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Role of Systemic Diseases in the Etiology of Periodontal Diseases. By Hani S. AlMoharib. Outline. Endocrine Disorders: - Diabets Mellitus. Hematologic Disorders: - Anemia. - Leukemia. Genetic Disorders: - Down Syndrome. - Papillon-Lefevre Syndrome. Hormonal Changes: - PowerPoint PPT Presentation
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Role of Systemic Diseases in the Etiology of Periodontal Diseases
ByHani S. AlMoharib
Outline• Endocrine Disorders:
- Diabets Mellitus.• Hematologic Disorders:
- Anemia.- Leukemia.
• Genetic Disorders:- Down Syndrome. - Papillon-Lefevre Syndrome.
• Hormonal Changes:- Female Sex Hormones.
Introduction• Many systemic diseases, disorders, and conditions have
been implicated as risk factors in periodontal disease.
• Systemic diseases have several effects that includes:1. Physiological response.2. Vascular system.3. Inflammatory response.4. Immune system.5. Tissue repair.
Outline• Endocrine Disorders and Hormonal Changes:
- Diabets Mellitus.• Hematologic Disorders:
- Anemia.- Leukemia.
• Genetic Disorders:- Down Syndrome. - Papillon-Lefevre Syndrome.
• Hormonal Changes:- Female Sex Hormones.
Diabetes Mellitus
What is Diabetes Mellitus?
Diabetes Mellitus• It is a complex metabolic disorder characterized by
chronic hyperglycemia.
• DM may either diminish insulin production, impair insulin action, or combination of both.
• This result in inability of glucose to be transported from blood stream into tissues.
What are the types of DM?
Diabetes Mellitus1. Insulin-dependent DM (IDDM-Type I):• Caused by cell-mediated autoimmune destruction of
the insulin-producing beta cells of the islets of Langerhans in the pancreas.
• This results in a lack of insulin production.• Age?• Occurs in children and young adults.• Precentage?• 5-10% of DM cases.
Diabetes Mellitus2. Non-insulin-dependent DM (NIDDM-Type II):• Caused by:a. Peripheral resistance to insulin action.b. Impaired insulin secretion.c. Increased glucose production by liver. • Usually has an adult onset.• 90-95% of DM cases.
What are the symptoms of DM?
Diabetes Mellitus• Typical signs and symptoms include:1. Polydipsia.2. Polyphagia.3. Polyuria.4. Pruritus.5. Weakness and fatigue.
What are the complications of uncontrolled DM?
Diabetes Mellitus• Uncontrolled DM complications includes:1. Microvascular diseases: Retinopathy, nephropathy, or
neuropathy.2. Macrovascular diseases: Cardiovascular or
cerebrovascular.3. Increased susceptibility to infections.4. Poor wound healing.
What are the Oral manifestations of DM?
Diabetes Mellitus• Oral changes in diabetic patient includes:1. Cheilosis.2. Mucosal drying and cracking.3. Burning mouth and tongue.4. Diminshed salivary flow.5. Alterations in the flora of the oral cavity.6. Increased rate of dental caries.• These changes are less likely to be observed in well-
controlled diabetic patients.
What are the manifestations of DM on periodontium?
Diabetes Mellitus• Changes of DM on periodontium includes:1. Tendency toward enlarged gingiva.
Diabetes Mellitus• Changes of DM on periodontium includes:2. Sessile or pedunculated gingival polyps.3. Polypoid gingival proliferations.4. Abscess formation.
Diabetes Mellitus• Changes of DM on periodontium includes:5. Periodontitis.
How does DM effects the periodontium?
Diabetes MellitusA. Bacterial Pathogens:• Glucose content of gingival fluid is higher in diabetic
patient.• This increase change the environment of the microflora.• This induce qualitative changes in bacteria and severity
of disease.
Diabetes MellitusB. Polymorphonuclear Leukocyte Function:• DM results in:i. Impaired chemotaxis.ii. Defective phagocytosis.iii. Impaired adherence.• This leads to increased susceptibility to infections.
Diabetes MellitusC. Altered Collagen Metabolism:• Chronic hyperglycemia adversely affects the synthesis,
maturation, and maintenance of collagen and extracellular matrix.
• As a result, collagen in the tissues of DM patients are more susceptible to pathogenic breakdown.
• This also will affect vascularity, in such:
Thickening of the capillary
basement membrane.
Impair oxygen
diffusion
Impair waste
elimination
Impair PMN migration
Impair diffusion of antibodies
Outline• Endocrine Disorders and Hormonal Changes:
- Diabets Mellitus.• Hematologic Disorders:
- Anemia.- Leukemia.
• Genetic Disorders:- Down Syndrome. - Papillon-Lefevre Syndrome.
• Hormonal Changes:- Female Sex Hormones.
Anemia
What is Anemia?
Anemia• Anemia is reduction in the number of erythrocytes and in
the amount of hemoglobin.• Anemia results in poor tissue oxygenation, making tissues
more friable and susceptible to breakdown.• Anemia results from:1. Extensive blood loss.2. Defective blood formation.3. Increased RBC destruction.
