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1.
2. Influence of Systemic Conditions
Department of periodontology
Prepared by: Dr.Mohammad Eissa Ahmadi
Supervised by:
associated professor Drs. Hassina shadab & associated professor Drs .Elaha Somia Ghafari
3. AGENDA
Influence of Systemic Conditions
Endocrine Disorders
and
Hormonal Changes
Stress and
psychosomatic
disorders
Influence of
Stress on periodontal therapy
outcome
Medication
01
03
05
07
Hematological disorder
And immune deficiencies
02
Genetic disorders
04
Nutrition influences
06
08
Other systemic
condition
4. 01
Type 1 & 2
02
03
04
05
Puberty
Metabolic syndrome
Diabetes Mellitus
Female Sex Hormones
Menstruation , pregnancy, menopause
hyperparathyroidism
Endocrine Disorders and Hormonal Changes
5. Diabetes
Diabetes Mellitus :
It is a complex metabolic disorder characterized by chronic
hyperglycemia
insulin-dependent
diabetes mellitus
poor wound healing
increased susceptibility
to infections
macrovascular
diseases
microvascular
diseases
STEP 1
STEP 2
STEP 3
STEP 4
STEP 5
high blood glucose levels and the
excretion of sugar in the urine.
Lipid and protein metabolism are
altered in diabetes as well.
retinopathy,
nephropathy,
Or neuropathy
cardiovascular and
cerebrovascular conditions
several long-term complications
5-10% of all cases of diabetes and most often
occurs in children and young adults
6. type 1 diabetes mellitus
Patients with present with the symptoms that
are traditionally associated with diabetes,
including:
polyphagia
very unstable and
difficult to control
polyuria, and
predisposition to
infections
ketosis and coma
polydipsia
it is not preceded by
obesity
7. type 2 diabetes mellitus
insulin-dependent diabetes mellitus
it is preceded by
obesity
G
gestational diabetes associated
with pregnancy
peripheral
resistance to
insulin action
Increased glucose
production in the liver
impaired
insulin
secretion
is caused
by:
90% to 95% of all diagnosed cases in adults
Ketosis and coma are
uncommon
8. Feature Type I diabetes Type II diabetes
Age of onset Generally <30 year In adulthood
Most common body type Thin or normal stature Obese
Most commonly affected race White African American, Hispanic
American and Pacific Islanders
Family history Common More common
Rapidity of clinical onset Abrupt Slow
Pathogenesis Autoimmune
β-cell
destruction
Insulin resistance, impaired insulin
secretion
Endogenous insulin production None Decreased, normal or elevated
Susceptibility to ketoacids High Low
Management Diet, exercise, insulin Diet, exercise, oral agents, insuline
10. The influence of diabetes on the periodontium
As fallowing :
enlarged gingiva
sessile or pedunculated
gingival polyps
loosened teeth
polypoid gingival proliferations
periodontitis
abscess
formation
11. Type I and Type II Diabetes American Diabetes Association classification of diabetes mellitus
includes:
1. Type I diabetes (formerly known as insulin-
dependent diabetes):
a. Immune mediated
b. Idiopathic.
2.Type II diabetes
3.Gestational diabetes
4. Other types of diabetes:
(formerly known as noninsulin dependent diabetes)
Genetic defects associated with β-cell function and
insulin action.
b. Pancreatic diseases or injuries.
c. Infections.
d. Drug-induced or chemical-induced diabetes.
e. Endocrinopathies, e.g. acromegaly,
hyperthyroidism.
f. Other genetic syndromes
12. Bacterial Pathogens:
GCF glucose of diabetic patient is more then non-diabetic
that is composed mainly of:
Capnocytophaga , anaerobic vibrios, Actinomyces species,
Porphyromonas gingivalis, Prevotella intermedia, and
Aggregatibacter actinomycetemcomitans
Aa , p.i, c.rectus ,p.m is more than others.
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qualitative changes in
bacteria
contribute to the severity of periodontal
disease observed in those with poorly
controlled diabetes
Patients with type 1 diabetes mellitus and periodontitis have been
reported to have a subgingival flora
13. Polymorphonuclear Leukocyte Function
The increased susceptibility of patients with diabetes to infection has
been hypothesized as being caused by
• polymorphonuclear leukocyte (PMN) deficiencies
• impaired chemotaxis
• defective phagocytosis,
• impaired adherence
No alteration of immunoglobulin A (IgA), G (IgG),or M (IgM) has
been found in patients with diabetes
14.
15. 04
03
02
Altered Collagen Metabolism
Chronic hyperglycemia
• impairs collagen structure and function
• adversely affects the synthesis, maturation, and maintenance of collagen
and extracellular matrix
Sample Headline
patients with poorly controlled diabetes + increase in AGEs
The formation of AGEs (advanced glycation end products)occurs
• at normal glucose levels as well
• in hyperglycemic environments, AGE formation is
excessive
impact the integrity of the periodontium
Decreased collagen synthesis, osteoporosis, and a reduction
in alveolar bone height have been demonstrated in diabetic
01
less resistant to destruction by periodontal infections
16. Cont.…
Renders the periodontal tissues more susceptible to destruction
response integrity metabolism
The cumulative effects of altered
cellular response to local factors
altered collagen
metabolism
Impaired tissue integrity
19. Hormonal Changes
Hormonal Contraceptives
Menopause
Pregnancy
Menstruation
Puberty STEP 1
STEP 2
STEP 3
STEP 4
STEP 5
Pronounced inflammation, edema, and gingival enlargement result from local factors that
might ordinarily elicit a comparatively mild gingival response
During the menstrual
period, the prevalence of
gingivitis increases
he accentuation of gingivitis during pregnancy occurs
has two peaks:
1. during the first trimester, when there is an
overproduction of gonadotropins,
2. during the third trimester, when estrogen and
progesterone levels are highest
when these drugs are taken for more than 1.5 years, there is an increase in periodontal
destruction
gingivitis is not a universal occurrence for all adolescents. With good oral hygiene, it can be prevented
Fissuring occurs in the mucobuccal fold, dry, burning sensation throughout the oral cavity
abnormal taste sensations, difficulty with removable partial prostheses.
