Endocrine influence on periodontium

Endocrine influence on periodontium

Dr. Guru Ram (P.G)

Dept of Periodontics

Introduction Endocrine system

Central endocrine glands

Hypothalamus

Pituitary gland

Hypothalamus

Homeostasis

Regulation

Hormones

Pituitary gland

Regulation

Hormones

Source Hormone Target tissue Principle function Periodontium

Hypothalamus Prolactin inhibiting hormone(dopamine)

Anterior pituitary gland Inhibits prolactin release

Stimulates periodontal ligament cell proliferation

Anterior pituitary

Growth hormone (somatotropin)

Bone, soft tissues and liver

Promotes growth, affects lipids and carbohydrate metabolism

Presence of growth hormone associated with protective effect on periodontium

Thyroid Thyroid hormones (tri iodothyrosine, thyroxine)

Most cells of body Regulators of numerous tissues including cardiac and brain involved with growth and metabolism

Deficiency may be associated with destructive periodontal diseases

Adrenal Cortisol,Weak androgens and estrogens

Most tissues of bodySex accessory tissues

Important for glucose, protein and lipid metabolismLow potency of secreted hormones diminishes effects on target tissues

Excess cortisol associated with destructive periodontal diseasesKnown effects on periodontal tissues including growth as well as disease progression

Pancreas Insulin (β cells) Skeletal muscle, liver, adipose tissue

Lowers the blood glucose, fatty acid and amino acid levels

Decreased insulin production associated with destructive periodontal diseases

Parathyroid Parathyroid hormone Bone, kidneys, intestine

Increases plasma calcium

Decreased cortical bone density and increased PDL width no effect on periodontal parameters

Effects of central endocrine gland hormones on the periodontium

Britto et al 2011- LIMITED EVIDENCE

M. Partovi et al in 2002

Mechanism proposedL- DOPA

Stimulates

Dopaminergic systems in the anterior position of hypophysis

To release

Growth hormone

 Promoter of healing process

Peripheral Endocrine glands

Peripheral endocrine glands

ADRENAL GLAND

THYROID GLAND

PARATHYROID GLAND

GONADS

PANCREAS

Peripheral endocrine glands

Adrenal gland hormones

The hormones produced by the adrenal cortex include mineralo-

carticoid hormones e. g., Aldosterone, Glucocorticoid, hormones e.

g., cortisol, gonodal hormones e. g., dehydro-epi-androsterone

Effects of adrenal gland hormones on the periodontium

Association between elevated cortisol levels and periodontitis were demonstrated by clinical studies by Rosania et al and Rai et al in 2009 and 2011.

ByPotential psycho-neuro-immunologic mechanism

Potential behavioural mechanism

Potential psycho-neuro-immunologic mechanism

Negative emotion

Polypeptides from sympathetic nor adrenaline transmitting and sensory nerve fibres and from endocrine glands

+

Bacterial antigens trigger immune responses

Hypothalamus release corticotropic hormone

Adreno-carticotropic hormone from pituitary

Adrenal cortex release

Cortisol

Short term elevations of cortisol reduce inflammation and mobilize immune components

Glucocorticoids(cortisol)

Decreases immunocompetency by inhibition of IgA, IgG and neutrophil function.

Potential behavioural mechanism

The higher cortisol and β endorphin concentrations significantly up regulates expression of MMP-1,2,7,11 and TIMP-1 in human

gingival fibroblasts

Increased periodontal breakdown

Periodontitis

Patricia et al 2007

• Various kinds of psychologic stress activate HPA(hypothalamus

Pituitary Aderno cortical) system and SM(sympathetic aderno

medullary) system and consequently induce significant increases in

salivary cortisol and catecholamine levels respectively

• Chromagranin A released by exocytosis from the sympathetic nerve

endings

Thyroid hormoneEffect of thyroid hormone on periodontium:

Parathyroid gland hormoneHormones- parathormone

Ca- Regulation

The resorption of calcium from bones by PTH is by

Rapid phase

Slow phase

Rapid phaseAfter reaching bone

PTH gets activated to receptors on cell membrane of osteoblasts and osteoclasts

Hormone receptor complex

Increases permeability of membranes of these cells for ca-ions

Accelerates ca-pump mechanism

Ca-ions move to bone cells into blood at faster rate

Slow phaseWhen Osteoclasts are activated by PTH

Lysosomes release enzymes and citric acid and lactic acid

These substances dissolve organic matrix of bone releasing ca ions

Ca ions release to plasma

Effect of parathyroid gland hormone on periodontium

Primary hyperthyroidism

Secondary hyperthyroidism

Suggested as therapeutic aid

Lindhe et al

Sex steroid hormones

Action of sex steroid hormones on periodontium

Sex steroid hormones

Microbiota immune cells

Cells of the periodontium

Altered gene expression

Changes in clinical phenotype

Proposed mechanisms

Sex steroid induced increase in specific microbiota

kumare et al in 2013

Immune endocrine interactions exaggerate periodontal

responses

Shiau, Reynolds in 2010

Specific populations of fibroblasts and epithelial cells are

modulated by sex steroid hormones:

Mariotti. In 1994

Sex steroid hormones and the cells of periodontium

Hormone Fibroblasts Androgens

(testosterone & hydrotestosterone)

Decrease proliferationDecrease IL-6 production

Progesterone Decrease proliferationDecrease protein synthesisDecrease cytokine production

Estradiol Increase proliferationIncrease cytokine productionIncrease growth factor

Factors influencing sex hormones on periodontium

Gender

Age

Hormone supplements

Gender

Studies by Lau et al 2001 showed that gender plays an

important role in changes associated with bone density

throughout the entire skeleton.

