Periodontitis as Manifestation of Systemic Disease Flashcards

1
Q

Disorder of glucose metabolism
Accumulation of AGEs AGEs - RAGE (Receptor of AGEs) interaction
Chronic status of elevated blood glucose level

A

Diabetes mellitus

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2
Q
Early onset
5-10% of cases
Destruction of beta cells
Absolute insulin deficiency
Marked tendency toward ketosis and coma
A

Type 1 DM

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3
Q

Adult onset
90-95% of cases
Obesity is a factor
Blood level of insulin is normal, increased or decreased
Development of ketosis and coma is uncommon

A

Type 2 DM

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4
Q

______as a risk factor for periodontal disease
-Increased prevalence and severity of attachment loss
Multiple periodontal abscess

A

Diabetes

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5
Q

Periodontitis ALSO affects ______ in relation to DM

A

glycemic control

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6
Q

What occurs when a pt is obese that causes more systemic effects?

A

State of low grade inflammation

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7
Q

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

A

Down syndrome

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8
Q

Moderate to severe periodontitis with rapid progression
Local factors alone failed to explain the severity of
periodontal destruction
Intrinsic immune system defects Poor PMN chemotaxis, phagocytosis, intracellular killing

A

Down syndrome

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9
Q

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 Disruption of neutrophil-associated homeostasis
History of severe recurrent infection but no pus Leukocytosis is common

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

– Seen in Down Syndrome too

A

Leukocyte Adhesion Deficiency

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10
Q

Mutations in the cathepsin C gene (CTSC) Chromosome 11q14
Compromised neutrophil function Decreased phagocytosis (Rathi, 2002)
Hyperkeratotic lesions Palms, soles of the feet, elbows, knees

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

A

Papillon–Lefèvre

Syndrome

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11
Q

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

Severe gingival inflammation
Early-onset and rapidly progressive alveolar bone loss
Early loss of the primary and permanent teeth
Poor response to dental treatment

A

Chediak-Higashi Syndrome

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12
Q

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

Severe periodontitis is common
Higher risk for tooth loss
Oral ulcers

A

Congenital Neutropenia

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13
Q

For the genetic systemic diseases, when is the onset of periodontitis?

A

Early onset

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14
Q

For the genetic systemic diseases, does dental tx help the prognosis of perio tooth loss?

A

Not effectively in most cases

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15
Q

Which of the following statement is incorrect?
A. Periodontitis as a manifestation of a systemic disease is defined
by influencing the course of periodontitis.
B. Periodontitis as a manifestation of a systemic disease is defined
by affecting the periodontal supporting tissues independently of
dental plaque biofilm‐induced inflammation
C. Acquired immunodeficiency diseases have a major impact on the
loss of periodontal tissue by influencing periodontal inflammation
D. Genetic disorders having a impact on the loss periodontal tissue
are related to early-onset periodontitis

A

B. Periodontitis as a manifestation of a systemic disease is defined
by affecting the periodontal supporting tissues independently of
dental plaque biofilm‐induced inflammation

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16
Q

Mutation in the fermitin family homologue 1 gene (kindlin-1; FERMT1)
Lack of integrin activation Affect keratinocyte cell adhesion
Lead to molecular defects in basement membrane zone
Photosensitivity
Recurrent blister formation

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

A

Epidermolysis Bullosa / Kindler syndrome

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17
Q

Mutations in genes encoding fibrillar collagens or
enzymes involved 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

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

A

Ehlers-Danlos Syndrome

18
Q

Alcaline phosphatase (ALPL) gene mutation
Mild form and severe form
Defective cementum, alveolar bone loss and premature
loss of teeth

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

A

Hypophosphatasia

19
Q
Estrogen withdrawal 
Increased bone turnover  
Net systemic bone loss 
Decrease in bone mineral density 
Weaken bone microarchitecture 
High risk of bone fracture
A

Osteoporosis

19
Q
Estrogen withdrawal 
Increased bone turnover  
Net systemic bone loss 
Decrease in bone mineral density 
Weaken bone microarchitecture 
High risk of bone fracture

Higher prevalence and severity of radiographic alveolar bone loss

A

Osteoporosis

20
Q

Does osteoporosis and periodontitis have a clear association?

