Hormonal changes occur throughout the entire life cycle of women. This presentation enlightens us about the impact of the endocrine influences on the oral and periodontal tissues. It thus becomes important for the clinician to identify and modify the periodontal therapy according to the hormonal stages of women.
PERIODONTAL THERAPY IN FEMALE PATIENTS Presented by- Dr. Himanshu gorawat Dr. Himanshu Gorawat
Throughout a human life cycle hormonal influences affect therapeutic decision making in periodontics. Historically therapies have been gender biased.
Oral health care professionals have greater awareness and capabilities of dealing with hormonal influences associated with reproductive process.
Periodontal and oral tissue responses may be altered, creating diagnostic and therapeutic dilemmas.
Therefore it is imperative that the clinician recognizes customize and appropriately alter periodontal therapy according to the individual woman’s needs based on the stage of her life cycle.
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
The defense mechanism of gingiva includes GCF, Saliva, epithelial barrier and connective tissue cells. All these protect the periodontium from bacterial invasion.
Host modulation therapy is recommended as an adjunct to scaling and root planing in the periodontal therapy. The basic purpose of host modulation therapy is to restore the balance between pro-inflammatory and anti-inflammatory mediators.
PERIODONTAL THERAPY IN FEMALE PATIENTS Presented by- Dr. Himanshu gorawat Dr. Himanshu Gorawat
Throughout a human life cycle hormonal influences affect therapeutic decision making in periodontics. Historically therapies have been gender biased.
Oral health care professionals have greater awareness and capabilities of dealing with hormonal influences associated with reproductive process.
Periodontal and oral tissue responses may be altered, creating diagnostic and therapeutic dilemmas.
Therefore it is imperative that the clinician recognizes customize and appropriately alter periodontal therapy according to the individual woman’s needs based on the stage of her life cycle.
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
The defense mechanism of gingiva includes GCF, Saliva, epithelial barrier and connective tissue cells. All these protect the periodontium from bacterial invasion.
Host modulation therapy is recommended as an adjunct to scaling and root planing in the periodontal therapy. The basic purpose of host modulation therapy is to restore the balance between pro-inflammatory and anti-inflammatory mediators.
A brief description of all topics to recent advances,SDD, host modulation and diabetes, host modulation in smokers, chemically modified tetracyclines, bisphosphonates
Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
ROS is a substractive method of having positive bone architecture. it includes osteotomy and ostectomy procedures. osteotomy is to remove non supporting bone and ostectomy is to remove supporting bone for having positive bony architecture. there is definitive osseous surgery and compromise osseous surgery. transgingival probing is a method of determining osseous topography. various hand and rotary instruments are use for this procedure.
Dentists play an important role in the diagnosis and management of desquamative gingivitis. The importance of being able to recognise and properly diagnose this condition is accentuated by the fact that a serious and life threatening disease may initially manifest as desquamative gingivitis.
Periodontitis is a complex infection initiated by bacteria –tissue destruction.
Host: the organism from which a parasite obtains its nourishment/ an individual who receives a graft
Modulation: the alteration of function or status of something in response to a stimulus or an altered physical or chemical environment
A brief description of all topics to recent advances,SDD, host modulation and diabetes, host modulation in smokers, chemically modified tetracyclines, bisphosphonates
Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
ROS is a substractive method of having positive bone architecture. it includes osteotomy and ostectomy procedures. osteotomy is to remove non supporting bone and ostectomy is to remove supporting bone for having positive bony architecture. there is definitive osseous surgery and compromise osseous surgery. transgingival probing is a method of determining osseous topography. various hand and rotary instruments are use for this procedure.
Dentists play an important role in the diagnosis and management of desquamative gingivitis. The importance of being able to recognise and properly diagnose this condition is accentuated by the fact that a serious and life threatening disease may initially manifest as desquamative gingivitis.
Periodontitis is a complex infection initiated by bacteria –tissue destruction.
Host: the organism from which a parasite obtains its nourishment/ an individual who receives a graft
Modulation: the alteration of function or status of something in response to a stimulus or an altered physical or chemical environment
The GDG stresses that the four-visit focused ANC (FANC) model does not offer women adequate contact with health-care practitioners and is no longer recommended. With the FANC model, the first ANC visit occurs before 12 weeks of pregnancy, the second around 26 weeks, the third around 32 weeks, and the fourth between 36 and 38 weeks of gestation
This presentation deals with information regarding a minor disorder of pregnancy i.e hyperemesis gravidarum, its manifestations, causes, diagnostic evaluation,complications, management, nursing interventions etc.Though its a minor disorder, delayed treatment can be fatal.
