1. INFLUENCE OF SYSTEMIC CONDITIONS ON PERIODONTIUM

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

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

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

5. 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)

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

7. 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

8. 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

9. 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)

10. 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

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

12. 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

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

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

15. 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

16. 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

17. 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

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

19. 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

20. 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