6. 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
7. Effects of central endocrine gland
hormones on the periodontium
Britto et al 2011- LIMITED EVIDENCE
M. Partovi et al in 2002
11. 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
12. 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
13. 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
14. Short term elevations of cortisol reduce inflammation and mobilize
immune components
Glucocorticoids(cortisol)
Decreases immunocompetency by inhibition of IgA, IgG and
neutrophil function.
15. 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
16. • 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
20. 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
21. 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
22. Effect of parathyroid gland hormone on
periodontium
Primary hyperthyroidism
Secondary hyperthyroidism
Suggested as therapeutic aid
Lindhe et al
24. Action of sex steroid hormones on
periodontium
Sex steroid hormones
Microbiota
immune cells
Cells of the periodontium
Altered gene expression
Changes in clinical phenotype
25. 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
26. 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
28. 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)
29. 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
30. Age
With regard to age, females undergo more biologic changes
(hormonal imbalances) compared to males such as during
puberty, menstrual cycle, pregnancy, menopause
31. 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,.
32. 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,
33. Etiology of gingival responses to elevated
estrogen & progesterone during pregnancy
Subgingival plaque composition
Maternal immuno-response.
Sex hormone concentration
34. 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
35. Oral manifestations
Oral changes described in diabetic patients including
Cheilosis
Mucosal drying
Cracking
Burning mouth and tongue
Diminished salivary flow
Altered oral cavity flora
37. Mechanisms of diabetic influence on
periodontium
These are primarily related to changes in
GCF glucose level
Periodontal vasculature
Collagen metabolism.
The subgingival microbiota
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