Hyperemesis Gravidarum - Disorder of PregnancyJaice Mary Joy
Hyperemesis gravidarum is characterized by severe nausea and intractable vomiting sufficient to interfere with maternal nutrition causing deleterious effect on her health. It has got deleterious effect on health of the patient and incapacitates her day-to-day activities. According to the national health portal 0.3%-3% pregnant women suffer from hyperemesis gravidarum – commonest indication for hospitalization in the first trimester of pregnancy.
This document covers following topics -
• Introduction
• Definition
• Prevalence
• Etiology
• Risk factors
• Theories behind hyperemesis gravidarum
• Symptoms:
• Signs
• Investigation
• Diagnosis
• Complications
• Prevention
• Management principles
• Nursing management
nausea and vomiting in pregnancy is very common. it may be a manifestation of some medical - surgical - gynecological complications. hyperemesis gravidarum is a severe type of vomiting in pregnancy which has got deleterious effects on the health of the mother. it is a very important topic and it is also a topic in obstetrics. we should encourage and help young mothers to identify the symptoms. please read it and get knowledge about nausea and vomiting in pregnancy. stay tuned.
Periodontal pocket is a pathologically deepened gingival sulcus. There are two types of pockets - gingival pocket and periodontal pocket. The periodontal pocket formation is the first step in the periodontal destruction. It is important to understand the etiopathogenesis of the periodontal pocket formation for appropriate diagnosis and treatment planning.
Majority of HIV infected individuals show oral manifestations of infection. Early diagnosis and treatment will improve the lifespan of HIV infected individuals.
Smoking is a major environmental risk factor associated with Periodontitis. Cessation of smoking is essential to prevent the progression of periodontal disease and for maintenance of health.
Dental caries is the major dental disease affecting a large population. Cariostatic efficacy of the fluorides have increased the use of fluoride agents. This presentation will enlighten us about the use of fluorides in preventive dentistry.
Halitosis is derived from a Latin word which means unpleasant breath. If not treated, it could affect your social life. Majority of the cases of halitosis have oral origin. Therefore, appropriate dental treatment eliminates the cause.
Vitamins & minerals are essential for the development and functioning of the organism. Maintaining a healthy life will help in maintaining a healthy mouth since poor health is a link to diseases.
Radiographs play an important role in the diagnosis and treatment of periodontal diseases. They provide important information regarding the anatomical structures and periodontal bone loss.
Acute periodontal diseases are clinical conditions of rapid onset that involve the periodontium. They are characterised by discomfort or pain and infection. They require urgent attention which involves prompt diagnosis and treatment to prevent the further destruction.
Periodontal abscess is a localised purulent infection in the tissues adjacent to the periodontal pocket that may lead to the destruction of the periodontal ligament and alveolar bone. Periodontal abscess is the third most prevalent emergency infection after acute alveolar abscess and pericoronitis. It could lead to complications due to bacteremia that may cause infection at distant locations. Proper management of the abscess is crucial to alleviate pain, establish drainage and control the spread of infection.
The cementum is a specialised calcified substance covering the root of the tooth. The cementum is a part of the periodontium that attaches the teeth to the alveolar bone by anchoring the periodontal ligament. This presentation covers the anatomy and pathologies associated with the cementum.
The gingiva may be involved in many of the local and systemic conditions. This presentation provides a review of the common pathological conditions affecting the gingiva and the diagnosis and the management associated with each of the conditions.
Every periodontal surgical procedure has its own indications. With proper knowledge of the etiology of the disease, correct diagnosis and treatment planning, the clinician is able to draw predictable success with periodontal flap surgery.
The future of dentistry and periodontics lies in regeneration. The goals of periodontal therapy lies in not only the arrest of periodontal disease progression but also regeneration of the lost periodontal structures. This presentation provides a review of the current understanding of the regeneration of the periodontium and the procedures involved to restore the periodontal tissues around the teeth.
The main objective of periodontal surgery is to achieve health and integrity of the periodontium by plaque removal and plaque control. Patient preparation is an important aspect of the intervention. The presentation mentions certain principles of periodontal surgery which are crucial for effective treatment of the patient.
