Kiliyamannil Campus, College Road

Chattiparamb, Malappuram

DEPARTMENT OF PERIODONTICS AND ORAL

IMPLANTOLOGY

SEMINAR ON ‘INFLUENCE OF SYSTEMIC CONDITIONS ON

PERIODONTIUM’

Grade:

Signature

SUBMITTED BY: FATHIMA SHIBILI

FINAL YEAR-PART 1

University Reg.NO: 160020450

 CERTIFICATE

This is to certify that “FATHIMA SHIBILI” has presented this seminar titled “INFLUENCE
OF SYSTEMIC DISEASES ON PERIODONTIUM” in the Department of Periodontics and
Oral Implantology

Head of the Department

DEPARTMENT OF PERIODONTICS AND ORAL IMPLANTOLOGY

Place:

Date:
 CONTENTS

• Introduction

• Endocrine disorder

• Diabetes Mellitus

• Hematological disorders

• Genetic disorders

• Stress and psychosomatic disorders

• Other systemic conditions

• Conclusions
 INTRODUCTION

• Systemic diseases, disorders, and conditions alter host tissues and physiology, which may
impair the host’s barrier function and immune defense against periodontal pathogens,
thereby creating the opportunity for destructive periodontal disease to progress.

• The relationships between periodontal infections and host defense are complex. A
number of environmental, physical, and psychosocial factors have the potential to alter
periodontal tissues and the host immune response, thereby resulting in more severe
periodontal disease expression
ENDOCRINE DISORDERS AND HORMONAL CHANGES
 DIABETES MELLITUS

• Diabetes mellitus is a complex metabolic disorder characterized by chronic hyperglycemia.

• Lipid and protein metabolism are altered in diabetes as well. Uncontrolled diabetes (chronic
hyperglycemia) is associated with several long-term complications.

.
Types of Diabetes Mellitus
Complications
• Microvascular diseases

• Retinopathy

• Nephropathy

• Neuropathy

• Macro vascular diseases

• Cardiovascular and

• Cerebrovascular conditions

• Increased susceptibility to infections, and

• Poor wound healing.

Periodontal disease is considered to be the sixth complication of

diabetes

• The increased glucose in the gingival fluid and blood of patients with diabetes could change
the environment of the microflora, thereby inducing qualitative changes in bacteria that may
contribute to the severity of periodontal disease
• In patients with poorly controlled diabetes, the functions of PMNS, monocytes, and
macrophages are impaired. As a result, the primary defense mounted by pmns against
periodontal pathogens is diminished, and bacterial proliferation is more likely to occur

BACTERIAL PMNL
PATHOGEN FUNCTION
S

• Chronic hyperglycemia adversely affects the synthesis, maturation, and maintenance of

collagen and extracellular matrix.

• In the hyperglycemic state, numerous proteins and matrix molecules undergo a

nonenzymatic glycosylation, thereby resulting in accumulated glycation end-products
(ages).

• The formation of ages occurs at normal glucose levels as well; however, in

hyperglycemic environments, age formation is excessive.

Many types of molecules are affected, including proteins, lipids, and carbohydrates. Collagen is
cross-linked by AGE formation, which makes the collagen less soluble and less likely to be
normally repaired or replaced

•
Enlarged gingiva Diabetes
Sessile or pedunculated
gingival polyps
with
Polypoid gingival Patients
proliferations Changes in
Abscess formation
Periodontitis and loosened
Periodontal
teeth
Cheilosis Diabetes
Mucosal drying and
cracking
with
Burning mouth and Patients
Diminished salivary flow
Alterations in the flora of
in
the oral cavity Changes
Increased rate of dental
caries
Oral
 HEMATOLOGIC DISORDERS AND IMMUNE DEFICIENCIES

• A specific diagnosis requires a complete physical examination and a thorough hematologic

study.

• Comparable oral changes occur in more than one form of blood dyscrasia, and secondary
inflammatory changes produce a wide range of variation in the oral signs.

• Hemorrhagic tendencies occur when the normal hemostatic mechanisms are disturbed.

• Abnormal bleeding from the gingiva or other areas of the oral mucosa that is difficult to
control is an important clinical sign that suggests a hematologic disorder.

• Petechiae and ecchymosis observed most

often in the soft palate area, are signs of an
underlying bleeding disorder.

Leukocyte (neutrophilic) disorder

• Neutropenia

• Agranulocytosis

• Leukemia

Neutropenia is a blood disorder that results in low levels of circulating

neutrophils. It is a serious condition that may be caused by diseases, medications,
chemicals, infections, idiopathic conditions, or hereditary disorders
Agranulocytosis is a more severe neutropenia that involves not only neutrophils
but also basophils and eosinophils.

• Ulceration.

• The mucosa exhibits isolated necrotic patches that are black and gray and
that are sharply demarcated from the adjacent uninvolved areas.

