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Periodontics I > Periodontitis as A Manifestation of Systemic Disease > Flashcards

Periodontitis as A Manifestation of Systemic Disease Flashcards

1
Q

Periodontitis can affect the ____

Likewise, systemic conditions & diseases can affect the ____.

A

rest of the body; periodontium

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2
Q

Periodontitis is a ____ mediated disease

A

host-mediated

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3
Q

Periodontitis is a host-mediated disease but can have ____ that alter its course

A

environmental factors

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4
Q

Periodontal disease and systemic condition have three common contributing factors including:

A
  1. environmental factors
  2. host factors
  3. microbial factors
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5
Q

What do we mean by :

Periodontitis as a manifestation of a systemic disease

A

meaning system disease is altering the course of peridontitis

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6
Q

How do systemic disorders result in loss of periodontal tissues?

A
  1. influence periodontal inflammation
  2. influence the pathogenesis of periodontal disease
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7
Q

Major impact of systemic diseases on periodontal health:

A

severe/early-onset periodontitis

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8
Q

Moderate impact of systemic disease on periodontal health:

A
  1. increase prevalence
  2. No otherwise different clinical presentations of chronic periodontitis
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9
Q

Systemic disorders that have a major impact on loss of periodontal tissue by influencing periodontal inflammation include: (3)

A
  1. genetic disorders
  2. acquired immunodeficiency diseases
  3. inflammatory diseases
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10
Q

List the categories of genetic disorders: (that affect the periodontium)

A
  1. diseases associated with immunologic disorders
  2. diseases affecting the oral mucosa and gingival tissue
  3. Diseases affecting the CT
  4. metabolic and endocrine disorders
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11
Q

Diseases associated with immunologic disorders: (that affect the periodontium)

A
  1. down syndrome
  2. leukocyte adhesion deficiency
  3. papillon lefevre syndrome
  4. chediak higashi syndrome
  5. congenital neutropenia
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12
Q

Down syndrome may also be called:

A
  1. Trisomy 21
  2. Mongolism
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13
Q

Down syndrome is characterized by:

A
  1. characteristic physical appearance
  2. mental deficiency
  3. growth retardation
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14
Q

List some physical characteristics associated with Down syndrome:

A
  1. small nose, mouth & ears
  2. slightly bent 5th finger
  3. almond-shape eyes with skin fold covering inner corner
  4. white spots on colored part of eyes
  5. flat, round face
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15
Q

What chromosome is affected with Down syndrome?

A

21st

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16
Q

Describe periodontitis in an individual with Down syndrome:

A

moderate to severe periodontitis with rapid progression

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17
Q

Describe the periodontitis progression in an individual with Down syndrome:

A

rapid progression

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18
Q

T/F: In an individual with Down syndrome, local factors alone explained the severity of the periodontal destruction

A

False- local factors alone FAILED to explain the severity of periodontal destruction

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19
Q

Describe the effects of Down syndrome on the immune system:

List some examples:

A

Intrinsic immune system defects

  1. poor PMN chemotaxis
  2. poor phagocytosis
  3. poor intracellular killing
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20
Q

Caused by a mutation in beta-2 integrin (ITGB2) gene:

A

Leukocyte adhesion deficiency

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21
Q

What gene is affected in LAD?

A

Beta-2 integrin (ITGB2)

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22
Q

In LAD, the mutation in beta-2 integrin (ITGB2) results in: (2)

A
  1. lack of beta-2 integrin mRNA in leukocytes
  2. low integrin (CD18 or CD15) expression on neutrophils
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23
Q

What happens to the neutrophils in leukocyte adhesion deficiency?

A

neutrophils are confined to the blood vessels (resulting in disruption of neutrophil- associated homeostasis)

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24
Q

In individuals affected by this disease we often see a history of severe recurrent infection but no pus; leukocytosis is common:

A

LAD

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25
Q

In individuals with LAD, we often see a history of ______. ____ is common

A

severe infection but no pus; leukocytosis

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26
Q

Describe the oral manifestations of LAD: (4)

A
  1. severe gingival inflammation
  2. acute gingival lesions
  3. early-onset and rapidly progressive alveolar bone loss
  4. early loss of primary AND permanent teeth
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27
Q

This image shows oral findings in a 6 year old boy with ___. Note the diastema, gingival retraction, and partial root exposure with cervical erosions affecting primary dentition. Permanent lower incisors are erupting.