DENTIN HYPERSENSITIVITY - ETIOLOGY, DIAGNOSIS AND TREATMENTDr.Shraddha Kode
Dentinal Hypersensitivity is a common clinical condition which is sharp in character and of short duration in response to stimuli. It is associated with exposed dentin surfaces. This presentation provides a brief overview - its etiology, diagnosis and treatment.
Biologic width - Importance in Periodontal and Restorative DentistryDr.Shraddha Kode
Biologic width plays a vital role for preservation of the periodontal health. This concept involves the dimensions of the epithelial and connective tissue attachment between the base of the sulcus and the alveolar crest which if involved can lead to gingival inflammation and gingival recession.
Bone Morphogenetic Proteins - Role in Periodontal RegenerationDr.Shraddha Kode
BMP's are the multifunctional growth factors extensively studied throughout the years. It has recently gained a lot of interest as therapeutic agents in periodontal regeneration.
Nicotine Replacement Therapy (NRT) can help with the withdrawal symptoms in patients who find it difficult to quit tobacco. It is available in the form of - gums, patches, sprays, inhalers or lozenges.
Platelet Rich Fibrin (PRF) is an autologous fibrin based biomaterial derived from human blood discovered by Choukroun and coworkers in the year 2006. The future of PRF has enormous therapeutic implications. Therefore, more clinicians should adopt this technology for the benefit of the patients.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
3. PUBERTY
• Average ages of 11 to 14 yrs
• ESTROGEN PROGESTERONE Later remains relatively constant
• Prevalence of gingivitis without an increase in the amount of plaque
• Association with P. intermedia
• Substitute for Vitamin K growth factor (KORNMAN & LOESCHE 1979)
4. • Association with Capnocytophaga Increased bleeding tendency
• Other organisms – Motile rods
Spirochetes
P. nigrescens
F. nucleatum
A. actinomycetemcomitans
5. • Periodontal tissues have exaggerated response to local factors
• Inflamed tissues become erythematous, lobulated and retractable
• Bleeding occurs easily
During reproductive years, women tend to have a vigorous and
strong immune response.
Allergy, sensitivity, and asthma occur more often in young men,
but after puberty, women become more susceptible than their
male counterparts.
6. MANAGEMENT
MILDER
GINGIVITIS:
Respond well to
SRP with
frequent OHI
reinforcement
SEVERE
GINGIVITIS:
•May require
microbial culturing,
antimicrobial
mouthwashes,
LDD or antibiotic
therapy
CHRONIC
REGURGITATION
OF GASTRIC
CONTENTS:
Perimolysis
Enlargement of
parotid glans
(occassionally
sublingual glands)
BULLIMIA &
ANOREXIA
NERVOSA:
•Referral to
physician
•Nutritional and
vitamin
supplements req
DIMINISHED SALIVARY FLOW RATE:
Increased oral mucous membrane sensitivity, gingival erythema and caries risk
7. MENSES
ANTERIOR
PITUITARY
FSH & LH
ESTROGEN &
PROGESTERONE
PREPARE UTERUS FOR
IMPLANTATION OF EGG
FOLLICULAR PHASE
FSH elevated
Estradiol peaks 2 days before
ovulation
Stimulates egg to move down
fallopian tubules and proliferation
of endometrium
LUTEAL PHASE
Corpus luteum synthesises
estradiol and progesterone
Rebuilding of endometrium for
implantation of egg
CORPUS LUTEUM INVOLUTES
HORMONE LEVELS DROP
MENSTRUATION ENSUES
8. BASED ON A 28 DAY CYCLE PROGESTERONE
INCREASES FROM SECOND WEEK AND DROPS
BEFORE MENTRUATION
9. • Ovarian hormones exaggerate the response to local irritants
• Fluctuation of TNF-α, elevated PGE-2 synthesis, angiogenetic and growth factors
• Increase gingival inflammation
PROGESTERONE
INCREASED PERMEABILITY
ALTERED COLLAGEN PRODUCTION &
IMMUNE RESPONSE
ESTROGEN
INCREASED PROLIFERATION,
DIFFERENTIATION AND
KERATINISATION OF ENDOMETRIUM
10. • Gingival tissues appear to be more edematous during menses and erythematous
before the onset of menses
• Increase in gingival exudate and bleeding
• Minor increase in tooth mobility
• Lab findings Slightly reduced platelet count and slight increase in clotting time
• Highest progesterone level (luteal phase) intraoral recurrent aphthous
ulcers,herpes labialis lesions and candidal infections occur in cyclic pattern
• Progesterone relaxes esophageal sphincter GERD
11. • Peak level of progesterone 7 to 10 days before menstruation
• No significant levels of estrogen progesterone
• But, lower levels of neurotransmitters enkephalins, endorphins,
GABA and serotonin
• Depression, irritability, mood swings, difficulty with memory and concentration,
heightened gag reflex, exaggerated response to pain
PRE MENSTRUAL
SYNDROME
70% have
PMS symptoms, but
only 5% meet the strict
diagnostic criteria.
