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8/17/2019 013.Systemic Diseases in the Etiology of PDD
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Dr Jaffar Raza Page 1
Systemic Diseases in the etiology of PDD
primary etiological agent in periodontal disease is bacterial plaque.
systemic factors that can alter the response of the tissue to plaque.
certain systemic disorders can have a direct effect on the periodontal tissues
and these represent the periodontal manifestations of systemic diseases.
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DIETARY AND NUTRITIONAL ASPECTS OF PERIODONTAL DISEASE
The Consistency of Diet
Firm and fibrous diet beneficial
Softer diet greater deposits and increase in plaque
A coarse diet, requires vigorous mastication
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Dr Jaffar Raza Page 3
Protein Deficiency and Periodontal Disease
The integrity of the periodontal ligament is also dependent upon proteins
Deprivation of protien marked degeneration of periodontal support
Vitamins and Periodontal Disease
Vitamin C
Its deficiency in humans results in scurvy, a disease characterized byhemorrhagic susceptability and retardation of wound healing.
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Periodontal Features of Scurvy
chronic gingivitis which can involve the free gingiva, attached gingiva and
alveolar mucosa
gingiva becomes brilliant-red, tender and swollen
The spongy tissues are extremely hyperemic and bleed spontaneously.
the tissues attain a dark blue or purple hue.
Alveolar bone resorption with increased tooth mobility.
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Vitamin D Deficiency
Vitamin D is essential for the absorption of calcium from the gastrointestinaltract and the maintenance of calciumphosphorus balance.
Radiographically, there is a generalized partial to complete disappearance of
the lamina dura
Reduced density of supporting bone.
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Vitamin E
vitamin E acts as a antioxidant
plays an important role in maintaining the stability of cell membranes
protecting blood cells against hemolysis.
interfere with the production of prostaglandins.
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Vitamin A
It is essential for growth, differentiation and maintenance of epithelial tissues
For bone growth and embryonic development.
Vitamin B-Complex
Oral changes common to—Vitamin B-complex deficiencies are
gingivitis,
glossitis,
glossodynia,
angular cheilitis
inflammation of the entire oral mucosa
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EFFECTS OF HEMATOLOGICAL DISORDERS ON PERIODONTIUM
Disorders of the blood and blood forming tissues can have a profound effect
on the periodontal tissues and their response to bacterial plaque.
There can be a defect in the vascular constriction, platelet adhesion and
aggregation, coagulation and fibrinolysis
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Dr Jaffar Raza Page 10
White Blood Cell Disorders
The WBC’s disorders that affect the periodontium can be categorized as eithera disorder of numbers or defect in function.
Neutropenias
a. Cyclic neutropenia.
b. Chronic benign neutropenia of childhood.
c. Benign familial neutropenia.
d. Severe familial neutropenia.
e. Chronic idiopathic neutropenia.
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Treatment:
Plaque control,
supportive measures like antiseptic mouth wash,
antimicrobial therapy
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Leukemia
malignant disease caused bthose in bone marrow.
Acute leukemia is more fre
Chronic leukemia’s occur in
Periodontal Manifestation
1..gingival enlargement,
2..gingival bleeding
3..periodontal infections.
proliferation of WBC forming tissu
uent in people under 20 years of ag
people over 40 years of age.
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, especially
.
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a. Gingival enlargement is due to a massive leukemic cell infiltration into the
gingival connective tissue.
The enlarged gingiva will hinder mechanical plaque removal
b. Gingival bleeding is a common oral manifestation of acute leukemia.
The bleeding is secondary to thrombocytopenia that accompanies leukemia.
c. Infections of the periodontal tissues secondary to leukemia can be of two
types,
1.. exacerbation of an existing periodontal disease
2.. increased susceptibility of the periodontium to fungal, viral or bacterial
infections.
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Dr Jaffar Raza Page 15
Treatment Plan for Leukemic Patients
1. Referral for medical evaluation and treatment.
2. Prior to chemotherapy, a complete periodontal plan should be developed.
a. Monitor hematologic laboratory values.
b. Administer suitable antibiotics before any periodontal treatment.c. scaling and root planing + 0.12 percent chlorhexidine gluconate
3. During the acute phases of leukemia:
a. Cleanse the area with 3% (H2O2) or 0.12% chlorhexidine.
b. remove any etiologic local factors.
c. Re-cleanse the area with 3 percent H2O2.
d. Place a cotton pellet soaked in thrombin against the bleeding point.
e. Cover with gauze and apply pressure for 15 to 20 minutes.
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f. Acute gingival or periodontal abscesses are treated by systemic antibiotics,
gentle incision and drainage or by treating with 3% H2O2/0.12% chlorhexidine
g. Oral ulcerations should be treated with antibiotics and bland mouth rinses.
4. In patients with chronic leukemia, scaling and root planing can be performed
but periodontal surgery should be avoided.
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Treatment
1. Physician referral for a definitive diagnosis.2. Oral hygiene instructions.
3. Prophylactic treatment of potential abscesses.
4. No surgical procedures are indicated unless platelet count is at least 80,000
cells/mm3.
