lecture 8 effect of systemic ds on periodontal ds

Question 1

what type of periodontitis for major impact

Answer 1

severe/early-onset periodontitis

Question 2

what type of periodontitis for moderate impact?

Answer 2

• chronic periodontitis
• increase prevalance

Question 3

systemic disorders cause –>

Answer 3

loss of periodontal tissue

Question 4

what three things can influence periodontal inflammation

Answer 4

• genetic disorder
• acquired immunodeficiency ds
• inflammatory ds

Question 5

what ds is associated with this oral presentation

Answer 5

• oral presentation of Down Syndrome
• moderate to severe periodontitis with rapid progression
• local factors do not explain the severity of the periodontal destruction
• intrinsic immune system defects

Question 6

explain what leukocyte adheesion deficiency is

Answer 6

• a mutation in beta-2 integrin gene where there is a lack of them in leukocytes.
• This causes for low integrin expression on the neutrophils so
• neutrophils are confined to blood vessels (loose neutrophil-associated homeostasis)

Question 7

oral manifestations seen in LAD

Answer 7

• severe gingial inflammation, acute gingival lesions
• early-onset and rapidly progressive alveolar bone loss
• early loss of the primary AND perm teeth

*not just oral but history of recurrent inection but with no pus

Question 8

what ds is this oral presentation associated with?

Answer 8

LAD leukocyte adhesion deficiency

• severe gingial inflammation, acute gingival lesions
• early-onset and rapidly progressive alveolar bone loss
• early loss of the primary AND perm teeth

Question 9

describe papillon-lefevre syndrome

Answer 9

mutations in the cathepsin C gene which can compromise neutrophil function

can have hyperkeratotic lesions

Question 10

if we have a pt with hyperkeratotic lesions on palms, soles of feet, elbow and/or knees with periodontal inflammation what could it be

Answer 10

papillon-lefevre syndroms

Question 11

oral presentation of papillon-lefevre

Answer 11

• severe gingival inflammation
• early-onset and rapidly progressive alveolar bone loss
• early loss of the primary and permanent teeth

Question 12

describe chediak-higashi syndrome

Answer 12

• a mutation in gene (CHS1 and LYST) which can cause albinism, pyogenic infections, and varying neurologic problems

Question 13

some clinical S&S of Chediak-Higashi Syndrome

Answer 13

• partial oculocutaneous albinism which can cause defects in melanin granules
• recurrent pyogenic infections
• varying neurologic probs like intellectual deficit and dementia

Question 14

oral manifestations seen in Chediak-higashi Syndrome

Answer 14

• severe gingival inflammation
• Early-onset and rapidly progressive alveolar bone loss
• Early loss of the primary and perm teeth
• Poor response to dental tx

Question 15

describe congenital neutropenia

Answer 15

Mutations in ELANE (50%), HAX1 (10%) gene.

A decrease # and dysfunction of neutrophils, and defficient in immune response so lots of severe and recurrent infections

Question 16

what are the ds associatd with immunologic disoders

Answer 16

1. Down syndrome
2. LAD
3. Papillon Lefevre
4. Chediak-higashi syndrome
5. Congenital neutropenia

Question 17

what are the ds affecting the oral mucosa and gingival tissue

Answer 17

1. epidermolysis bullosa

Question 18

describe epidermolysis bullosa

Answer 18

aka Kindler Syndrome

a mutation in the fermitin family homologue 1 gene.

Has a lack of integrin activiation which affects the keratinocyte cell adhesion which can lead to defects in basement membrane zones as well.

Recurrent blister formation

Photosensitivity

Question 19

oral manifestations of epidermolysis bullosa

Answer 19

oral blisters, severe periodontitis, and you need immunofluorescence to confirm dx

Question 20

what are the ds affecting the CT

Answer 20

1. ehlers danlos syndrome

Question 21

describe ehlers-danlos syndrome

Answer 21

a mutation in genes encoding fibrillar collagens or enzymes in the biosynth

it affects collegen production and composition so pts will have joint hypermobility, skin extensibility and tissue fragility

Question 22

oral manfestations of ehlers-danlos syndrome

Answer 22

• generalized, early onset severe periodontitis and gingival recession
• early loss of primary and perm teeth

Question 23

what are the metabolic and endocrine disorders

Answer 23

1. hypophosphatasia
2. DM
3. Obesity
4. Osteoporosis
5. Acquired Immunodeficiency ds
6. Inflammatory ds
7. Epidermolysis Bullosa Acquisita
8. Inflammatory bowel ds
9. Rhemuatoid arthritis

Question 24

describe Hypophosphatasia

Answer 24

lack of phosphate in the body. ALPL gene mutation.

so you have defective cementums, alveolar bone loss and premature loss of teeth

Question 25

oral manifestations of Hypophosphatasia

Answer 25

- impaired bone/tooth mineralization - defects in root cementum

Question 26

describe DM

Answer 26

disorder of glucose metabolism there is an accumulation of AGEs There are two types 1 and 2.

