Periodontitis as a manifestation of systemic disease Flashcards
diseases and conditions that can affect the periodontal tissues by:
- influencing the course of periodontitis
- affecting the periodontal supporting tissues independently of dental plaque biofilm induced inflammation
what are the systemic disorders that have a major impact on the loss of the periodontal tissue by influencing periodontal inflammation
- genetic disorders
- acquired immunodeeficiency diseases
- inflammatory diseases
what are the genetic disorders that affect periodontal disease
- diseases associated with immunologic disorders
- diseases affecting the oral mucosa and gingival tissue
- diseases affecting the connective tissues
- metabolic and endocrine disorders
what are the diseases associated with immunologic disorders
- down syndrome
- leukocyte adhesion deficiency
- papillon lefevre syndrome
- chediak higashi syndrome
- congenital neutropenia
what is down syndrome
- trisomy 21 or mongolism
- characteristic physical appearance
- mental deficiency and growth retardation
how does down syndrome affect periodontal disease
- 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
what is leukocyte adhesion deficiency
- 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
how does leukocyte adhesion deficiency affect periodontal disease
- severe, gingival inflammation, acute gingival lesions
- early onset and rapidly progressive alveolar bone loss
- early loss of the primary and permanent teeth
what is papillon lefevre syndrome
- mutations in the cathepsin C gene (CTSC): chromosome 11q14
- compromised neutrophil function: decreased phagocytosis
- hyperkeratotic lesions: palms, soles of feet, elbows, knees
how does papillon lefevre syndrome correlate with periodontal disease
- severe gingival inflammation
- early onset and rapidly progressive alveolar bone loss
- early loss of the primary and permanent teeth
describe chediak higashi syndrome
- 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
how is chediak higashi syndrome related to periodontal disease
- severe gingival inflammation
- early onset and rapidly progressive alveolar bone loss
- early loss of the primary and permanent teeth
- poor response to dental treatment
what is congenital neutropenia
- 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
what is the correlation of congenital neutropenia and periodontal disease
- severe periodontitis is common
- higher risk for tooth loss
- oral ulcers
what are the diseases affecting the oral mucosa and gingival tissue
- epidermolysis bullosa (kindler syndrome)
- ehlers danlos
what is epidermolysis bullosa
- 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
what is ehlers danlos syndrome
- 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
what is the correlation between ehlers danlos and periodontal disease
- generalized, early onset severe periodontitis, and gingival recession
- early loss of primary and permanent teeth
- generalized lack of attached gingiva
what are the metabolic and endocrine disorders
- hypophosphatasia
- DM
- osteoporosis
what is hypophosphatasia
- alkaline phosphatase (ALPL) gene mutation
- mild and severe forms
- defective cementum, alveolar bone loss, and premature loss of teeth
what is the correlation of hypophosphatasia and periodontal disease
- 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
what are the oral signs of hypophosphatasia
- 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
what is DM
- disorder of glucose metabolism
- accumulation of AGEs
- chronic status of elevated blood glucose level
what is the correlation betweeen DM and periodontal disease
- increased prevalance and severity of attachment loss
- multiple periodontal abscess
what is the progression of obesity
- obesity -> state of low grade inflammation -> predispose to major chronic diseases
obesity and periodontitis lead to:
elevated synthesis of inflammatory cytokines such as TNF alpha, IL-1, IL-6-> chronic diseases such as type 2DM and CHD
what is osteoporosis
- 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
what is periodontitis
- bacterial infection
- local inflammatory insult
- initial cortical bone compromise
- bone loss
what are the shared risk factors of osteoporosis and periodontitis
- age
- smoking
- vitamin D and calcium deficiency
osteoporosis and periodontitis are both ____ diseases
resorptive
which has a higher prevalance and severity of radiographic bone loss: periodontal disease or osteoporosis
perioontitis
what are the acquired immune deficiency diseases
- acquired neutropenia
- HIV infection
what is the etiology of acquired neutropenia
autoimmune disease, cytotoxic chemotherapy, or other drugs
- sometimes idiopathic
what is the biologic mechanism of acquired neutropenia
either decreased production or increased destruction of granulocytes
what is the correlation between acquired neutropenia and perioodntal disease
increased risk for infections and periodontitis is correlated with the severity of neutropenia
what are the diagnoses of stages in acquired neutropenia
- mild: ANC less than 1500 cells/ul
- moderate: ANC less than 1000 cells/ul
- severe: less than 500 cells/ul
what is HIV infection
deficiency of the immune system due to infection with the HIV virus
- increased risk for opportunistic infections and neoplasms such as Kaposi’s sarcoma
what is the dx of HIV
- depends on the stage of infection
- test HIV antibody/p24 antigen and PCR based HIV
what are the inflammatory diseases
- epidermolysis bullosa acquisita
- IBS
- rheumatoid arthritis
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
what is IBS
- hypersensitivity of immune response
- inflammation and alveolar bone loss in a susceptible host
- increased prevalance and severity of periodontitis
what are the bacteria involved in IBS
- commensal gut bacteria
- dental plaque bacteria
what is RA
- chronic auto inflammatory disease
- increased risk for loss of periodontal attachment, alveolar bone
- biological link between RA and periodontitis
what is the relation of periodontal disease to arthritis - rheumatoid and osteoarthritis
- 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
what is the prevalence of RA
- 1.3 million affected with 3x more women than men
studies show associated between periodontitis and RA in that they both invoke the same:
cytokines and pro inflammatory mediators
what are the bacteria associated with RA and periodontitis and what does it do
- 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
what are other systemic disorders that may contribute to periodontal tissue loss by influencing the pathogenesis of perioodntal diseases
- stress/depression
- smoking
how does stress contribute to periodontal disease
- 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
what is the oral association with smoking cigarettes, cigars, pipe smokers and vapers and smokeless tobacco
- 4x attachment loss
- leukoplakia
- carcinoma
- tooth loss
- gingival recession
what does chronic nicotine exposure cause
- impairment of antigen mediated T cell signaling
- inhibits antibody forming cell response
- immunosuppresion
- the inflammation in response to plaque accumulation is reduced
what are the effects of smoking
- 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
what are the neoplastic diseases of periodontal tissue
- oral SCC
- odontogenic tumors
- other primary neoplasms of periodontal tissue
what types of ehlers danlos will affect the periodontium
type IV and VIII
what is langerhans cell histiocytosis
- peripheral small vessel necrotizing vasculitis
- respiratory and renal impairment
- characteristic fiery and hyperplastic gingival inflammation
- alveolar bone loss
what are giant cell granulomas
- reactive proliferarion, benign lesion
- no systemic features
what is a peripheral giant cell granuloma
- expanding epulis like gingival swelling
- occasional loss of periodontal supporting tissue
- expanding epulis like gingival swelling
- occasional loss of periodontal supporting tissue
what are the three types of hyperparathyroidism
- primary: benign adenoma of parathyroid glands
- secondary: result of hypercalcemia
- tertiary: parathyroid hypertrophy following secondary type
what is seen in radiographs with hyperparathyroidism
- widening PDL
- single/multiple osteolytic lesions in the jaw that mimic periodontal bone loss
- brown tumors
what is systemic sclerosis (scleroderma)
- autoimmune disease of the CT
- many different systemic presentations
- widening PDL and higher prevalence of periodontitis
- raynaud phenomenon
- autoantibody screening
