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PERIO I > perio dx as a manifestation of systemic dx > Flashcards

perio dx as a manifestation of systemic dx Flashcards

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1
Q

how do systemic dx affect periodontium

A

Diseases and conditions that can affect the periodontal tissues by influencing the course of periodontitis.

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2
Q

major impacts of sys dx on perio

A

Severe/early-onset
periodontitis

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3
Q

moderate impacts of sys dx on perio dx

A

Increase prevalence
No otherwise different clinical presentations of chronic periodontitis

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4
Q

what can sys dx influence regarding perio dx

A

Influence periodontal inflammation
Influence the pathogenesis of periodontal diseases

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5
Q

what type of sys dx influence perio inflamm

A

Genetic Disorders
Acquired Immunodeficiency Diseases
Inflammatory Diseases

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6
Q

types of Genetic Disorders

A
  1. Diseases associated with immunologic disorders
  2. Diseases affecting the oral mucosa and gingival tissue
  3. Diseases affecting the connective tissues
  4. Metabolic and endocrine disorders
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7
Q

Down Syndrome

A

Trisomy 21 or mongolism
Characteristic physical appearance
Mental deficiency and growth retardation

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8
Q

Down Syndrome perio dx

A

Moderate to severe periodontitis with rapid progression
Local factors alone failed to explain the severity of
periodontal destruction

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9
Q

DS immune affects
predisposed to?
Impaired functions?

A

Predispose to infections: intrinsic immune system defects
Poor PMN chemotaxis, phagocytosis, intracellular killing

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10
Q

Leukocyte Adhesion
Deficiency

A

Mutation in beta-2 integrin (ITGB2) gene Lack of beta-2 integrin mRNA in leukocytes
Low integrin (CD18 or CD15) expression on neutrophils
Neutrophils are confined to blood vessels and absent from the periodontium
Leukocytosis is common
History of severe recurrent infection but no pus
Disruption of neutrophil-associated homeostasis
Lack of neutrophil immune surveillance

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11
Q

Leukocyte Adhesion Deficiency perio effects

A

Severe gingival inflammation, acute gingival lesions
Early-onset and rapidly progressive alveolar bone loss
Early loss of the primary and permanent teeth

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12
Q

Papillon–Lefèvre Syndrome
what is compromised?
decreased immune function?
signs?

A

Compromised neutrophil function, not the quantity
Decreased phagocytosis
Hyperkeratotic lesions Palms, soles of the feet, elbows, knees

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13
Q

Papillon–Lefèvre Syndrome perio effects

A

Severe gingival inflammation, pocket formation
Early-onset and rapidly progressive alveolar bone loss
Early loss of the primary and permanent teeth

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14
Q

Chediak-Higashi Syndrome
defective function of cell?
oculocutaneous sign?
Defects in?
Recurrent?
Circulating leukocytes exhibit defective?
Decrease in what immune function?
neurologic problems

A

Lysosomal trafficking defect
Partial oculocutaneous albinism
Defects in melanin granules
Recurrent pyogenic infections
Circulating leukocytes exhibit defective lysosomes
Decrease in phagocytosis
Varying neurologic problems: Intellectual deficit and dementia

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15
Q

Chediak-Higashi Syndrome perio effects
gingiva?
alveolar bone loss ?
teeth?
response to dental treatment?

A

Severe gingival inflammation
Early-onset and rapidly progressive alveolar bone loss
Early loss of the primary and permanent teeth
Poor response to dental treatment

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16
Q

Congenital Neutropenia

A

Mutations in the ELANE (50%), HAX1(10%) gene 1/3 causes remain unknown
Decrease in number of neutrophils ANC < 500 cell/uL and static
Deficiency in the immune response
Severe and recurrent infections

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17
Q

Congenital Neutropenia oral effects
common perio dx form?
Higher risk for?
mucosa?

A

Severe periodontitis is common
Higher risk for tooth loss
Oral ulcerations

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18
Q

congenital Diseases Associated with
Immunologic Disorders

A

trisomy 21
LAD
Papillon–Lefèvre Syndrome
Chediak-Higashi Syndrome
Congenital Neutropenia

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19
Q

Epidermolysis Bullosa/ kindler syndrome
Imparied function?
Molecular defects where?
Reduced resistance at?
signs?

