Endocrine influence on periodontium


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Endocrine influence on periodontium

  1. 1. Endocrine influence on periodontium Dr. Guru Ram (P.G) Dept of Periodontics
  2. 2. Introduction Endocrine system Central endocrine glands Hypothalamus Pituitary gland
  3. 3. Hypothalamus Homeostasis Regulation Hormones
  4. 4. Pituitary gland Regulation Hormones
  5. 5. Source Hypothalamus Anterior pituitary Thyroid Adrenal Pancreas Parathyroid Hormone Target tissue Principle function Periodontium Prolactin inhibiting hormone Anterior pituitary gland Inhibits prolactin Stimulates periodontal ligament (dopamine) release cell proliferation Growth hormone Bone, soft tissues and Promotes growth, Presence of growth hormone (somatotropin) liver affects lipids and associated with protective carbohydrate effect on periodontium metabolism Thyroid hormones (tri Most cells of body Regulators of Deficiency may be associated iodothyrosine, thyroxine) numerous tissues with destructive periodontal including cardiac diseases and brain involved with growth and metabolism Cortisol, Most tissues of body Important for Excess cortisol associated with Weak androgens and estrogens Sex accessory tissues glucose, protein and destructive periodontal diseases lipid metabolism Known effects on periodontal Low potency of tissues including growth as secreted hormones well as disease progression diminishes effects on target tissues Insulin (β cells) Skeletal muscle, liver, Lowers the blood Decreased insulin production adipose tissue glucose, fatty acid associated with destructive and amino acid periodontal diseases levels Parathyroid hormone Bone, kidneys, Increases plasma Decreased cortical bone density intestine calcium and increased PDL width no effect on periodontal parameters
  6. 6. Effects of central endocrine gland hormones on the periodontium Britto et al 2011- LIMITED EVIDENCE M. Partovi et al in 2002
  7. 7. Mechanism proposed L- DOPA Stimulates Dopaminergic systems in the anterior position of hypophysis To release Growth hormone Promoter of healing process
  8. 8. Peripheral Endocrine glands
  10. 10. Peripheral endocrine glands Adrenal gland hormones The hormones produced by the adrenal cortex include mineralo- carticoid hormones e. g., Aldosterone, Glucocorticoid, hormones e. g., cortisol, gonodal hormones e. g., dehydro-epi-androsterone
  11. 11. Effects of adrenal gland hormones on the periodontium Association between elevated cortisol levels and periodontitis were demonstrated by clinical studies by Rosania et al and Rai et al in 2009 and 2011. By Potential psycho-neuro-immunologic mechanism Potential behavioural mechanism
  12. 12. Potential psycho-neuro-immunologic mechanism Negative emotion Polypeptides from sympathetic nor adrenaline transmitting and sensory nerve fibres and from endocrine glands + Bacterial antigens trigger immune responses Hypothalamus release corticotropic hormone Adreno-carticotropic hormone from pituitary Adrenal cortex release Cortisol
  13. 13. Short term elevations of cortisol reduce inflammation and mobilize immune components Glucocorticoids(cortisol) Decreases immunocompetency by inhibition of IgA, IgG and neutrophil function.
  14. 14. Potential behavioural mechanism The higher cortisol and β endorphin concentrations significantly up regulates expression of MMP-1,2,7,11 and TIMP-1 in human gingival fibroblasts Increased periodontal breakdown Periodontitis Patricia et al 2007
  15. 15. • Various kinds of psychologic stress activate HPA(hypothalamus Pituitary Aderno cortical) system and SM(sympathetic aderno medullary) system and consequently induce significant increases in salivary cortisol and catecholamine levels respectively • Chromagranin A released by exocytosis from the sympathetic nerve endings
  16. 16. Thyroid hormone Effect of thyroid hormone on periodontium:
  17. 17. Parathyroid gland hormone Hormones- parathormone
  18. 18. Ca- Regulation The resorption of calcium from bones by PTH is by Rapid phase Slow phase
  19. 19. Rapid phase After reaching bone PTH gets activated to receptors on cell membrane of osteoblasts and osteoclasts Hormone receptor complex Increases permeability of membranes of these cells for ca-ions Accelerates ca-pump mechanism Ca-ions move to bone cells into blood at faster rate
  20. 20. Slow phase When Osteoclasts are activated by PTH Lysosomes release enzymes and citric acid and lactic acid These substances dissolve organic matrix of bone releasing ca ions Ca ions release to plasma
  21. 21. Effect of parathyroid gland hormone on periodontium Primary hyperthyroidism Secondary hyperthyroidism Suggested as therapeutic aid Lindhe et al
  22. 22. Sex steroid hormones
  23. 23. Action of sex steroid hormones on periodontium Sex steroid hormones Microbiota immune cells Cells of the periodontium Altered gene expression Changes in clinical phenotype
  24. 24. Proposed mechanisms Sex steroid induced increase in specific microbiota kumare et al in 2013 Immune endocrine interactions exaggerate periodontal responses Shiau, Reynolds in 2010 Specific populations of fibroblasts and epithelial cells are modulated by sex steroid hormones: Mariotti. In 1994
  25. 25. Sex steroid hormones and the cells of periodontium Hormone Androgens (testosterone & hydrotestosterone) Progesterone Estradiol Fibroblasts Decrease proliferation Decrease IL-6 production Decrease proliferation Decrease protein synthesis Decrease cytokine production Increase proliferation Increase cytokine production Increase growth factor
  26. 26. Factors influencing sex hormones on periodontium Gender Age Hormone supplements
  27. 27. Gender Studies by Lau et al 2001 showed that gender plays an important role in changes associated with bone density throughout the entire skeleton. It was showed that 80% of decreased bone density patients were females.( 80% osteoporotic patients were females)
  28. 28. Regarding periodontal anatomic differences: Residual ridge height was lower in women compared to men + decreased amount of estrogen in post menopausal women was associated with decreased crestal/subcrestal bone density
  29. 29. Age With regard to age, females undergo more biologic changes (hormonal imbalances) compared to males such as during puberty, menstrual cycle, pregnancy, menopause
  30. 30. Hormone supplements These are common used drugs that stimulates a state of pregnancy to prevent ovulation. HRT has helped in overcoming bone loss in menopausal women, it also has been associated with side effects like thromboembolism, irregular bleeding, fear of cancer,.
