Week 2 Sharma: Systemic Diseases and Perio

Question 1

What systemic diseases/disorders affect the periodontium?

Answer 1

• Endocrine disorders
• Haematological disorders
• Genetic factors
• Stress
• Nutritional influences

Question 2

How can hormonal disturbances affect periodontal tissues (3)?

Answer 2

• Directly as perio manifestation of endocrine disease
• Modify tissue response to plaque
• Produce anatomic changes that may favour plaque accumulation or trauma from occlusion

Question 3

What are oral manifestations of diabetes mellitus?

Answer 3

• Frequent periodontal abscesses
• Diminished saliva flow (mucosal drying, cracking, burning mouth/tongue)
• Inc rate of caries

Question 4

How does uncontrolled diabetes impact periodontium?

Answer 4

• Limited to gingiva: severe inflammation, gingival enlargements
• Features extending to attachment: abscesses, mobility, deep pockets, rapid bone loss

Question 5

What is the only systemic disease positively associated with AL?

Answer 5

Diabetes Mellitus

Question 6

What are the contributing pathogenic mechanisms to periodontal disease in diabetics?

Answer 6

Bacteria + PMN function → altered collagen metabolism (normal healing doesn’t occur) and periodontal disease

Question 7

What is the consequence of PMN deficiency in uncontrolled diabetic?

Answer 7

Impaired chemotaxis

Defective phagocytosis

Impaired adherence

Question 8

Why is the glucose content of GCF and blood higher in diabetics?

Answer 8

Blood glucose seeps into GCF. GCF increases with inflammation.
Bacteria that need glucose would be higher in diabetics as there is glucose in GCF.

Question 9

How is collagen turnover affected in uncontrolled diabetics? What is the role of insulin?

Answer 9

• Dec in collagen production and impaired collagen degradation.
• Insulin prevents onset and corrects defective collagen production

Question 10

What are the mechanisms of bone destruction?

Answer 10

• Inc RANKL/OBP (activation of osteoclasts)
• Inc AGE’s
• Inc ROS (reactive oxygen species)
• Inc cytokines

Question 11

What is AGE RAGE?

Answer 11

RAGE is receptor sitting on different cell types. AGE is present in pts with diabetes. AGE and RAGE interact and trigger inflammation

Question 12

How does menstruation impact periodontium?

Answer 12

• Inc prevalence of gingivitis
• Bleeding gums or bloated/tense feeling in gums in days preceding menstrual flow
• Inc salivary bacteria

Question 13

How does pregnancy impact periodontium?

Answer 13

• If no plaque, no notable changes present
• Inc tooth mobility, pocket depth, GCF

Question 14

How long does it take for gums to revert back to pre-pregnancy state?

Answer 14

21 months

Question 15

What is the clinical presentation of pregnancy gingivitis?

Answer 15

• Pronounced ease of bleeding
• Edematous, pitting, smooth, shiny gingiva
• Extreme redness
• Painless unless complicated by acute infection

Question 16

Why is there redness during pregnancy?

Answer 16

• P. intermedia
• Depressed T cell response alters tissue response to plaque
• Elevations in systemic levels of hormones.
• Gingival mast cells

Question 17

What is pregnancy granuloma (angiogranuloma)?

Answer 17

• Semi-firm, painless, mushroom like mass protruding from IP space/gingival margin
• Can become painful if debris accumulate or interfered with occlusion
• Often appears after 3rd month of pregnancy
• Doesn’t invade underlying bone

Question 18

What is menopausal gingivostomatitis?

Answer 18

• Uncommon
• Gingiva and oral mucosa are dry, shine, vary in colour
• Occurs during or after menopause

Question 19

How do quantitative vs functional PMN deficiencies affect periodontium?

Answer 19

• Quantitative: generalised periodontal destruction
• Functional: localised destruction

Question 20

What is chronic neutropenia?

Answer 20

Low neutrophil count for greater than 6 months

Question 21

What are symptoms of cyclic neutropenia?

Answer 21

• Periodic recurring symptoms of fever, malaise, mucosal ulcers, infections
• Usually before age 10
• Generalised severe periodontitis

Question 22

What is leukaemia characterised by?

Answer 22

• Diffuse replacement of bone marrow with proliferating leukemic cells
• Abnormal numbers and forms of immature WBC
• Widespread infiltrates in liver, spleen, lymph nodes

Question 23

How is leukaemia classified?

Answer 23

• Lymphocytic or myelogenous
• Acute, subacute or chronic

Question 24

What are the oral/periodontal manifestations of leukemic patients?

Answer 24

• Leukemic infiltration
• Bleeding (thrombocytopenia)
• Oral ulcers
• Infections
• Gingival enlargements (not in edentulous pts)

Question 25

How does gingiva appear in leukemic patients?

Answer 25

• Bluish, red and cyanotic
• Rounding and tenseness of gingival margin
• Inc size of interdental papilla
• Ulcerated, necrosed marginal gingiva with pseudo membrane formation

Question 26

What are microscopic features of leukemic patients?

Answer 26

• Dense infiltrate of immature leukocystes
• Mitotic figures
• Connective tissue components displaced by leukemic cells
• Blood vessels distended (dec RBC)

Question 27

What should you do if you suspect leukaemia in patient?

Answer 27

Often better to refer than do biopsy

Question 28

What is Papillon-Lefevre Syndrome?

Answer 28

• Rare genetic disease
• Diffuse palmar plantar keratosis + Severe periodontitis in primary and secondary dentition
• Appear together 2-4 years old
• Assoc w/ premature exfoliation

Question 29

How do vit A, B and C deficiency disturb periodontium?

Answer 29

Reduce resistance of tissues to irritation and infection

Question 30

How does vit K deficiency disturb periodontium?

Answer 30

Affects permeability of blood vessels or blood clotting mechanism