Role of Systemic Diseases in the Etiology of Periodontal Diseases

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.