A

LAD1

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28
Q

Caused by a mutation in the cathepsin C gene (CTSC)

A

papillon-lefévre syndrome

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29
Q

What gene is mutated in papillon-lefévre syndrome? What chromosome is this located on?

A

Cathepsin C gene (CTSC); chromosome 11q14

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30
Q

In papillon-lefévre syndrome, these patients experience compromised ______ function resulting in _____.

A

neutrophil function; decreased phagocytosis

31
Q

What characteristic lesion is seen in papillon-lefévre syndrome? What are some common locations for this lesion?

A

Hyperkeratotic lesions
- palms
- soles of feet
- elbows
- knees

32
Q

The following images of characteristic of:

A

papillon-lefévre syndrome

33
Q

Describe the oral manifestations of papillon-lefévre syndrome: (3)

A
  1. severe gingival inflammation
  2. early-onset and rapidly progressive alveolar bone loss
  3. early loss of primary & permanent teeth
34
Q

Case Study:

  • A 10 year old male child presented with what appeared to be severe generalized aggressive periodontitis. His parents presented no contributory medical history excepted for skin lesions that had been managed by his medical doctor since birth.

CC: Parents complaining about child’s bad breath and loose teeth

History of main complaint: 1 year. Previously attended da private dentist who had done cleanings and prescribed antibiotics

Medical history: NKDA, med history unknown

Eczema: Hands and feet from early age, been treated by GP with aqueous real since early childhood

Fam medical history: none known

Dental history & habits: Patient brushes once er day, no other dental aids used

Initial presentation seen in image:

A

Diagnosis: papillon-lefévre syndrome

35
Q

Disease caused by mutations in CHS1 and LYST gene:

A

Chediak-Higashi Syndrome

36
Q

Chediak-Higashi Syndrome is caused by mutations in:

A

CHS1 and LYST genes

37
Q

The mutations in Chediak-Higashi Syndrome (CHS1 and LYST genes) result in what lysosomal defect?

A

Lysosomal trafficking defect

38
Q

In Chediak-Higashi Syndrome, defects in melanin granules results in:

A

partial oculocutaneous albinism

39
Q

What results in the partial oculocutaenous albinism in chediak-higashi syndrome?

A

defects in melanin granules

40
Q

In Chediak-Higashi Syndrome, the circulating leukocytes exhibit defective lysosomes causing a decrease in phagocytosis, clinically, what does this cause?

A

recurrent pyogenic infections

41
Q

In Chediak-Higashi Syndrome, we clinically see recurrent pyogenic infections. What causes this?

A

circling leukocytes exhibit defective lysosomes resulting in a decrease in phagocytosis

42
Q

Describe the neurologic aspects of Chediak-Higashi Syndrome:

A

varying neurologic problems; intellectual deficit & dementia

43
Q

Describe the oral manifestations of Chediak-Higashi Syndrome:

A
  1. Severe gingival enlargement
  2. Early-onset and rapidly progressive alveolar bone loss
  3. Early loss of the primary and permanent teeth
  4. Poor response to dental treatment
44
Q

Cause by a mutation in the ELANE (50%), or HAX1 (10%) gene:

A

congenital neutropenia

45
Q

Congenital Neutropenia is caused by a mutation in ____ in 50% of cases and ____ in 10% of cases.

A

ELANE (50%); HAX1 (10%)

46
Q

In Congenital Neutropenia, ____ causes remain unknown

A

1/3

47
Q

Congenital Neutropenia results in a ____ number of ____

A

decreased number of neutrophils

48
Q

What neutrophil level is considered “neutropenic”?