5. Scaling and root planning.
Disorders of WBC Function
Chédiak-Higashi Syndrome
Lazy Leukocyte Syndrome
Chronic Granulomatous Disease
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METABOLIC AND ENDOCRINE DISORDERS
Diabetes Mellitus and Periodontal Disease
diabetic patient is more susceptible to periodontal breakdown, which is
characterized by
extensive bone loss,
increased tooth mobility,
widening of periodontal ligament space,
suppuration and abscess formation.
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Pathogenesis
1. Vascular changes:
thickening and hyalinization of vascular walls.
swelling and occasional proliferation of the endothelial cells
changes in the capillary basement membrane may have an inhibitory effect on
the transport of oxygen, white blood cells, immune factors and waste products
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2. PMNL’s function
Reduced Phagocytosis
Reduced intracellular killing
Reduced adherence
Impaired chemotaxis
3. crevicular fluid:
Alterations in the constituents and flow rate of crevicular fluid is noted
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Treatment
a. Periodontal treatment in patient with uncontrolled diabetes iscontraindicated.
b. If suspected to be a diabetic, following procedures should be performed:
1. Consult the patient’s physician.
2. Analyze laboratory tests, FBS, RBS and GTT
3. prophylactic antibiotics should be given.
4. Glucose levels should be continuously monitored and periodontal treatment
should be performed when the disease is in a wellcontrolled state.
5.Prophylactic antibiotics should be started 2 days preoperatively
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Thyroid Gland
Hypothyroidism leads to cretinism in children and myxedema in adults.
There are no notable periodontalchanges.
Treatment
1. Patients with thyrotoxicosis should not receive periodontal therapy until the
condition is stabilized.
2. Medications such as epinephrine, atropine should be given with caution.
3. caution with administration of sedatives and narcotics because of their
diminished ability to tolerate drugs.
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Pituitary Gland
Hyperpituitarism causes enlarged lips
localized areas of hyperpigmentation.
It is also associated with food impaction
hypercementosis is seen.
Hypopituitarism leads to crowding and malposition of teeth.
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Parathyroid Glands
Parathyroid hypersecretion produces generalized demineralization of theskeleton.
Oral changes include malocclusion and tooth mobility,
radiographically alveolar osteoporosis, widening of the periodontal spaceand absence of lamina dura.
Treatment:
Routine periodontal therapy must be instituted but the dental practitioner
must be attuned to the oral and dental changes.
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Dr Jaffar Raza
Sex Harmones
There are several types of ghormones is considered to
Gingivitis in Puberty
Pronounced inflammation,
bluish-red discoloration,
edema
enlarged gingiva may be se
ingival diseases in which modificatioe either an initiating or complicatin
n
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n of the sexfactor.
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Gingival Changes Associated with Menstrual Cycle
There is increased prevalence of gingivitis,
bleeding gingiva.
inreased Exudation from inflamed gingiva
crevicular fluid flow is not affected.
The salivary bacterialcount is increased.
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Menopausal Gingivostomatitis
Clinical manifestations include
dry, shiny oral mucosa,
dry burning sensation of oral mucosa,
abnormal taste sensation
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Dr Jaffar Raza
Gingival Diseases in Pregna
Clinical Features
1. Pronounced bleeding.
2. Gingiva is bright-red to bl
3. Marginal and interdental
sometime presents raspber
4. depression of maternal T
6. Increased crevicular fluid
ncy
uish-red.
gingiva is edematous, pits on press
ry-like appearance.
-lymphocyte response.
flow, pocket depth and mobility ar
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re and
also seen.
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Dr Jaffar Raza
Treatment:
Elimination of all local irrita
Treatment of tumor-like gi
scaling and planing of tooth
In pregnancy emphasis sho
• Preventing gingival diseas
• Treating existing gingival
nts by scaling and root planing.
gival enlargements consists of surgi
surfaces.
ld be on:
e before it occurs.
isease before it becomes worse.
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al excision,
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CARDIOVASCULAR DISEASES
Arteriosclerosis
In aged individuals, arteriosclerotic changes in the blood vessels are
characterized by,
initial thickening,
narrowing of lumen,
thickening & hyalinization of media and adventitia
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Congenital Heart Disease
oral changes includes
purplish-red discoloration of the lips and gingiva
sometimes severe marginal gingivitis
periodontal destruction.
The tongue appears coated, fissured and edematous
extreme reddening of the fungiform and filliform papillae
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Dr Jaffar Raza Page 33
HIV gingivitis:
In HIV gingivitis persistent, linear, easily bleeding, erythematous gingivitis.
lesions may be localized or generalized in nature.
HIV periodontitis: NUP (Necrotizing ulcerative periodontitis)
characterized by soft tissue necrosis
rapid periodontal destruction, marked interproximal bone loss.
severely painful at onset.
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Treatment:
a. Instruct the patient to perform meticulous oral hygiene.
b. Scale and polish affected areas.
c. Prescribe chlorhexidine gluconate mouth rinse.
d. Reevaluation and frequent recall visits.
e. Systemic antibiotics.
f.prophylactic antifungal medication should be considered.
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Lead Intoxication
increased salivation,
coated-tongue,
peculiar sweetish taste,
gingival pigmentation and ulceration.
steel gray dicoloration, associated with local irritation.
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Mercury Intoxication
ulceration of the gingiva
destruction of underlying bone
Other Chemicals may cause necrosis of the alveolar bone with loosening and
exfoliation of teeth
Phosphorus
arsenic
chromium
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