12. • Periodontal maintenance titrated to individual patient’s needs
• Antimicrobial oral rinse before cyclic inflammation
• For patient with history of excessive postoperative hemorrhage or menstrual flow
Schedule surgical visits after cyclic menstruation
• Anemia is common Appropriate consultation req
• Fluoride rinses and trays, frequent periodontal debridement and avoidance of
mouthwashes with high alcohol content may reduce the associated gingival and caries
sequelae.
MANAGEMENT
13. • PMS is often treated by antidepressants
• SSRIs are generally the first-line choice because they have fewer side effects than
other antidepressants, do not require blood monitoring, and are safe in overdoses
• The PMS patient may be difficult to treat because of emotional and physiologic
sensitivity
• Treat the gingival and oral mucosal tissues gently. Gauze pads or cotton rolls should
be moistened with a lubricant, chlorhexidine rinse or water before placing them in the
aphtha-prone patient
• Careful retraction of the oral mucosa, cheeks, and lips is necessary in patients prone
to aphthous or herpetic lesions
• Because the hypoglycemic threshold is elevated, the clinician should advise the patient
to have a light snack before her appointment
14. • GERD may make it more uncomfortable for the patient to lay fully supine, especially
after a meal and the woman may have a more sensitive gag reflex
• Clinician should be aware that NSAIDs and acidic foods exacerbate GERD and
interact with some antibiotics and antifungals
15. PREGNANCY
• 1778 Vermeeran Tooth pains in pregnancy
• 1818 Pitcarin Gingival hyperplasia in pregnancy
• Current research Periodontal disease may alter the systemic health - Risk
for low birth weight, pre-term infants
• 1877 Pinard First case of “pregnancy gingivitis”
• Occurence 30 – 100% (HASSON 19966 & LUNDGREN ET AL 1973)
16. • ANTERIOR INTERPROXIMAL (DE LIEFDE 1984)
• Erythema, edema, hyperplasia, increased bleeding, increased pocket depths and
transient tooth mobility
• Gingiva 70% followed by tongue, lips, buccal mucosa and palate
• Anterior site inflammation may be exacerbated by increased mouth breathing in the
third trimester from pregnancy rhinitis
17. • PYOGENIC GRANULOMAS = PREGNANCY TUMOR = PREGNANCY EPULIS – 0.2
TO 9.6%
• Second or third month of pregnancy
• Clinically bleed easily, hyperplastic and nodular
• Purplish red to deep blue
• Sessile or pedunculated and ulcerated
• Associated with poor oral hygiene and calculus
• Alveolar bone loss is usually not associated with it
18. • Associated with increase in B.melaninogenicus and P.intermedia (2.2 to 10.1%)
• Offenbacher et al Untreated periodontal disease in pregnant women may be a
significant risk factor for preterm (<37 weeks of gestation), low birth weight (<2500g)
infants
• TRANSMISSION
• Pre-eclampsia Late pregnancy Associated with hypertension and excess
urine protein
19. • MATERNAL IMMUNORESPONSE Supressed during pregnancy so fetus is
allowed to grow as an allograft
• High concentrations of sex hormones found in gingival tissues (due to specific
receptors), saliva, serum and GCF
Cell mediated immunity
Neutrophil chemotaxis
Antibody and T cell responses
CD4/CD8 ratio
Prostaglandins
SUSCEPTIBILITY TO GINGIVAL
INFLAMMATION
20. • OTHER ORAL MANIFESTATIONS
PERIMOLYSIS
Due to morning
sickness and
esophageal reflux
XEROSTOMIA
El-Ashiry G et al
1970: Persistent
dryness in 44% of
pregnant patients
PTYALISM OR
SIALLORRHOE
A
Begins at 2 to 3
weeks of gestation
and ends at 1st
trimester
Etiology: Inability
to swallow normal
amounts of saliva
IMMUNOCOMPROMISE
D STATE
Gestational
diabetes, leukemia
or other conditions
may appear
21. MANAGEMENT
• A thorough medical history is prudent
• Maintaining optimal oral hygiene, nutritional counselling and rigorous plaque control
measures
• Increased gingival inflammation tendency during pregnancy should be explained to the
patient
• Non- alcohol based oral rinses to be preferred
