progress rapidly
Need immunofluorescence to confirm diagnosis
Skin biopsy of an included blister
Ehlers-Danlos Syndrome
(3)
Mutations in genes encoding fibrillar collagens or
enzymes involve in the biosynthesis of these proteins
Affecting collagen production and composition
Joint hypermobility, skin extensibility, and tissue fragility
Affecting collagen production and composition Mainly involves
joint, skins and walls of the blood vessels
Ehlers-Danlos Syndrome
EDS type VIII have
gingival recession and generalized
severe periodontitis that often leads to loss of all teeth.
EDS type IV and, to a lesser extent, in EDS type I may
also demonstrate the
periodontitis as oral manifestation
Ehlers-Danlos Syndrome
dental (2)
Generalized, early-onset severe periodontitis and
gingival recession
Early loss of the primary and permanent teeth
Hypophosphatasia
(3)
Alcaline phosphatase (ALPL) gene mutation
Mild form and severe form
Dentin is not affected with defective cementum
Hypophosphatasia
dental
(3)
Impaired bone/tooth mineralization
Defects in root cementum
Alveolar bone loss and premature loss of teeth
Defects in root cementum
(2)
Compromised periodontal attachment, reduction in alveolar bone height
The teeth are not adequately anchored to the alveolar bone via the PDL
Osteoporosis
Postmenopausal women with osteoporosis or osteopenia
exhibit greater loss of periodontal attachment compared
with women with normal bone mineral density.
Osteoporosis
Estrogen withdrawal
Increased bone turnover
Net systemic bone loss
Decrease in bone mineral density
Weaken bone microarchitecture
High risk of bone fracture
Periodontitis
Bacterial infection
Local inflammatory insult
Initial cortical bone compromise
Bone loss
Shared Risk Factors
Age, vitamin D and calcium deficiency, and smoking
Osteoporosis, Periodontitis
Homeostasis
Both are bone resorptive diseases
Higher prevalence and severity of
radiographic alveolar bone loss
No clear association with probing depth or clinical attachment loss
Diabetes Mellitus
(3)
An important risk factor for periodontal diseases
Associated with significantly higher prevalence and
severity of periodontitis.
A disorder of glucose metabolism
Diabetes Mellitus
Chronic status of
elevated blood glucose level
Accumulation of AGEs AGEs - RAGE (Receptor of AGEs) interaction
Diabetes Mellitus
dental (2)
Diabetes as a risk factor for periodontal disease
Periodontal abscess may be a common complication
Diabetes as a risk factor for periodontal disease
Increased prevalence and severity of attachment loss
Periodontal abscess may be a common complication 58.6% of patients having periodontal abscesses had HbA1c ≥
6.5%
Diabetes Mellitus
Periodontal disease as a complicating factor for
Diabetes
Periodontitis ALSO affects glycemic control
Diabetes Mellitus
Monitor
fasting plasma glucose level and HBA1c
Obesity
(3)
Metabolic syndrome:
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
Metabolic syndrome: (4)
Hypertension, Hyperglycemia,
Obesity, and dyslipidemia
Rather than the amount of fat mass, adipose tissue
dysfunction may be the key factor in
pathophysiology
(4)
Cross-talk between T cells and adipose tissue
Increased releasing myriad proinflammatory cytokines and chemokines
Decreased phagocytic activity
Impaired antigen presentation
Acquired
Immunodeficiency
Diseases (2)
Acquired neutropenia
HIV infection
Inflammatory Diseases
(3)
Epidermolysis bullosa acquisita
Inflammatory bowel disease
Reumatoid arthritis
Epidermolysis Bullosa
Acquisita
(4)
The presence of autoantibodies against type VII collagen
Recurrent blister formation
Generalized gingival inflammation and enlargement, gingival
recession, alveolar bone loss, and mobile teeth
Immunofluorescence on basement membrane zone - split skin
Epidermolysis Bullosa
AcquisitaThe presence of autoantibodies against type VII collagen
(2)
Mechanobullous type
Inflammatory form (mimic pemphigoid)
Inflammatory Bowel
Disease
dental (3)
Hypersensitivity of immune response
Inflammation and alveolar bone loss in a susceptible host
Increased prevalence and severity of periodontitis
Rheumatoid Arthritis
(3)
Chronic auto-inflammatory disease
Increased risk for loss of periodontal attachment, alveolar bone
Biological link between rheumatoid arthritis and periodontitis
Influence the pathogenesis of periodontal diseases
(3)
Stress/depression
Smoking
Medications for malignancies, anti-inflammatory agents, bisphosphonates
Smoking
(2)
Chronic nicotine exposure
Immunosuppression
Chronic nicotine exposure
(2)
Impairment of antigen-mediated T cell signaling
Inhibits antibody-forming cell response
Immunosuppression
(1)
The inflammation in response to plaque accumulation is reduced
Bisphosphonates
(3)
Treat cancer (IV administration)
Treat osteoporosis (oral administration)
Inhibit osteoclast activity and interfere with bone turnover
Bisphosphonates
Not currently used to prevent
further
alveolar bone loss
Independent etiology
Neoplasms
Other disorders
langerhans cell histiocytosis, giant cell granuloma,
hyperparathyroidism, systemic sclerosis
Neoplasms
(2)
Neoplastic diseases of periodontal tissue
Secondary metastatic neoplasms of periodontal tissue
Neoplastic diseases of periodontal tissue
(3)
Oral squamous cell carcinoma
Odontogenic tumors
Other primary neoplasms of periodontal tissue
Other Disorders Langerhans cell histiocytosis
(4)
Peripheral small vessel necrotizing vasculitis
Respiratory and renal impairment
Characteristic fiery and hyperplastic gingival inflammation
Alveolar bone loss
Other Disorders Giant cell granuloma
(2)
Reactive proliferation, benign lesion
No systemic features
Peripheral giant cell granuloma
(2)
*Expanding epulis-like gingival swelling
*Occasional loss of periodontal
supporting tissue
Central giant cell granuloma
(2)
*Loss of periodontal supporting tissue
*May expand toward marginal
periodontal tissue
Other Disorders Hyperparathyroidism
Primary :
Secondary:
Tertiary:
benign adenoma of parathyroid glands
result of hypercalcemia
parathyroid hypertrophy following 2o type
Other Disorders
Systemic sclerosis
(scleroderma)
(3)
Autoimmune disease of the connective tissues
Many different systemic presentations
Widening PDL and higher prevalence of periodontitis