It was showed that 80% of decreased bone density patients

were females.( 80% osteoporotic patients were females)

Regarding periodontal anatomic differences:

Residual ridge height was lower in women compared

to men + decreased amount of estrogen in post menopausal

women was associated with decreased crestal/subcrestal bone

density

Age

With regard to age, females undergo more biologic changes

(hormonal imbalances) compared to males such as during

puberty, menstrual cycle, pregnancy, menopause

Hormone supplementsThese are common used drugs that stimulates a state of pregnancy to prevent ovulation.

HRT has helped in overcoming bone loss in menopausal women, it also has been associated with side effects like thromboembolism, irregular bleeding, fear of cancer,.

Longitudinal studies have examined the transformation of

subgingival flora from pre puberty to puberty and have

demonstrated a significant increase in the frequency of

Eikenella corrodens,

Prevotella intermedia,

Bacteroides melaninogenicus ,

Prevotella nigrescens,

Etiology of gingival responses to elevated estrogen & progesterone

during pregnancy

Subgingival plaque composition

Maternal immuno-response.

Sex hormone concentration

Pancreatic hormones

Effect of pancreatic hormones on periodontium

The metabolic disturbances and the resulting disease sequallae of diabetes mellitus are ultimately the result of a complete or partial reduction in insulin secretion from the β cells

Oral manifestations

Oral changes described in diabetic patients including

Cheilosis

Mucosal drying

Cracking

Burning mouth and tongue

Diminished salivary flow

Altered oral cavity flora

Complications of diabetes mellitus

Mechanisms of diabetic influence on periodontium

These are primarily related to changes in

GCF glucose level

Periodontal vasculature

Collagen metabolism.

The subgingival microbiota

CONCLUSION

References Newmann, Takei, Klokkevold, Fermin A Carranza: Carranza’s clinical Periodontology: 10th Ed: Saunders, Elsevier

Britto IM et al , JCP 2011 :38:525-531

Partovi et al. Mitogenic effect of L dopa on human periodontal ligament fibroblast cells: Jour of Endodontics. Vol 28(3): 193-196

Eriksen. Cellular mechanism of bone remodelling: Rev Endocr. Metab Disord 2010: 11: 219-227

Amy Romania et al: stress, depression, cortisol and periodontal disease. J periodontol 2009: 80: 260-266

Depression: Psychiatric clinics of North America. March 2012: 35: 1

references…Glassman et al: where there is depression there is inflammation. Biol Psychiatry 2007: 62: 280

Kaufman et al: Analysis of saliva for periodontal diagnosis- A review: JCP 2000: 27: 453-465

Johanssen et a: Dental plaque, gingival inflammation and elevated levels of IL-6 and cortisol in GCF from women with stress related depression and excusion: J Periodontol 2006:77: 1403

Balwanth Rai et al: salivary stress markers, stress and periodontitis: A pilot study . J Periodontol 2011: 82: 287-292

Patricia R Cury et al: hydrocortisone affects the expression of MMP-1,2,3,7,11 and tissue inhibitor of matrix metalloproteinases TIMP-1 in human gingival fibroblasts: J Periodontol 2007: 78: 1309-1315

Peruzzo et al. Systemic review of stress and psychological factors as possible risk factors for periodontal disease. J Periodontol 2007: 78: 1491-1504

references…Persson RE, Hollender et al. assessment of periodontal conditions and systemic disease in older subjects. Focus on osteoporosis: J Clin Periodontol 2002: 29: 796-802

Frankenthal S et al: the effect of the secondary hyperthyroidism and hemodialysis therapy on alveolar bone and periodontium: J Clin Periodontol 2002: 29: 479-483

Barros et al: parathyroid hormone protects against periodontitis associated bone loss: J Dent Res 2003: 83: 791

Marriotti A: Sex steroid hormones and cell dynamics in the periodontium. Crit Rev Oral Biol Med 1994:5:27-53

Liang et al: effect of estrogen receptor β on osteoblasticdifferentiation function of human periodontal ligament cells: Arch Oral Biol 2008: 53: 553-557

Tang et al: Up regulation of estrogen receptor β expression during osteogenic differentiation of human periodontal ligament cells. J Periodontol Res ;2008: 43: 311-321

Lindhe et al : influence of sex hormones on gingival exudation in dogs with chronic gingivitis: J Periodontol Res: 3 :279-283

Kumare et al: sex and the subgingival microbiome: do female sex steroids effect periodontol bacteria Perio 2000: 2013: 103

Shiau, Reynolds: sex differences in destructive periodontal disease: exploring the biologic basis. J Periodontol 2010: 81: 1505-1517

Mariotti. Sex steroid hormones and cell dynamics in the periodontium: Crit Rev Oral Biol Med 1994: 5: 27-53

Mariotti AJ. Estrogen and extracellular matrix influence human gingival fibroblast proliferation and protein production. J Periodontol 2005: 76: 1391-1397

Lapp CA, Thomas et al. Modulation by progesterone of Interleukin-6 production by gingival fibroblasts. J Periodontol 1995: 66: 279-284

Loe H: Periodontal disease: the sixth complication of diabetes mellitus: Diabetes Care: 1993: 16: 329

references…