Endocrine influence on periodontium

Dr. Guru Ram (P.G)

Dept of Periodontics

IntroductionEndocrine 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 body

Sex accessory tissues

Important for

glucose, protein and

lipid metabolism

Low potency of

secreted hormones

diminishes effects

on target tissues

Excess cortisol associated with

destructive periodontal diseases

Known 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 proposed

L- 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.

By

Potential 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 hormone

Effect of thyroid hormone on periodontium:

Parathyroid gland hormone

Hormones- parathormone

Ca- Regulation

The resorption of calcium from bones by PTH is by

Rapid phase

Slow phase

Rapid phase

After 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

periodontiumPrimary 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 proliferation

Decrease IL-6 production

Progesterone Decrease proliferation

Decrease protein synthesis

Decrease cytokine production

Estradiol Increase proliferation

Increase cytokine production

Increase 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 supplements

These 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

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references…