• ADA does not recommend use of prenatal fluoride because its efficacy has not been
demonstrated
22. TREATMENT
• ELECTIVE DENTAL TREATMENT
• AVOID dental care during 1st and last half of 3rd trimester
• Prolonged chair time to be avoided
• Early in 2nd trimester (14-20 weeks of gestation) is the safest period for routine dental
care
• Major oral or periodontal surgery to be postponed after delivery
• Pregnancy tumours that are painful, interfere with mastication, continue to bleed or
suppurate after mechanical debridement may require excision and biopsy before
delivery
23. • SUPINE HYPOTENSIVE SYNDROME
• Preventive 6 inch soft wedge placed on patient’s right side
24. • DENTAL RADIOGRAPHS
• No irradiation during pregnancy especially 1st trimester because developing foetus is
susceptible to radiation damage
• When radiograph needed Protective lead apron to be used since gonadal and
fetal irradiation is immeasurable
25. • MEDICATIONS
• Ideally no drug should be administered during pregnancy. But it is virtually impossible
to adhere to this rule
• Drug therapy in pregnant patients is controversial because drugs can affect fetus by
placental diffusion
• According to FDA Drug Classification 1979 Category A and B drugs can be
prescribed, Category C drugs are given with caution, Category D drugs are avoided
and Category X drugs are contraindicated
27. BREAST-FEEDING
• Risk that the drug can enter breast milk and transferred to nursing infant in whom
adverse effects may appear
• But, little conclusive information
• Amount of drug excreted in breast milk 1% to 2% of maternal dose
• Hence most unlikely that most drugs can have pharmacologic effects on infant
Mother should take drugs just after breast-
feeding and avoid nursing for 4 hours or more to
decrease drug concentration in breast milk
28. MENOPAUSE
• No. of oocytes reduce steadily throughout a woman’s life
• Estrogen progesterone deficiency due to absent corpus luteum function
• PERIMENOPAUSE FSH LH
• OVARIAN UNRESPONSIVENESS
• SPORADIC OVULATION
• Median age for menopause is 50 years
29. • ORAL CHANGES
• Thinning of oral mucosa (Estrogen deficiency causes decrease in collagen formation in
CT. Hence decrease in skin thickness)
• Oral discomfort (Burning mouth)
• Altered taste sensation
• Xerostomia
• Gingival recession
• Alveolar bone loss
• Alveolar ridge resorption
30. • OSTEOPENIA OSTEOPOROSIS
• Peak bone mass in women occurs during 20 to 30 years of age. Menopause
accelerates the declining bone loss
• Association between post-menopausal primary osteoporosis with bone loss, tooth loss,
ridge atrophy is probable and inconclusive. Also effect of HRT on oral bone loss and
tooth loss is under investigation
• KRALL ET AL 1998 Odds of being edentulous were reduced by 6% for each 1
year increase in duration of HRT use
• KAYE EK 2007 Research supports that osteoporosis independantly influences
alveolar bone loss and that strategies for reducing osteoporosis may help retard
alveolar bone loss
31. MANAGEMENT
• Review patient’s medical history and questioning regarding hormonal changes should
be performed and documented
• Many available therapies for HRT/ERT from prescriptions to holistic approach should
be performed
• In cases of gingival or mucosal thinning soft tissue augmentation should be done
• Brushing with extra-soft toothbrush using toe/heel of brush prevents scrubbing of
thinned gingiva
• Dentrifices with minimal abrasive particles to be used
32. • Low alcohol concentration mouthrinses
• Root surfaces to be debrided gently with minimal soft tissue trauma
• Oral pain may occur due to thinning tissues, xerostomia, inadequate nutritional intake
or hormone depletion
• Close monitoring of periodontal tissues and maintenance and consultation of physician
advised
33. • BONE SPARING DRUGS Reduces fracture risk
• Primary medication for osteoporosis – BISPHOSPHONATES Reduces perio disease
progression
• Rare side effect associated with bisphosphonates OSTEONECROSIS OF JAW