What are the oral manifestations of Anemia?
Anemia• The tongue appears red, smooth, and shiny because of
atrophy of the papillae.• There is also marked pallor of the gingiva.
Leukemia
What is Leukemia?
Leukemia• Leukemias are malignant neoplasias of WBC precursors.• Leukemia is characterized by:1. Diffuse replacement of the bone marrow with
proliferating leukemic cells.2. Abnormal numbers and forms of immature WBCs in the
circulating blood.3. Widespread infiltrates in the liver, spleen, lymph nodes,
and other body sites.• This leads to anemia, leukopenia and
thrombocytopenia.
What are the effects of Leukemia on periodontium?
Leukemia1. Leukemic gingival enlargement:• Caused by infiltration of gingiva by leukemic cells.
Do we have Leukemic Gingival Enlargement on edentulous patients?
Infiltration of gingival
corium by leukemic cells
Increases gingival
thickness
Creates gingival pockets
Bacterial plaque
accumulates and
secondary inflammation
Enlargement of gingiva
Leukemia2. Bleeding:• Spontaneous gingival hemorrhage can be an early sign
of leukemia.• It is caused by the thrombocytopenia.
Leukemia3. Oral Infection:• Granulocytopenia (diminished WBC count) results from
the displacement of normal bone marrow cells by leukemic cells.
• This increases the host susceptibility to opportunistic microorganisms and leads to ulcerations and infections.
Leukemia3. Oral Infection:
Leukemia4. Oral Ulceration:• These lesions occur in sites of trauma such as the buccal
mucosa in relation to the line of occlusion or on the palate.
Outline• Endocrine Disorders and Hormonal Changes:
- Diabets Mellitus.• Hematologic Disorders:
- Anemia.- Leukemia.
• Genetic Disorders:- Down Syndrome. - Papillon-Lefevre Syndrome.
• Hormonal Changes:- Female Sex Hormones.
Down Syndrome
What is Down Syndrome?
Down Syndrome• Down syndrome is a congenital disease caused by a
chromosomal abnormality.
• Characterized by mental deficiency and growth retardation.
• Almost 100% of patients have periodontal diseases.
What is the effect of Down Syndrome on periodontium?
Down Syndrome• Periodontal condition characterized by deep pockets
with substantial local factors and moderate recessions.
• The disease progresses rapidly because of:1. Poor PMN chemotaxis.2. Deficient phagocytosis.3. Intercellular killing.
Down Syndrome
Papillon-Lefevre Syndrome
What is Papillon-Lefevre Syndrome?
Papillon-Lefevre Syndrome• Very rare inherited condition that appears to follow an
autosomal recessive pattern.• The syndrome is characterized by:1. Hyperkeratotic skin lesions.2. Severe destruction of the periodontium.3. Calcification of the dura.
Papillon-Lefevre Syndrome• The cutaneous and periodontal changes usually appear
together between the ages of 2 and 4 years. • The skin lesions consist of hyperkeratosis and ichthyosis
of localized areas on palms, soles, knees, and elbows.
What is the effect of Papillon-Lefevre Syndrome on periodontium?
Papillon-Lefevre Syndrome• Periodontal involvement consists of early inflammatory
changes that lead to bone loss and exfoliation of teeth.• Primary teeth are lost by 5 or 6 years of age.• The permanent dentition then erupts normally, but
within a few years, the permanent teeth are also lost because of destructive periodontal disease.
• At a very early age, usually 15 to 20 years, patients are often edentulous except for the third molars.
• These may be lost as well a few years after eruption.
Papillon-Lefevre Syndrome
Outline• Endocrine Disorders and Hormonal Changes:
- Diabets Mellitus.• Hematologic Disorders:
- Anemia.- Leukemia.
• Genetic Disorders:- Down Syndrome. - Papillon-Lefevre Syndrome.
• Hormonal Changes:- Female Sex Hormones.
Female Sex Hormones
What conditions are associated with altered hormones in female patients?
Female Sex Hormones1. Puberty:• Puberty is often accompanied by an exaggerated
response of the gingiva to plaque.• Pronounced inflammation, edema, and gingival
enlargement result from slight local factors.• As adulthood approaches, the severity of the gingival
reaction diminishes, even when local factors persist.
Female Sex Hormones2. Pregnancy:• The hormonal changes of pregnancy accentuate the
gingival response to plaque.• Extreme redness results from marked vascularity, and
there is an increased tendency to bleed.• Increased levels of progesterone produce dilation of the
gingival microvasculature and increased susceptibility to mechanical irritation.
Female Sex Hormones2. Pregnancy:• The marginal and interdental gingivae are edematous,
smooth and shiny, are soft and pliable, and sometimes present a raspberry-like appearance.
• In some cases the inflamed gingiva forms discrete “tumorlike” masses, referred to as pregnancy tumors.
Thank You
Hani S. AlMoharib
References:1- Carranza’s Clinical Periodontology 11th Ed. Pages 304-319.2- Clinical Periodontology and Implant Dentistry 5th Ed by Jan Lindhe Pages 307-327.