signs and symptoms of menopausal gingivostomatitis aresomewhat comparable with those of chronic
desquamative gingivitis
20. Pregnancy
• 50-100 gingivitis - caused by bacterial plaque
• Tooth mobility, pocket depth, and gingival fluid
are also increased during pregnancy
• Onset (2 / 3 month) sever at (8month)
• Pronounced ease of bleeding is the most striking
inflamed and varies in color from bright red to bluish red
The marginal and interdental gingivae are edematous;
they pit on pressure
appear smooth and shiny, are soft and pliable, and
sometimes have a raspberry-like appearance.
the inflamed gingiva forms discrete “tumorlike” masses
P. intermedia appears to be the only micro-organism that
increases significantly during pregnancy
FINISH
pregnancy tumors
21. Hyperparathyroidism
Parathyroid hypersecretion
produces ….
generalized
demineralization
of the skeleton
osteitis
fibrosa cystica/ von
Recklinghausen’s
bone disease
formation of
bone cysts and giant
cell tumors
Loss of LD
Paget’s disease,
fibrous dysplasia,
and osteomalacia
radiographic evidence
• of alveolar osteoporosis with closely
meshed trabeculae
• widening of the periodontal ligament space
• absence of the lamina dura
• and radiolucent cyst like spaces
• Bone cysts / brown tumors / reparative giant
cell granuloma
increased osteoclasis
with proliferation of the
connective tissue in the
enlarged marrow spaces
Loss of the lamina dura
& giant cell tumors
in the jaws are late
signs
include malocclusion
and tooth mobility
22.
23.
24. Hematologic Disorders and Immune Deficiencies
Enter your sub headline here
Leukocyte (Neutrophil)
Disorders
Leukemia
Anemia
Thrombocytopenia
Anti body deficiency syndrome
• Neutropenia.
• Agranulocytosis.
The Periodontium in Leukemic
Patients
1. Pernicious anemia
2. Iron deficiency anemia
3. Sickle cell anemia
4. Aplastic anemia
Purpura
Agammaglobulinemia, or
hypogammaglobulinemia
25. Leukocyte (Neutrophil) Disorders
• Neutropenia.
• Agranulocytosis. associated with a more generalized periodontal destruction that affects all teeth.
Neutropenia: low levels of circulating neutrophils
Chronic , cyclic / sever , benign
It affects as many as one in three patients who are receiving chemotherapy for cancer
who are receiving chemotherapy for cancer.
• absolute neutrophil count (ANC) of 1000 to 1500 cells/μL is diagnostic for mild neutropenia.
• ANC of 500 to 1000 cells/μL is considered moderate neutropenia
• ANC of less than 500 cells/μL Indicates a severe neutropenia
26. INSTRUCTIONS
defined as an ANC of less than 100 cells/μL
• Drug idiosyncrasy is the most common cause of agranulocytosis
• aminopyrine, barbiturates and their derivatives, benzene ring derivatives,
sulfonamides, gold salts, and arsenical agents
Characteristic:
• fever, malaise, general weakness, and sore throat.
• Ulceration in the oral cavity
• The mucosa exhibits isolated necrotic patches that are black and gray
Agranulocytosis is a more severe neutropenia that involves not only neutrophils
but also basophils and eosinophils
It may be chronic or periodic, with recurring neutropenic cycles
(e.g., cyclic neutropenia). generally occurs as an acute disease
Gingival hemorrhage, necrosis, increased salivation, and fetid odor
are accompanying clinical features.
generalized aggressive periodontitis has been described in patients
with cyclic neutropenia
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27. Leukemia
leukemias are malignant neoplasias of WBC precursors
replacement immature
WBCs widesprea
d infiltrates
cell type
involved
evolution
Sign of
leukemia
Step 1 Step 2 Step 3 Step 4 Step 5 Step 6
the diffuse replacement of the
bone marrow with
proliferating leukemic cells
Abnormal numbers and
forms of immature WBCs
in the circulating blood
widespread infiltrates in the
liver, spleen, lymph nodes, and
other body sites
Anemia – RBC
Leukopenia - WBC
Thrombocytopenia - platelet
Acute
Sub acute
chronic
Lymphocytic
myelogenous
28. Conclusion.
6 Months Example Roadmap
Leukemia
Epithelium changes:
• Thinning & hyperplastic of epith
• Degeneration intracellular
• Leukemic infiltration cells
• Decrease of keratinization
Bleeding
Infected oral ulcer Agranulocytosis
DDX: NUG,Noma,NU OF TONSIL
Leukocyte (Neutrophil) Disorders
Petechia ,ecchymosis most in soft palate Hyper parathyroids
Osteoporosis ,widening of PDL, loss of LD, brown tumor
Diabetes
CAL in diabetic is 2x of non diabetic
Periodontitis
45y > +poor oral hygiene HbA1C>9%
=2/9 X non diabetic
Smoker +diabetic =4/6 non diabetic
Pregnancy
Pregnancy tumor , inflammation
,edema, hyperplastic epith, gingivitis ,…
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