• Mandible 65% prevalence Maxilla 26%
• Exposed or necrotic bone present in the maxillofacial region for atleast 8 continuous months
in patients with no h/o radiation therapy
• PREDISPOSING FACTORS Type and dose of bisphosphonates, h/o dental trauma,
dental surgery or dental infection
34. • Consult the physician in such cases
• 2011 ADA RECOMMENDATIONS
• Thorough but gentle debridement
• Appropriate antibiotics, stringent home care, antimicrobial mouthrinse
• Exposed necrotic and sequestered bone can be gently debrided. (Surgical resection is
questionable. Healing predictability is good in maxilla variable in mandible. It may lead
to severe sequelae)
35. • Patients should have dental clearance before starting with bisphosphonate therapy
• Teeth with poor or hopeless prognosis should be extracted and healthy periodontal
tissues to be established
• Sharp or irregular bony prominences should be removed and prostheses should be
assessed for accurate fit
36. • Physicians have raised the upper allowable limit to 2000mg/day
• VITAMIN D RECOMMENDATION:
• Premenopausal women – 400IU/day
• Postmenopausal women – 800IU/day
• Extremely low serum VIT D levels: 50000 IU/week for 4 to 12 weeks
37. ORAL CONTRACEPTIVES
• MULLALLY ET AL 2007 Use of OC’s had poorer periodontal health
• Exaggerated response of gingival tissues to local irritants ranging from mild edema
and erythema to severe inflammation with hemorrhagic or hyperplastic gingiva
• KALKWARF 1978 Response due to altered microvasculature, increased gingival
permeability and increased synthesis of prostaglandin (PGE2)
38. • JENSEN ET AL 1981 Significant microbial changes in pregnant and OC group
compared to non-pregnant group. 16 fold increase in Bacteriodes species (Increased
female sex hormones substitute for naphthoquinone requirement)
• PRESHAW PM 2013 Earlier formulations (1970-1990) had more concentration
of female sex hormones than the current. Current data suggests that OC’s do not have
significant effect on inflammatory component of periodontium
• SWEET JB, BUTLER DP 1977 Women taking OC’S experience 2 to 3 fold
increase in incidence of localised osteitis after mandibular third molar extraction. Other
studies refute these findings. So, results are inconclusive
39. MANAGEMENT
• Medical history should include OC’s under medication
• Patient should be informed about the oral and periodontal side effects of OC’s and
need for periodontal maintenance
• Treatment of gingival inflammation should include establishing oral hygiene program
and elimination of local predisposing factors
• It is advisable to perform extraction of teeth especially 3rd molars on nonestrogenic
days (days 23 to 28) to reduce the risk of post-operative localised osteitis
40. • ADA REPORT OF 1991 All women of childbearing age should be informed of
possible reduced efficacy of steroid OC’s during antibiotic therapy and advised to use
additional forms of contraception during short term antibiotic therapy
41. CONCLUSION
• Clinical periodontal therapy includes an understanding of the clinicians role in the total
health and wellbeing of female patients
• Dentists do not treat localized oral infections without affecting other systems of the
body
• Female patients may present with periodontal and systemic considerations that alter
conventional periodontal therapy
• Patients should be educated regarding the profound effects that sex hormones may
play on periodontal and oral tissues as well as the need for proper oral self-care and a
frequent professional intervention.
42. REFERENCES
• CARRANZA 12TH EDITION
• JOAN OTOMO-CORGEL; DENTAL MANAGEMENT OF THE FEMALE PATIENT
;PERIO 2000 VOL 61
• GARY C. ARMITAGE; Bi-directional relationship between pregnancy and periodontal
disease; PERIO 2000 VOL 61
• PHILIP M. PRESHAW; Oral contraceptives and the periodontium; PERIO 2000 VOL 61
• G. WRIGHT BATES & MEAGHAN BOWLING; Physiology of the female reproductive
axis; PERIO 2000 VOL 61