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Periodontics I > Periodontitis as a manifestation of systemic disease > Flashcards

Periodontitis as a manifestation of systemic disease Flashcards

1
Q

diseases and conditions that can affect the periodontal tissues by:

A
  • influencing the course of periodontitis
  • affecting the periodontal supporting tissues independently of dental plaque biofilm induced inflammation
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2
Q

what are the systemic disorders that have a major impact on the loss of the periodontal tissue by influencing periodontal inflammation

A
  • genetic disorders
  • acquired immunodeeficiency diseases
  • inflammatory diseases
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3
Q

what are the genetic disorders that affect periodontal disease

A
  • diseases associated with immunologic disorders
  • diseases affecting the oral mucosa and gingival tissue
  • diseases affecting the connective tissues
  • metabolic and endocrine disorders
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4
Q

what are the diseases associated with immunologic disorders

A
  • down syndrome
  • leukocyte adhesion deficiency
  • papillon lefevre syndrome
  • chediak higashi syndrome
  • congenital neutropenia
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5
Q

what is down syndrome

A
  • trisomy 21 or mongolism
  • characteristic physical appearance
  • mental deficiency and growth retardation
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6
Q

how does down syndrome affect periodontal disease

A
  • moderate to severe periodontitis with rapid progression
  • local factors alone failed to explain the severity of periodontal destruction
  • instrinsic immune system defects
  • poor PMN chemotaxis, phagocytosis, intracellular killing
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7
Q

what is leukocyte adhesion deficiency

A
  • mutation in beta 2- integrin (ITGB2) gene: lack of beta-2 integrin mRNA in leukocytes, low integrin expression on neutrophils
  • neutrophils are confined to blood vessels: disruption of neutrophil associated homeostasis
  • history of severe recurrent infection but no pus: leukocytosis is common
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8
Q

how does leukocyte adhesion deficiency affect periodontal disease

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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9
Q

what is papillon lefevre syndrome

A
  • mutations in the cathepsin C gene (CTSC): chromosome 11q14
  • compromised neutrophil function: decreased phagocytosis
  • hyperkeratotic lesions: palms, soles of feet, elbows, knees
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10
Q

how does papillon lefevre syndrome correlate with periodontal disease

A
  • severe gingival inflammation
  • early onset and rapidly progressive alveolar bone loss
  • early loss of the primary and permanent teeth
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11
Q

describe 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
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12
Q

how is chediak higashi syndrome related to periodontal disease

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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13
Q

what is congenital neutropenia

A
  • mutations in the ELANE (50%), HAX1 (10%) gene
  • 1/3 causes remain unknown
  • decrease in the number of neutrophils
  • ANC less than 500 cells/ul and static
  • deficiency in the immune repsonse
  • severe and recurrent infections
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14
Q

what is the correlation of congenital neutropenia and periodontal disease

A
  • severe periodontitis is common
  • higher risk for tooth loss
  • oral ulcers
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15
Q

what are the diseases affecting the oral mucosa and gingival tissue

A
  • epidermolysis bullosa (kindler syndrome)
  • ehlers danlos
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16
Q

what is epidermolysis bullosa

A
  • mutation in the fermitin family homologue 1 gene
  • lack of integrin activation
  • affective keratinocyte adhesion
  • can lead to molecular defects in the basement membrane zone
  • photosensitivity
  • recurrent blister formation
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17
Q

what is ehlers danlos syndrome

A
  • mutations in genes coding fibrillar collagens or enzymes involved in the biosynthesis of these proteins
  • affecting collagen production and compositions: mainly involves joints, skins, and walls of blood vessels
  • joint hypermobility, skin extesnibiility, and tissue fragility
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18
Q

what is the correlation between ehlers danlos and periodontal disease

A
  • generalized, early onset severe periodontitis, and gingival recession
  • early loss of primary and permanent teeth
  • generalized lack of attached gingiva
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19
Q

what are the metabolic and endocrine disorders

A
  • hypophosphatasia
  • DM
  • osteoporosis
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20
Q

what is hypophosphatasia

A
  • alkaline phosphatase (ALPL) gene mutation
  • mild and severe forms
  • defective cementum, alveolar bone loss, and premature loss of teeth
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21
Q

what is the correlation of hypophosphatasia and periodontal disease

A
  • impaired bone/tooth mineralization
  • defects in cementum
  • compromised periodontal attachment, reduction in alveolar bone height
  • the teeth are not adequately anchored to the alveolar bone via the PDL
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22
Q

what are the oral signs of hypophosphatasia

A
  • exfoliation of the primary dentition before the age of 3
  • exfoliation of primary teeth with roots intact
  • alveolar bone loss
  • loss of permanent teeth with no signs of periodontal inflammation
  • enlarged pulp chambers and root canals
  • thin dentinal walls
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23
Q

what is DM

A
  • disorder of glucose metabolism
  • accumulation of AGEs
  • chronic status of elevated blood glucose level
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24
Q

what is the correlation betweeen DM and periodontal disease

A
  • increased prevalance and severity of attachment loss
  • multiple periodontal abscess
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25
Q

what is the progression of obesity

A
  • obesity -> state of low grade inflammation -> predispose to major chronic diseases
26
Q

obesity and periodontitis lead to:

A

elevated synthesis of inflammatory cytokines such as TNF alpha, IL-1, IL-6-> chronic diseases such as type 2DM and CHD

