INFLUENCE OF SYSTEMIC CONDITIONS ON PERIODONTIUM

INTRODUCTION Systemic diseases,disorders&conditions Altered host tissue&physiology Impair the host’s barrier function&immunity Creating opportunity –periodontal destruction

ENDOCRINE DISORDERS&HARMONAL CHANGES DIABETES MELLITUS: -Complex metabolic disorders-ch. Hyperglycem -6th complication-Periodontitis -Type I (IDDM) -TypeII(NIDDM) -Gestational diabetes

DIABETES MELLITUS Contd… ORAL MANIFESTATION -Cheilosis -Mucosal drying -Cracking -Burning mouth&Tounge -Decrease salivary flow -Greater predominance of Candida albicance

DIABETES MELLITUS Contd… PERIODONTIUM -Tendency towards enlarge gingiva -Sessile/Pedunculated gingival polyps -Abscess formation/Rapid bone loss -Mobile teeth -Function of PMNs/Monocyte/Macrophages impaired -Decrease collagen synthesis&Alv bone height ->>AGEs(accumulated glycation end-products)

FEMALE SEX HORMONES PUBERTY -Pronounced Inflammation -Edema -Gingival Enlargement MENSTRUATION -Bleeding gums -Tense feeling of gums

FEMALE SEX HORMONES Contd… PREGNANCY -Gingivitis due to Bacterial plaque -Greater senstivity-2nd&3rd trimester -Raspberry gingiva -Pregnancy tumor -P.intermedia increase HORMOANAL CONTRACEPTIVES -Increase gingival response to local factors ->>1.5ys – incresaes periodontal destruction

FEMALE SEX HORMONES Contd… MENOPAUSE -Gingiva&oral mucosa-shiny,dry,paleness to redness&bleed easily -Burning sensation -Excess senstivity to thermal changes -Abnormal taste sensation -Ch. Desquamative gingivitis

HYPERPARTHYROIDISM -Generalized demineralization of the skeleton -Increased osteoclast -Formation of bone cyst&giant cell tumor -Loss of lamina dura ORAL CHANGES -Malocclusion -Tooth mobility -Widening of Pdl -Brown Tumors (bone cyst+fibrous tissuse+hemosiderin-laden macrophages&giant cells)

HEMATOLOGIC DISORDERS NEUTROPENIA -Decrease levels of circulating neutrophils -<500µl severe –life threting AGRANULOCYTOSIS -Ulcerative necrotising lesion-oral/skin/GIT/UTI -Fever,malaise,weakness&sore throat -Gingival haemorrage -Fetid odor

HEMATOLOGIC DISORDERS Contd… LEUKEMIA ORAL MANIFESTAION: -Gingival enlargement -Bleeding gingiva -Oral ulceration -Petechiae&Ecchymosis -Infection

HEMATOLOGIC DISORDERS Contd.. ANEMIA -Glossitis(painful&burning lingual sensatiion) -Craked/fissure at the corner of mouth -pallor skin -Dysphagia -Koilonychia THROMBOCYTOPENIA -Focal hemorrhages-various tissues&organs -Petechiae/echymosis

GENETIC DISORDERS DOWN SYNDROME -Trisomy of 21,mangolism -Growth retardation -Mental deficiency -Increase prevalence of periodontal diseases -Deep periodontal pocket -Poor PMNs chemotaxis,phagocytosis

STRESS -ANUG(Trench mouth) -Desquamative lesions -Decreasse level of IL-1&MMP-9 -Influence outcomes of periodontal therapy -Grinding&clenching –teeth&periodontium

MEDICATIONS BISPHOSPHONATES -Cancer&osteoporesis -Inhibit osteoclasic activity -BRON -BION -Pathologic fracture CARTICOSTEROIDS -Osteoporesis of alv bone -Capillary dilatation -Hemorrhage Pdl&gingival CT -Reduction collagen fibers

MCQ-1 Which of the following ulteration can be observed in the Periodontium due to Chronic hyperglycemia (a)Gingival polyp (b)Gingival bleeding (c)Widening Periodontal ligament (d)Necrotic gingiva

MCQ-2 Which of the following is related with poorly controlled diabetic patients (a)Impaired functions of PMNs (b)Increase collagen synthesis (c)Normal AGEs formation (d)Impaired bone loss

MCQ-3 In which of the following condition Raspberry like gingiva can be seen (a)Puberty (b)Pregnancy (c)Menopause (d) Menstruation

MCQ-4 The following is a clinical picture of gingiva in leukemic patients (a)Gingival bleeding (b)Gingival necrosis (c)Gingival abscess (d)Gingival atrophy

MCQ-5 Radiographic widening of periodontal ligament space and loss of lamina dura are the important findings of (a)Diabetes mellitus (b)Hyperparathyroidism (c)Leukemia (d)Agranulocytosis