Periodontitis as Manifestation of Systemic Disease Flashcards
Disorder of glucose metabolism
Accumulation of AGEs AGEs - RAGE (Receptor of AGEs) interaction
Chronic status of elevated blood glucose level
Diabetes mellitus
Early onset 5-10% of cases Destruction of beta cells Absolute insulin deficiency Marked tendency toward ketosis and coma
Type 1 DM
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
Type 2 DM
______as a risk factor for periodontal disease
-Increased prevalence and severity of attachment loss
Multiple periodontal abscess
Diabetes
Periodontitis ALSO affects ______ in relation to DM
glycemic control
What occurs when a pt is obese that causes more systemic effects?
State of low grade inflammation
Trisomy 21 or mongolism
Characteristic physical appearance
Mental deficiency and growth retardation
Down syndrome
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
Down syndrome
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
Leukocyte Adhesion Deficiency
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
Papillon–Lefèvre
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
Severe gingival inflammation
Early-onset and rapidly progressive alveolar bone loss
Early loss of the primary and permanent teeth
Poor response to dental treatment
Chediak-Higashi Syndrome
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
Congenital Neutropenia
For the genetic systemic diseases, when is the onset of periodontitis?
Early onset
For the genetic systemic diseases, does dental tx help the prognosis of perio tooth loss?
Not effectively in most cases
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
B. Periodontitis as a manifestation of a systemic disease is defined
by affecting the periodontal supporting tissues independently of
dental plaque biofilm‐induced inflammation
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
Epidermolysis Bullosa / Kindler syndrome
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
Ehlers-Danlos Syndrome
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
Hypophosphatasia
Estrogen withdrawal Increased bone turnover Net systemic bone loss Decrease in bone mineral density Weaken bone microarchitecture High risk of bone fracture
Osteoporosis
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
Osteoporosis
Does osteoporosis and periodontitis have a clear association?
No
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
C. Accumulation of AGEs in the periodontal tissues down regulate
the inflammatory response and increase the severity of attachment
loss
•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
Acquired neutropenia
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
HIV Infection
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
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
Chronic auto-inflammatory disease
Increased risk for loss of periodontal attachment, alveolar bone
Biological link between rheumatoid arthritis and periodontitis
Rheumatoid Arthritis
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
4x Attachment loss Leukoplakia Carcinoma Gingival recession Tooth loss
Smoking
Impaired immune response
Subgingival anaerobic infection
Connective tissue cytotoxicity
Impaired wound healing
Increased severity of periodontal disease
Smoking
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
Treat cancer (IV administration) Treat osteoporosis (oral administration) Inhibit osteoclast activity and interfere with bone turnover
Bisphosphonates
How do bisphosphonates impact bone density and blood flow?
Increase bone density
Decrease blood flow
Diseases and conditions that can affect the periodontal tissues by affecting the periodontal supporting tissues \_\_\_\_\_\_\_ of dental plaque biofilm‐induced inflammation.
independently
The following have an ______ etiology of perio disease
Neoplasms
Other disorders langerhans cell histiocytosis, giant cell granuloma,
hyperparathyroidism, systemic sclerosis
Independent
_______ diseases of periodontal tissue Oral squamous cell carcinoma
Odontogenic tumors
Other primary neoplasms of periodontal tissue
Secondary metastatic neoplasms of periodontal tissue
Neoplastic diseases
Peripheral small vessel necrotizing vasculitis
Respiratory and renal impairment
Characteristic fiery and hyperplastic gingival inflammation
Alveolar bone loss
Langerhans cell histiocytosis
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
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
Autoimmune disease of the connective tissues
Many different systemic presentations
Widening PDL and higher prevalence of periodontitis
Systemic sclerosis
scleroderma
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