• The absence of a notable inflammatory reaction

• Gingival hemorrhage

• Necrosis

• Increased salivation

• Fetid odor

The periodontium in leukemic

patients

Oral and periodontal

manifestations :

• Leukemic infiltration

• Bleeding

• Oral ulcerations

• Infections
Leukemic infiltration

• Leukemic gingival enlargement is not found

in edentulous patients or in patients with
chronic leukemia.

• It may be localized to the interdental papilla

area or it may expand to include the
marginal gingiva and partially cover the
crowns of the teeth .

• clinically, the gingiva appears bluish red

and cyanotic, with a rounding and tenseness
of the gingival margin.

• The abnormal accumulation of leukemic cells in the dermal and subcutaneous connective
tissue is called leukemia cutis, and it forms elevated and flat
macules and papules .

Bleeding
 Gingival hemorrhage is a common finding. Bleeding gingiva
can be an early sign of leukemia.

Oral ulceration and infection In patients with leukemia

• There is a pronounced infiltration of immature leukemic
cells in addition to the usual inflammatory cells

• Granulocytopenia (diminished WBC count) leads to

ulcerations and infections.

• Discrete, punched-out ulcers on the oral mucosa

 GENETIC DISORDERS
Chédiak–higashi syndrome

• This is a rare disease that affects the

production of organelles found in
almost every cell. It affects mostly the
melanocytes, platelets, and
phagocytes.

• Patients with Chédiak–Higashi

syndrome are susceptible to repeated
infections that can be serious and life
threatening.

• Aggressive periodontitis has been described in these patients.

Lazy leukocyte syndrome

• Lazy leukocyte syndrome is characterized by susceptibility to severe microbial

infections, neutropenia, defective chemotactic response by neutrophils, and an abnormal
inflammatory response.

• Susceptible to aggressive periodontitis with destruction of bone and early tooth loss.
 STRESS AND PSYCHOSOMATIC DISORDERS
• Individuals with high levels of financial stress and poor coping skills had twice as much
periodontal disease as those with minimal stress and good coping skills.

• Also individuals with problem-focused (practical) coping skills fared better than
individuals with emotion focused (avoidance) coping skills with respect to periodontal
disease.

• It is found that chronic stress and inadequate coping could lead to changes in daily
habits, such as;

• Poor oral hygiene

• Clenching

• Grinding

• Decreased saliva flow and

• Suppressed immunity

NUTRITIONAL INFLUENCES
The majority of opinions and research findings regarding the effects of nutrition on oral and periodontal
tissues to the following;
1. There are no nutritional deficiencies that by themselves can cause gingivitis or periodontitis.
However, nutritional deficiencies can affect the condition of the periodontium and thereby may
accentuate the deleterious effects of plaque-induced inflammation in susceptible individuals.

2. There are nutritional deficiencies that produce changes in the oral cavity. These changes include

• alterations of the tissues of the lips

• oral mucosa

• gingiva

• bone.

SCURVY
 Vitamin D
receptor gene
polymorphism
Innate and
Alveolar bone acquired
metabolism immune
response

Role of
vitamin D on
periodontal
health

•
 OTHER CONDITIONS
1. PUBERTY
– Pronounced inflammation
– Edema
– Gingival enlargement
2. MENSTRUATION
– Bleeding gums
– Tense feeling of gums
3. PREGNANCY
• Gingivitis due to bacterial plaque
• Greater sensitivity at 2nd and 3rd trimester
• Raspberry gingiva
• Pregnancy tumor
• P.intermedia elevated
4 .MEDICATIONS
• Bisphosphonates :cancer and osteoporosis
• inhibits osteoclastic activity
• BRON
• BION
• Pathologic fracture
5.HYPERPARATHYROIDISM

• Generalized demineralization
• Increased osteoclast
• Formation of bone cyst and giant cell tumor
• Loss of lamina dura
ORAL CHANGES
• Malocclusion
• Tooth mobility
• Widening of PDL
• Brown tumors (bone cyst +fibrous tissue+hemosiderin laden
macrophages and giant cells)

Gingivitis

Pyogenic Salivary
granuloma changes

ORAL
CAVIT
Y IN
PREGN
ANCY
Gingival Tooth
hyperplasia mobility

Melasma
 CONCLUSION

The pathogenesis of periodontal diseases is influenced by various host factors, including immune
response, anatomical factors, and tissue structural factors. Most of these factors are determined
by the genetic profile of the host and may be modified by environmental and host behavioral
factors.

Periodontal diseases and certain systemic disorders share similar genetic and/or environmental
etiological factors and, therefore, affected individuals may show manifestations of both diseases.
Hence, loss of periodontal tissue is a common manifestation of certain systemic disorders, which
could have important diagnostic value and therapeutic implications.
 REFERENCE

• Newman and Carranza’s Clinical Periodontology,

3rd South Indian Edition