21
Q

Which of the following statement about the
relationship between metabolic and endocrine
disorders and periodontitis is incorrect?
A. Elevated inflammation state in obesity patients increases the risk
of periodontitis
B. Estrogen withdrawal in osteoporosis is related to high
prevalence and severity of radiographic alveolar bone loss
C. Accumulation of AGEs in the periodontal tissues down regulate
the inflammatory response and increase the severity of attachment
loss
D. Effective periodontal therapy aids in the glycemic control

A

C. Accumulation of AGEs in the periodontal tissues down regulate
the inflammatory response and increase the severity of attachment
loss

22
Q
•Caused by autoimmune 
disease, cytotoxic 
chemotherapy or other 
drug or idiopathic etiology 
•Due to decreased 
production or 
increased 
destruction of 
granulocytes
Increased risk for 
infections and 
periodontitis 
correlated with 
severity of 
neutropenia 
•ANC 
< 1500 cell/uL: mild 
< 1000 cell/uL: moderate 
< 500 cell/uL: severe
A

Acquired neutropenia

23
Q
Deficiency of the immune 
system due to infection 
with the HIV virus
Increased risk for 
opportunistic 
infections, 
neoplasms (eg. 
kaposi sarcoma)
•Depends on the stage 
of infection 
•Test HIV antibody/
p24 antigen and 
PCR-based HIV
A

HIV Infection

24
``` 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
Epidermolysis Bullosa Acquisita
25
Hypersensitivity of immune response Inflammation and alveolar bone loss in a susceptible host Increased prevalence and severity of periodontitis Related to periodontitis due to similarity of bacteria
Inflammatory Bowel Disease
26
Chronic auto-inflammatory disease Increased risk for loss of periodontal attachment, alveolar bone Biological link between rheumatoid arthritis and periodontitis
Rheumatoid Arthritis
27
Increased Serum Cortisol Activate the limbic-hypothalamic-pituitary-adrenal axis Immune System Depression Change in behavior/mood/physiological markers Risk factor for necrotizing periodontal disease
Stress
28
``` 4x Attachment loss Leukoplakia Carcinoma Gingival recession Tooth loss ```
Smoking
29
Impaired immune response Subgingival anaerobic infection Connective tissue cytotoxicity Impaired wound healing Increased severity of periodontal disease
Smoking
30
Chronic ______ exposure Impairment of antigen-mediated T cell signaling Inhibits antibody-forming cell response (Sopori et al 1998) The inflammation in response to plaque accumulation is reduced
nicotine
31
``` Treat cancer (IV administration) Treat osteoporosis (oral administration) Inhibit osteoclast activity and interfere with bone turnover ```
Bisphosphonates
32
How do bisphosphonates impact bone density and blood flow?
Increase bone density | Decrease blood flow
33
``` Diseases and conditions that can affect the periodontal tissues by affecting the periodontal supporting tissues _______ of dental plaque biofilm‐induced inflammation. ```
independently
34
The following have an ______ etiology of perio disease Neoplasms Other disorders langerhans cell histiocytosis, giant cell granuloma, hyperparathyroidism, systemic sclerosis
Independent
35
_______ diseases of periodontal tissue Oral squamous cell carcinoma Odontogenic tumors Other primary neoplasms of periodontal tissue Secondary metastatic neoplasms of periodontal tissue
Neoplastic diseases
36
Peripheral small vessel necrotizing vasculitis Respiratory and renal impairment Characteristic fiery and hyperplastic gingival inflammation Alveolar bone loss
Langerhans cell histiocytosis
37
Reactive proliferation, benign lesion No systemic features Peripheral version: •Expanding epulis-like gingival swelling •Occasional loss of periodontal supporting tissue Central version: •Loss of periodontal supporting tissue •May expand toward marginal periodontal tissue
Giant cell granuloma
38
Primary : benign adenoma of parathyroid glands Secondary: result of hypercalcemia Tertiary: parathyroid hypertrophy following 2o type Widening PDL, single/multiple osteolytic lesions in the jaw that mimic periodontal bone loss (brown tumors)
Hyperparathyroidism
39
Autoimmune disease of the connective tissues Many different systemic presentations Widening PDL and higher prevalence of periodontitis
Systemic sclerosis | scleroderma
40
Which of the following systemic conditions can result in loss of periodontal tissue independent of the etiology of periodontitis? A. Leukocyte Adhesion Deficiency B. Reumatoid arthritis C. Giant cell granuloma D. Bisphosphonates IV administration
C. Giant cell granuloma