A

Imparied keratinocyte cell adhesion
Molecular defects in basement membrane zone
Reduced resistance at the junctional epithelium
Photosensitivity
Recurrent blister formation

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20
Q

Epidermolysis Bullosa/kindler syndrome oral effects
what may form?
periodontitis form?
Alveolar bone loss?
Need what to confirm diagnosis?
Skin biopsy of?

A

Oral blisters formation
Severe periodontitis
Alveolar bone loss that progress rapidly
Need immunofluorescence to confirm diagnosis
Skin biopsy of an included blister

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21
Q

Diseases Affecting the Oral
Mucosa and Gingival Tissue

A

Epidermolysis Bullosa

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22
Q

Ehlers-Danlos Syndrome

A

Mutations in genes encoding fibrillar collagens or
enzymes involve in the biosynthesis of these proteins
Affecting collagen production and composition Mainly involves joint, skins and walls of the blood vessels
Joint hypermobility, skin extensibility, and tissue fragility

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23
Q

Ehlers-Danlos Syndrome types

A

EDS type VIII/IV/I

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24
Q

EDS type VIII perio effects

A

EDS type VIII have gingival recession and generalized
severe periodontitis that often leads to loss of all teeth.

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25
EDS type IV/I perio effects
EDS type IV and, to a lesser extent, in EDS type I may also demonstrate the periodontitis as oral manifestation
26
Ehlers-Danlos Syndrome perio dx
Generalized, early-onset severe periodontitis and gingival recession Early loss of the primary and permanent teeth
27
Hypophosphatasia mutation? forms? affects on dentin/cementum?
Alcaline phosphatase (ALPL) gene mutation Mild form and severe form Dentin is not affected with defective cementum
28
Hypophosphatasia oral effects: Impaired? Defects in? Compromised? result? The teeth are not? Alveolar bone/teeth loss?
Impaired bone/tooth mineralization Defects in root cementum Compromised periodontal attachment, reduction in alveolar bone height The teeth are not adequately anchored to the alveolar bone via the PDL Alveolar bone loss and premature loss of teeth
29
Osteoporosis
Postmenopausal women with osteoporosis or osteopenia exhibit greater loss of periodontal attachment compared with women with normal bone mineral density.
30
Osteoporosis flow chart
31
osteoperosis and periodontitis relation
Both are bone resorptive diseases
32
osteoperosis and periodontitis relation radiographs
Higher prevalence and severity of radiographic alveolar bone loss No clear association with probing depth or clinical attachment loss
33
Diabetes Mellitus
An important risk factor for periodontal diseases Associated with significantly higher prevalence and severity of periodontitis. A disorder of glucose metabolism
34
DM I vs II
35
what is accumulated in DM? result of this?
Accumulation of AGEs (advanced glycation end products) AGEs - RAGE (Receptor of AGEs) interaction
36
Diabetes Mellitus and perio dx
Diabetes as a risk factor for periodontal disease Increased prevalence and severity of attachment loss
37
DM perio abcesses
Periodontal abscess may be a common complication 58.6% of patients having periodontal abscesses had HbA1c ≥6.5%
38
DM and perio dx relation
Periodontal disease as a complicating factor for Diabetes Periodontitis ALSO affects glycemic control
39
Obesity Metabolic syndrome including: Adipose tissue effect key factor of pathophys?
Metabolic syndrome: Hypertension, Hyperglycemia, Obesity, and dyslipidemia Adipose tissue is a complex organ secrets numerous endocrine mediators Rather than the amount of fat mass, adipose tissue dysfunction may be the key factor in pathophysiology
40
obesity immune effects: * Cross-talk? * release of? * Decreased activity? * Impaired function?
* Cross-talk between T cells and adipose tissue * Increased releasing myriad proinflammatory cytokines and chemokines * Decreased phagocytic activity * Impaired antigen presentation
41
Obesity and inflammation progression
42
Obesity factors
Environmental Factors (Eg. smoking, nutrition, physical activity) Genetic Factors
43
what is eleveated in synthesis in obesity. perio dx
Elevated synthesis of inflammatory cytokines TNF-a, IL-1, IL-6
44
chronic dx associated with obesity (and perio dx)
Eg. Type-2 DM, Coronary heart disease (CHD)
45
Acquired Immunodeficiency Diseases
Acquired neutropenia HIV infection