Question 27

oral manifestations of DM

Answer 27

- increased prevalence and severity of attachment loss and multiple periodontal abscess - RED gingiva

Question 28

relationship between DM and periodontal ds

Answer 28

DM is a risk factor for periodontal ds BUT periodontal ds is also a complicating factor for DM. Periodontitis also affects glycemic control.

Question 29

relationship between obesity and periodontitis

Answer 29

it is a 2 way relationship

Question 30

obesity can cause an elevated \_\_\_\_

Answer 30

synthesis of inflammatory cytokines (TNF, IL-1, IL-6) these can then cause chronic ds

Question 31

describe osteoporosis

Answer 31

due to lack of estrogen (withdrawals) it can stimulate osteoclasts and decreases bone mineral density.

Question 32

estrogen and inflammtion shared risk factors

Answer 32

age, vitamin D and calcium deficiency, smoking

Question 33

what are the Acquired immunodeficiency ds

Answer 33

1. acquired neutropenia 2. HIV infection

Question 34

describe aquired neutropenia

Answer 34

due to a decreased production or increased destruction of granulocytes so pt has increase irks for infections and periodontitis correclty with severety of neutropenia

Question 35

describe HIV infection

Answer 35

deficiency of the immune system due to infection with the HIV virus increase risk for infections, neosplasms (kaposi sarcoma)

Question 36

what are the inflammatory diseases

Answer 36

Epidermyloysis bullosa acquisita Inflammatory bowel ds Rheumatoid arthritis all of these are autoimmune ds

Question 37

describe epidermolysis bullosa acquisita

Answer 37

a pathogenic autoantibodies bind to target antigens. two types: inflammatory form and mehcanobullous types

Question 38

oral manifestations of epidermolysis bullosa acquisita

Answer 38

- Generalized gingival inflammation. Severe alveolar bone loss. Recurrent blister formation. Immunoflourescence on basment membrane - split skin.

Question 39

describe inflammatory bowel ds

Answer 39

it is a hypersensitivity of immune responses with microbiological, host and environmenetal determinants.

Question 40

describe rheumatoid arthritis

Answer 40

a chronic auto-inflammatory ds - increased risk for loss of periodontal attachment, alveolar bone there is a biological link between rhematoid arthritis and periodontits.

Question 41

stress/anxiety/depression/negative life event causes what cascade

Answer 41

increase serum cortisol (activates limbic-hypothalamic-pituitary-adrenal axis) --\> immune system depression --\> change in behavior/mood/physiological markers risk facotrs for necrotitizng peridontal ds

Question 42

smoking caues what cycle

Answer 42

impaired immune system --\> subgingival anaerobic infection --\> connective tissue cytotoxicity --\> imparied wound healing --\> increased severity of periodontal ds --\> impaired immune system

Question 43

chronic nicotine exposure process

Answer 43

chronic nicotine exposure --\> impairment of antigen-mediated T cell signaling --\> inhibits antibody-forming cell response --\> immunosupreesion.

Question 44

smoking (nicotine and tars) cause what

Answer 44

overal a decrease tissue oxygenation which cauess **subgingival anerobic infection, CT cytotoxicity and impaired wound healing**

Question 45

chronicity = what effetcs

Answer 45

fibrotic

Question 46

what are bisphosphonates

Answer 46

- function to inhibit osteoclast activity - they treat cancer (IV administration), treat osteoporosis (oral administration) and inhibit osteoclast activity and interfere with bone turnover

Question 47

neoplasms that have independent etiology to loss of peridontal tissue

Answer 47

oral squamous cell carcinoma odontogenic tumors other primary neoplasms of periodontal tissue secondary netastatic neoplasms of periodontal tissue

Question 48

other disorders that have independent etiology to loss of peridontal tissue

Answer 48

langerhans cell histiocytosis

Question 49

what is langerhans cell histiocytosis

Answer 49

has peripheral small vessel necrotizing vasculitis, respiratory and renal impairment, characterisitic fiery and hyperplastic gingival inflammation and alveolar bone loss

Question 50

describe giant cell granuloma

Answer 50

a reactive proliferation, beningn lesion with no systemic features. peripheral giant cell granuloma - gingiva only. gingival swelling and some loss of periodontal tissue central giant cell granuloma - loss of periodontal supporting tissue, may extend toward marginal periodontal tissue

Question 51

oral manifestations of hyperparathyroidism

Answer 51

widening of pdl, single/multiple osteolytic lesions in the jaw that mimic peridontal bone loss (brown tumors)

Question 52

what is scleroderma

Answer 52

autoimmune ds of the CT with many different systemic presentations

Question 53

oral manifestations of scleroderma

Answer 53

widening pdl, and higher prevalence of periodontitis