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DS4102 > W2 - Systemic Perio Relationship - Sharma > Flashcards

W2 - Systemic Perio Relationship - Sharma Flashcards

1
Q

3 Ways endocrine disorders affect perio tissues

A
  1. Directly - perio manifestations of endocrine disease
  2. Modify the tissue response - makes it more inflamed
  3. Produces anatomic changes - may favor plaque accumulation
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2
Q

Oral manifestations of diabetes mellitus (3)

A

Frequent periodontal abscess

Diminished salivary flow (drying and cracking of soft tissues)

Increased caries

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3
Q

What is the only systemic disease positively associated with attachment loss?

A

Diabetes mellitus

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4
Q

What risk factor ontop of having diabetes severely worsens the chance of developing perio?

A

Smoking

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5
Q

3 pathogenic mechanisms contributing to severe periodontal disease

(not smoking, diabetes, etc)

A
  1. PMN function
  2. Bacteria
  3. Altered collagen metabolism
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6
Q

How does PMN function with diabetes?
(3 parts of impaired functioning)

A

impaired functioning

  • impaired chemotaxis
  • defective phagocytosis
  • impaired adherence
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7
Q

Why do oral/perio bacteria proliferate in diabetes pts?

A

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)

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8
Q

How does diabetes affect collagen turnover? (3)

A

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

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9
Q

Describe the collagen changes in diabetics (steps) (4)

A
  1. Increased cross linkage
  2. Resistant to digestion
  3. Impaired remodeling
  4. Impaired wound healing
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10
Q

Mechanism of Diabetes bone destruction

A

**ROS = reactive o2 species released by neutrophils directly responsible for tissue destruction

**AGE = advanced glycated end products

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11
Q

How does the periodontium change during menstruation

A
  1. Increased prevalence of gingivitis
  2. Bleeding gums, tense feelings in gums in days preceding menstrual flow
  3. No tooth mobility
  4. Increased bacteria during menstruation and ovulation
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12
Q

Does pregnancy gingivitis happen if there arent any local factors?

A

No plaque = no problems, even in preg

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13
Q

How does periodontium (potentially) change during pregnancy (5)

A

Increased tooth mobility

Pocket depth

Increased gingival fluid

Gingivitis

Epulis

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14
Q

When is the peak of pregnancy gingivitis

A

8 months

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15
Q

Clinical presentation of preg gingivitis

A

Ease of bleeding

Extreme redness

Usually painless (unless acute infection)

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16
Q

What bacteria is mostly responsible for preg gingivitis

A

P Intermedia

17
Q

Why does Pregnancy gingivitis occur? (4)

A

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)

18
Q

How does progesterone affect preg gingivitis?

A
19
Q

How do increased sex hormones affect pregnancy gingivits? (steps + cell type)

A
20
Q

Features of pregnancy granuloma (consistency, symptoms, etc)

A

semi-firm consistency

Causes food impaction

Painless

becomes painful due to ulceration - cause: accumulation of debris under margin, occlusion interference

21
Q

What is this and when does it appear?

A

Pregnancy epulis / pregnancy tumor

  • appears after third month of pregnancy
22
Q

Features of menopausal gingivostomatitis (3)

A
  • Occurs during menopause or post menopausal period
  • Not a common condition
  • gingiva is dry and shiny, bleeds easily
23
Q

How are WBC disorders classified

A

quantitative or qualitative leukocyte disorders

24
Q

What is neutropenia? 2 types?

A

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

25
Q

What is leukemia?

A

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
26
Q

Describe the periodontium in leukemic patients (4)

A

Leukemic infiltration

Bleeding

Ulcerations

Infections

27
Q

How is leukemia classified?

A
  1. According to type - lymphocytic or myelogenous/monocytic
  2. According to their presentation - Acute, subacute, chronic
28
Q

How do leukemic pt periodontium appear?

A

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

29
Q
A

Leukemia periodontitis

30
Q

What can gingival bleeding (unprovoked, easily) be a sign of?

A

Early sign of leukemia

  • Due to decrease in platelets due to increased malformed wbcs
31
Q

What granulocytopenia (from leukemia) cause?

A

Opportunistic infections and ulcerations

32
Q

What are 4 genetic disorders associated with perio

A

Papillon lefevre syndrome

Lazy leukocyte syndrome

Down Syndrome

Leukocyte adhesion deficiency

33
Q

pt has perio

A

Papillon lefevre syndrome

  • difuse palmar plantar keratosis is a sign
34
Q

Features of papillon lefevre syndrome (6)

A
  • 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
35
Q

What defects in PMN affect perio (3)

A
  • Decreased chemotactic activity
  • Decreased phagocytosis
  • Decreased intracellular killing of bacteria
36
Q

How does nutrition affect perio?

A

Poor nutrition weakens the immune system → increased infection = increased perio

Ex: Worst examples of NUG and noma are in malnourished african children

37
Q

How does stress affect perio?

A

Makes it worse

Perhaps not physiologically but behaviour may change (increased smoking, not brushing, etc)

DS4102 (37 decks)

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