Week 2 Sharma: Systemic Diseases and Perio Flashcards
What systemic diseases/disorders affect the periodontium?
- Endocrine disorders
- Haematological disorders
- Genetic factors
- Stress
- Nutritional influences
How can hormonal disturbances affect periodontal tissues (3)?
- Directly as perio manifestation of endocrine disease
- Modify tissue response to plaque
- Produce anatomic changes that may favour plaque accumulation or trauma from occlusion
What are oral manifestations of diabetes mellitus?
- Frequent periodontal abscesses
- Diminished saliva flow (mucosal drying, cracking, burning mouth/tongue)
- Inc rate of caries
How does uncontrolled diabetes impact periodontium?
- Limited to gingiva: severe inflammation, gingival enlargements
- Features extending to attachment: abscesses, mobility, deep pockets, rapid bone loss
What is the only systemic disease positively associated with AL?
Diabetes Mellitus
What are the contributing pathogenic mechanisms to periodontal disease in diabetics?
Bacteria + PMN function → altered collagen metabolism (normal healing doesn’t occur) and periodontal disease
What is the consequence of PMN deficiency in uncontrolled diabetic?
Impaired chemotaxis
Defective phagocytosis
Impaired adherence
Why is the glucose content of GCF and blood higher in diabetics?
Blood glucose seeps into GCF. GCF increases with inflammation.
Bacteria that need glucose would be higher in diabetics as there is glucose in GCF.
How is collagen turnover affected in uncontrolled diabetics? What is the role of insulin?
- Dec in collagen production and impaired collagen degradation.
- Insulin prevents onset and corrects defective collagen production
What are the mechanisms of bone destruction?
- Inc RANKL/OBP (activation of osteoclasts)
- Inc AGE’s
- Inc ROS (reactive oxygen species)
- Inc cytokines
What is AGE RAGE?
RAGE is receptor sitting on different cell types. AGE is present in pts with diabetes. AGE and RAGE interact and trigger inflammation
How does menstruation impact periodontium?
- Inc prevalence of gingivitis
- Bleeding gums or bloated/tense feeling in gums in days preceding menstrual flow
- Inc salivary bacteria
How does pregnancy impact periodontium?
- If no plaque, no notable changes present
- Inc tooth mobility, pocket depth, GCF
How long does it take for gums to revert back to pre-pregnancy state?
21 months
What is the clinical presentation of pregnancy gingivitis?
- Pronounced ease of bleeding
- Edematous, pitting, smooth, shiny gingiva
- Extreme redness
- Painless unless complicated by acute infection
Why is there redness during pregnancy?
- P. intermedia
- Depressed T cell response alters tissue response to plaque
- Elevations in systemic levels of hormones.
- Gingival mast cells
What is pregnancy granuloma (angiogranuloma)?
- Semi-firm, painless, mushroom like mass protruding from IP space/gingival margin
- Can become painful if debris accumulate or interfered with occlusion
- Often appears after 3rd month of pregnancy
- Doesn’t invade underlying bone
What is menopausal gingivostomatitis?
- Uncommon
- Gingiva and oral mucosa are dry, shine, vary in colour
- Occurs during or after menopause
How do quantitative vs functional PMN deficiencies affect periodontium?
- Quantitative: generalised periodontal destruction
- Functional: localised destruction
What is chronic neutropenia?
Low neutrophil count for greater than 6 months
What are symptoms of cyclic neutropenia?
- Periodic recurring symptoms of fever, malaise, mucosal ulcers, infections
- Usually before age 10
- Generalised severe periodontitis
What is leukaemia characterised by?
- Diffuse replacement of bone marrow with proliferating leukemic cells
- Abnormal numbers and forms of immature WBC
- Widespread infiltrates in liver, spleen, lymph nodes
How is leukaemia classified?
- Lymphocytic or myelogenous
- Acute, subacute or chronic
What are the oral/periodontal manifestations of leukemic patients?
- Leukemic infiltration
- Bleeding (thrombocytopenia)
- Oral ulcers
- Infections
- Gingival enlargements (not in edentulous pts)
How does gingiva appear in leukemic patients?
- Bluish, red and cyanotic
- Rounding and tenseness of gingival margin
- Inc size of interdental papilla
- Ulcerated, necrosed marginal gingiva with pseudo membrane formation
What are microscopic features of leukemic patients?
- Dense infiltrate of immature leukocystes
- Mitotic figures
- Connective tissue components displaced by leukemic cells
- Blood vessels distended (dec RBC)
What should you do if you suspect leukaemia in patient?
Often better to refer than do biopsy
What is Papillon-Lefevre Syndrome?
- Rare genetic disease
- Diffuse palmar plantar keratosis + Severe periodontitis in primary and secondary dentition
- Appear together 2-4 years old
- Assoc w/ premature exfoliation
How do vit A, B and C deficiency disturb periodontium?
Reduce resistance of tissues to irritation and infection
How does vit K deficiency disturb periodontium?
Affects permeability of blood vessels or blood clotting mechanism