  31. 31. Longitudinal studies have examined the transformation of subgingival flora from pre puberty to puberty and have demonstrated a significant increase in the frequency of Eikenella corrodens, Prevotella intermedia, Bacteroides melaninogenicus , Prevotella nigrescens,
  32. 32. Etiology of gingival responses to elevated estrogen & progesterone during pregnancy Subgingival plaque composition Maternal immuno-response. Sex hormone concentration
  33. 33. Pancreatic hormones Effect of pancreatic hormones on periodontium The metabolic disturbances and the resulting disease sequallae of diabetes mellitus are ultimately the result of a complete or partial reduction in insulin secretion from the β cells
  34. 34. Oral manifestations Oral changes described in diabetic patients including Cheilosis Mucosal drying Cracking Burning mouth and tongue Diminished salivary flow Altered oral cavity flora
  35. 35. Complications of diabetes mellitus
  36. 36. Mechanisms of diabetic influence on periodontium These are primarily related to changes in GCF glucose level Periodontal vasculature Collagen metabolism. The subgingival microbiota
  37. 37. CONCLUSION
  38. 38. References Newmann, Takei, Klokkevold, Fermin A Carranza: Carranza’s clinical Periodontology: 10th Ed: Saunders, Elsevier Britto IM et al , JCP 2011 :38:525-531 Partovi et al. Mitogenic effect of L dopa on human periodontal ligament fibroblast cells: Jour of Endodontics. Vol 28(3): 193-196 Eriksen. Cellular mechanism of bone remodelling: Rev Endocr. Metab Disord 2010: 11: 219-227 Amy Romania et al: stress, depression, cortisol and periodontal disease. J periodontol 2009: 80: 260-266 Depression: Psychiatric clinics of North America. March 2012: 35: 1
  39. 39. references… Glassman et al: where there is depression there is inflammation. Biol Psychiatry 2007: 62: 280 Kaufman et al: Analysis of saliva for periodontal diagnosis- A review: JCP 2000: 27: 453-465 Johanssen et a: Dental plaque, gingival inflammation and elevated levels of IL-6 and cortisol in GCF from women with stress related depression and excusion: J Periodontol 2006:77: 1403 Balwanth Rai et al: salivary stress markers, stress and periodontitis: A pilot study . J Periodontol 2011: 82: 287-292 Patricia R Cury et al: hydrocortisone affects the expression of MMP1,2,3,7,11 and tissue inhibitor of matrix metalloproteinases TIMP-1 in human gingival fibroblasts: J Periodontol 2007: 78: 1309-1315 Peruzzo et al. Systemic review of stress and psychological factors as possible risk factors for periodontal disease. J Periodontol 2007: 78: 1491-1504
  40. 40. references… Persson RE, Hollender et al. assessment of periodontal conditions and systemic disease in older subjects. Focus on osteoporosis: J Clin Periodontol 2002: 29: 796-802 Frankenthal S et al: the effect of the secondary hyperthyroidism and hemodialysis therapy on alveolar bone and periodontium: J Clin Periodontol 2002: 29: 479-483 Barros et al: parathyroid hormone protects against periodontitis associated bone loss: J Dent Res 2003: 83: 791 Marriotti A: Sex steroid hormones and cell dynamics in the periodontium. Crit Rev Oral Biol Med 1994:5:27-53 Liang et al: effect of estrogen receptor β on osteoblasticdifferentiation function of human periodontal ligament cells: Arch Oral Biol 2008: 53: 553-557 Tang et al: Up regulation of estrogen receptor β expression during osteogenic differentiation of human periodontal ligament cells. J Periodontol Res ;2008: 43: 311-321
  41. 41. references… Lindhe et al : influence of sex hormones on gingival exudation in dogs with chronic gingivitis: J Periodontol Res: 3 :279-283 Kumare et al: sex and the subgingival microbiome: do female sex steroids effect periodontol bacteria Perio 2000: 2013: 103 Shiau, Reynolds: sex differences in destructive periodontal disease: exploring the biologic basis. J Periodontol 2010: 81: 1505-1517 Mariotti. Sex steroid hormones and cell dynamics in the periodontium: Crit Rev Oral Biol Med 1994: 5: 27-53 Mariotti AJ. Estrogen and extracellular matrix influence human gingival fibroblast proliferation and protein production. J Periodontol 2005: 76: 1391-1397 Lapp CA, Thomas et al. Modulation by progesterone of Interleukin-6 production by gingival fibroblasts. J Periodontol 1995: 66: 279-284 Loe H: Periodontal disease: the sixth complication of diabetes mellitus: Diabetes Care: 1993: 16: 329