27
Q

what is osteoporosis

A
  • estrogen withdrawal
  • increase in IL-6
  • increased bone turnover
  • net systemic bone loss
  • decrease in bone mineral density
  • weaken bone microarchitecture
  • high risk of bone fracture
28
Q

what is periodontitis

A
  • bacterial infection
  • local inflammatory insult
  • initial cortical bone compromise
  • bone loss
29
Q

what are the shared risk factors of osteoporosis and periodontitis

A
  • age
  • smoking
  • vitamin D and calcium deficiency
30
Q

osteoporosis and periodontitis are both ____ diseases

A

resorptive

31
Q

which has a higher prevalance and severity of radiographic bone loss: periodontal disease or osteoporosis

A

perioontitis

32
Q

what are the acquired immune deficiency diseases

A
  • acquired neutropenia
  • HIV infection
33
Q

what is the etiology of acquired neutropenia

A

autoimmune disease, cytotoxic chemotherapy, or other drugs
- sometimes idiopathic

34
Q

what is the biologic mechanism of acquired neutropenia

A

either decreased production or increased destruction of granulocytes

35
Q

what is the correlation between acquired neutropenia and perioodntal disease

A

increased risk for infections and periodontitis is correlated with the severity of neutropenia

36
Q

what are the diagnoses of stages in acquired neutropenia

A
  • mild: ANC less than 1500 cells/ul
  • moderate: ANC less than 1000 cells/ul
  • severe: less than 500 cells/ul
37
Q

what is HIV infection

A

deficiency of the immune system due to infection with the HIV virus
- increased risk for opportunistic infections and neoplasms such as Kaposi’s sarcoma

38
Q

what is the dx of HIV

A
  • depends on the stage of infection
  • test HIV antibody/p24 antigen and PCR based HIV
39
Q

what are the inflammatory diseases

A
  • epidermolysis bullosa acquisita
  • IBS
  • rheumatoid arthritis
40
Q

what is epidermolysis bullosa acquisita

A
  • 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
41
Q

what is IBS

A
  • hypersensitivity of immune response
  • inflammation and alveolar bone loss in a susceptible host
  • increased prevalance and severity of periodontitis
42
Q

what are the bacteria involved in IBS

A
  • commensal gut bacteria
  • dental plaque bacteria
43
Q

what is RA

A
  • chronic auto inflammatory disease
  • increased risk for loss of periodontal attachment, alveolar bone
  • biological link between RA and periodontitis
44
Q

what is the relation of periodontal disease to arthritis - rheumatoid and osteoarthritis

A
  • arthritis -> patients with arthritis have a higher incidence of periodontal disease compared to healthy controls -> perioodntal treatment decreases arthritis parameters of swollen and tender joints; pain
45
Q

what is the prevalence of RA

A
  • 1.3 million affected with 3x more women than men
46
Q

studies show associated between periodontitis and RA in that they both invoke the same:

A

cytokines and pro inflammatory mediators

47
Q

what are the bacteria associated with RA and periodontitis and what does it do

A
  • P. gingivalis may play key role in the pathogenesis of periodontitis- associated RA
  • P. gingivalis produced Peptidylarginine deiminase (PAD) and it is associated with RA
48
Q

what are other systemic disorders that may contribute to periodontal tissue loss by influencing the pathogenesis of perioodntal diseases

A
  • stress/depression
  • smoking
49
Q

how does stress contribute to periodontal disease

A
  • stress/anxiety/depression + negative life event -> icnreased serum cortisol (activates limbic- hypothalamic-pituitary adrenal axis) -> immune system depression -> change in behavior/mood/physiological markers and risk factor for necrotizing periodontal disease
50
Q

what is the oral association with smoking cigarettes, cigars, pipe smokers and vapers and smokeless tobacco

A
  • 4x attachment loss
  • leukoplakia
  • carcinoma
  • tooth loss
  • gingival recession
51
Q

what does chronic nicotine exposure cause

A
  • impairment of antigen mediated T cell signaling
  • inhibits antibody forming cell response
  • immunosuppresion
  • the inflammation in response to plaque accumulation is reduced
52
Q

what are the effects of smoking

A
  • nicotine -> vasoconstriction -> peripheral blood vessels -> decreases tissue oxygenation -> subgingival anaerobic infection, CT cytotoxicity, impaired wound healing
  • tars -> cytotoxic and sticky -> lung (COPD, cancer) -> smoking decreases tissue oxygenation -> subgingival anaerobic infection, CT cytotoxicity, impaired wound healing
53
Q

what are the neoplastic diseases of periodontal tissue

A
  • oral SCC
  • odontogenic tumors
  • other primary neoplasms of periodontal tissue
54
Q

what types of ehlers danlos will affect the periodontium

A

type IV and VIII

55
Q

what is langerhans cell histiocytosis

A
  • peripheral small vessel necrotizing vasculitis
  • respiratory and renal impairment
  • characteristic fiery and hyperplastic gingival inflammation
  • alveolar bone loss
56
Q

what are giant cell granulomas

A
  • reactive proliferarion, benign lesion
  • no systemic features
57
Q

what is a peripheral giant cell granuloma

A
  • expanding epulis like gingival swelling
  • occasional loss of periodontal supporting tissue
  • expanding epulis like gingival swelling
  • occasional loss of periodontal supporting tissue
58
Q

what are the three types of hyperparathyroidism

A
  • primary: benign adenoma of parathyroid glands
  • secondary: result of hypercalcemia
  • tertiary: parathyroid hypertrophy following secondary type
59
Q

what is seen in radiographs with hyperparathyroidism

A
  • widening PDL
  • single/multiple osteolytic lesions in the jaw that mimic periodontal bone loss
  • brown tumors
60
Q

what is systemic sclerosis (scleroderma)

A
  • autoimmune disease of the CT
  • many different systemic presentations
  • widening PDL and higher prevalence of periodontitis
  • raynaud phenomenon
  • autoantibody screening
61
Q
A

Periodontics I (13 decks)

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