A

ANC < 500 cell/uL and static

49
Q

The decreased number of neutrophils in Congenital Neutropenia, results in: (2)

A
  1. deficiency in the immune response
  2. severe & recurrent infections
50
Q

Describe the oral manifestations of congenital neutropenia:

A
  1. severe periodontitis is common
  2. higher risk for tooth loss
  3. oral ulcers
51
Q

Epidermolysis Bullosa (Kindler Syndrome) is categorized as a disease affecting the:

A

oral mucosa and gingival tissue

52
Q

Mutation in the fermitin family homologue 1 gene:

A

Epidermolysis Bullosa (Kindler Syndrome)

53
Q

Epidermolysis Bullosa (Kindler Syndrome) is a disease caused by a mutation in:

A

Fermitin family homologue 1 gene

54
Q

In Epidermolysis Bullosa (Kindler Syndrome) , the mutation in the fermitin family homologue 1 gene causes:

  1. lack of ____
  2. affects ____
  3. can lead to defects in the ____
A
  1. integrin activation
  2. keratinocyte adhesion
  3. basement membrane zone
55
Q

In Epidermolysis Bullosa (Kindler Syndrome) , the mutation in the fermitin family homologue 1 gene causes:

  1. lack of integrin activation
  2. affects keratinocyte adhesion
  3. can lead to defects in the basement membrane zone

And these all contribute clinically to:

A
  1. photosensitivity
  2. recurrent blister formation
56
Q

The following images show symptoms characteristic of:

A

Epidermolysis Bullosa (Kindler Syndrome)

57
Q

Ehlers-Danlos Syndrome is categorized as a disease affecting the:

A

connective tissue

58
Q

Caused by mutations in genes coding fibrillar collagens or enzymes involved in the biosynthesis of these proteins:

A

Ehlers-Danlos Syndrome

59
Q

In Ehlers-Danlos Syndrome, the mutations in genes coding fibrillar collagens or enzymes involved in the biosynthesis of these proteins result in alterations of:

A

collagen production and compositions

60
Q

What is clinically seen in Ehlers-Danlos Syndrome? (3)

A
  1. joint hyper mobility
  2. skin extensibility
  3. tissue fragility
61
Q

Based on these images, what disease does this individual have?

A

Ehlers-Danlos Syndrome

62
Q

What is the MAIN oral manifestation seen in Ehlers-Danlos Syndrome. What are some others seen?

A
  1. GENERALIZED LACK OF ATTACHED GINGIVA
  2. generalized, early-onset severe periodontitis
  3. gingival recession
  4. early loss of primary & permanent teeth
63
Q

Hypophosphotasia is categorized as a:

A

metabolic and endocrine disorder

64
Q

Caused by a mutation in the alkaline phosphatase (ALPL) gene:

A

Hypophosphotasia

65
Q

Hypophosphotasia is a disease caused by a mutation in:

A

alkaline phosphatase (ALPL) gene

66
Q

There are both ___ & ___ forms of Hypophosphotasia

A

mild and severe

67
Q

Describe the oral manifestations seen in Hypophosphotasia:

A
  1. defective cementum
  2. alveolar bone loss
  3. premature loss of teeth
  4. impaired bone/tooth mineralization
  5. compromised periodontal attachment
68
Q

In Hypophosphotasia, patients have a compromised ____, resulting in reduction in alveolar bone height

A

compromised periodontal attachment

69
Q

In Hypophosphotasia, the teeth are not adequately:

A

anchored to the alveolar bone via the PDL

70
Q

Oral signs of HPP (common dental signs): (6)

A
  1. exfoliation of the primary dentition before the age of three
  2. exfoliation of primary teeth with roots intact
  3. alveolar bone loss
  4. loss of permanent teeth with no signs of periodontal inflammation
  5. enlarged pulp chambers and root canals
  6. thin dentinal walls
71
Q

Disorder of glucose metabolism:

A

diabetes mellitus

72
Q

AGEs:

A

Advanced Gllycation End Products

  • Where there is excess amount of glucose in the circulation, everything gets glycated (once glycated no longer a simple molecule)
73
Q
A

Periodontics I (18 decks)

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