013.Systemic Diseases in the Etiology of PDD

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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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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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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Dr Jaffar Raza

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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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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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

013.Systemic Diseases in the Etiology of PDD

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