46
Acquired Neutropenia mechanism
*Caused by autoimmune disease, cytotoxic chemotherapy or other drug or idiopathic etiology *Due to decreased production or increased destruction of granulocytes
47
Acquired Neutropenia risk for perio dx
increased risk for infections and periodontitis correlated with severity of neutropenia
48
acquired neutropenia possible forms of diagnosis
ANC < 1500 cell/uL: mild < 1000 cell/uL: moderate < 500 cell/uL: severe
49
HIV mechanism
Deficiency of the immune system due to infection with the HIV virus
50
HIV increased risk for?
Increased risk for opportunistic infections, neoplasms (eg. kaposi sarcoma)
51
diagnosis HIV
Depends on the stage of infection *Test HIV antibody/p24 antigen and PCR-based HIV
52
Inflammatory Diseases
Epidermolysis bullosa acquisita Inflammatory bowel disease Reumatoid arthritis
53
Epidermolysis Bullosa Acquisita The presence of autoantibodies against? form? (mimics?) Recurrent formation? Immunofluorescence on?
The presence of autoantibodies against type VII collagen (Mechanobullous type) Inflammatory form (mimic pemphigoid) Recurrent blister formation Immunofluorescence on basement membrane zone - split skin
54
Epidermolysis Bullosa Acquisita oral findings gingiva? Alveolar bone? teeth?
Generalized gingival inflammation and enlargement, gingival recession, alveolar bone loss, and mobile teeth
55
Inflammatory Bowel Disease
Hypersensitivity of immune response
56
Inflammatory Bowel Disease oral effects
Inflammation and alveolar bone loss in a susceptible host Increased prevalence and severity of periodontitis
57
Rheumatoid Arthritis
Chronic auto-inflammatory disease
58
RA oral effects Increased risk for? Biological link?
Increased risk for loss of periodontal attachment, alveolar bone Biological link between rheumatoid arthritis and periodontitis
59
what non-dx factors can influence perio dx by influencing pathogenesis
Stress/depression Smoking Medications for malignancies, anti-inflammatory agents, bisphosphonates
60
Stress and perio dx
61
smoking results
4x Attachment loss Leukoplakia Carcinoma Gingival recession Tooth loss
62
smoking effects flow chart
63
Chronic nicotine exposure effect on IS what cells are affected? Process affected? result?
d
64
nicotine and tar effects flow chart
both from smoking
65
Bisphosphonates
Treat cancer (IV administration) Treat osteoporosis (oral administration) Inhibit osteoclast activity and interfere with bone turnover
66
Bisphosphonates effects on alveolar bone/osteonecrosis
67
Can dx affect the periodontium independent of bio-film-induced inflammation?
affecting the periodontal supporting tissues independently of dental plaque biofilm‐induced inflammation.
68
independent etiologies of perio dx
direct effect on the periodontium without regard to biofilm
69
possible independent etiologies
* Neoplasms * langerhans cell histiocytosis * giant cell granuloma, * hyperparathyroidism * systemic sclerosis
70
Neoplasms
Neoplastic diseases of periodontal tissue * Oral squamous cell carcinoma * Odontogenic tumors * Other primary neoplasms of periodontal tissue * Secondary metastatic neoplasms of periodontal tissue biopsy when suspicious
71
Langerhans cell histiocytosis * Peripheral small vessel effect? * impairment where? * gingiva? * Alveolar bone?
* Peripheral small vessel necrotizing vasculitis * Respiratory and renal impairment * Characteristic fiery and hyperplastic gingival inflammation * Alveolar bone loss
72
Giant cell granuloma
Reactive proliferation, benign lesion No systemic features
73
Peripheral giant cell granuloma
*Expanding epulis-like gingival swelling *Occasional loss of periodontal supporting tissue should bne biopsy
74
Central giant cell granuloma
*Loss of periodontal supporting tissue *May expand toward marginal periodontal tissue should also be biopsy
75
Hyperparathyroidism forms
Primary : benign adenoma of parathyroid glands Secondary: result of hypocalcemia Tertiary: parathyroid hypertrophy following 2o type
76
hyperPTH oral effects lesions? PDL?
Widening PDL, single/multiple osteolytic lesions in the jaw that mimic periodontal bone loss (brown tumors)
77
Systemic sclerosis (scleroderma)
Autoimmune disease of the connective tissues Many different systemic presentations
78
sys sclerosis oral effects
Widening PDL and higher prevalence of periodontitis
79
sys sclerosis sign/ screening
Raynaud phenomenon Autoantibody screening
80
bisphosphonate t1/2
10yrs

PERIO I (13 decks)

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