W2 - Systemic Perio Relationship - Sharma Flashcards
3 Ways endocrine disorders affect perio tissues
- Directly - perio manifestations of endocrine disease
- Modify the tissue response - makes it more inflamed
- Produces anatomic changes - may favor plaque accumulation
Oral manifestations of diabetes mellitus (3)
Frequent periodontal abscess
Diminished salivary flow (drying and cracking of soft tissues)
Increased caries
What is the only systemic disease positively associated with attachment loss?
Diabetes mellitus
What risk factor ontop of having diabetes severely worsens the chance of developing perio?
Smoking
3 pathogenic mechanisms contributing to severe periodontal disease
(not smoking, diabetes, etc)
- PMN function
- Bacteria
- Altered collagen metabolism
How does PMN function with diabetes?
(3 parts of impaired functioning)
impaired functioning
- impaired chemotaxis
- defective phagocytosis
- impaired adherence
Why do oral/perio bacteria proliferate in diabetes pts?
In addition to impaired neutrophils,
Glucose content in GCF is higher in diabetics due to high BGL
High glucose in GCF = more bacteria (AA, P ging)
How does diabetes affect collagen turnover? (3)
Decrease in collagen production
Impaired collagen degradation
AGE-RAGE interaction instrumental (AGE = advanced glycated end products, in hyperglycaemic environments responsible for sustained perio destruction
Administration of insulin prevents onset and corrects defective collagen production
Describe the collagen changes in diabetics (steps) (4)
- Increased cross linkage
- Resistant to digestion
- Impaired remodeling
- Impaired wound healing
Mechanism of Diabetes bone destruction
**ROS = reactive o2 species released by neutrophils directly responsible for tissue destruction
**AGE = advanced glycated end products
How does the periodontium change during menstruation
- Increased prevalence of gingivitis
- Bleeding gums, tense feelings in gums in days preceding menstrual flow
- No tooth mobility
- Increased bacteria during menstruation and ovulation
Does pregnancy gingivitis happen if there arent any local factors?
No plaque = no problems, even in preg
How does periodontium (potentially) change during pregnancy (5)
Increased tooth mobility
Pocket depth
Increased gingival fluid
Gingivitis
Epulis
When is the peak of pregnancy gingivitis
8 months
Clinical presentation of preg gingivitis
Ease of bleeding
Extreme redness
Usually painless (unless acute infection)
What bacteria is mostly responsible for preg gingivitis
P Intermedia
Why does Pregnancy gingivitis occur? (4)
Increased P intermedia
Depressed maternal T-lymphocyte response (more sensitive to plaque)
Elevations in systemic levels of hormones
Gingival mast cells (increased histamines → increased redness / inflammation)
How does progesterone affect preg gingivitis?
How do increased sex hormones affect pregnancy gingivits? (steps + cell type)
Features of pregnancy granuloma (consistency, symptoms, etc)
semi-firm consistency
Causes food impaction
Painless
becomes painful due to ulceration - cause: accumulation of debris under margin, occlusion interference
What is this and when does it appear?
Pregnancy epulis / pregnancy tumor
- appears after third month of pregnancy
Features of menopausal gingivostomatitis (3)
- Occurs during menopause or post menopausal period
- Not a common condition
- gingiva is dry and shiny, bleeds easily
How are WBC disorders classified
quantitative or qualitative leukocyte disorders
What is neutropenia? 2 types?
Decreased # of PMN’s
- Causes increased risk of infection
Chronic neutropenia (low Absolute Neutrophil Count ANC for > 6 months)
Cyclic Neutropenia - periodic recurring symptoms of sickness, generalised severe perio, usually presents before 10years
What is leukemia?
Malignant neoplasia of WBC precursors
- Overabundance of immature WBC in circulating blood
- Diffuse replacement of bone marrow with proliferating leukemic cells
- Widespread infiltrates in liver, spleen, lymph nodes
Describe the periodontium in leukemic patients (4)
Leukemic infiltration
Bleeding
Ulcerations
Infections
How is leukemia classified?
- According to type - lymphocytic or myelogenous/monocytic
- According to their presentation - Acute, subacute, chronic
How do leukemic pt periodontium appear?
Gingiva can appear bluish red/cyanotic
Rounding & tenseness of gingival margin
Increase in size, often in interprox
Marginal gingiva is ulcerated and necrotic with pseudo membrane formation
Leukemia periodontitis
What can gingival bleeding (unprovoked, easily) be a sign of?
Early sign of leukemia
- Due to decrease in platelets due to increased malformed wbcs
What granulocytopenia (from leukemia) cause?
Opportunistic infections and ulcerations
What are 4 genetic disorders associated with perio
Papillon lefevre syndrome
Lazy leukocyte syndrome
Down Syndrome
Leukocyte adhesion deficiency
pt has perio
Papillon lefevre syndrome
- difuse palmar plantar keratosis is a sign
Features of papillon lefevre syndrome (6)
- Rare genetic disease
- Diffuse palmar plantar keratosis
- Severe perio
- Appears together btw 2-4 yo
- Primary teeth lost by 5-6
- Permanent teeth lost by 15-20
What defects in PMN affect perio (3)
- Decreased chemotactic activity
- Decreased phagocytosis
- Decreased intracellular killing of bacteria
How does nutrition affect perio?
Poor nutrition weakens the immune system → increased infection = increased perio
Ex: Worst examples of NUG and noma are in malnourished african children
How does stress affect perio?
Makes it worse
Perhaps not physiologically but behaviour may change (increased smoking, not brushing, etc)
