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INFLUENCE OF
ENDOCRINE
SYSTEM
ON
PERIODONTIU
M
DR. MANISHA SINHA
2ND YR
DEPT OF PERIODONTOLOGY
RAJARAJESWARI DENTAL COLLEGE AND HOSPITAL
CONTENTS
 Introduction
 Hypothalamus and pituitary gland
 Pancreatic hormone
 Diabetes mellitus
 Adrenal gland
 Sex hormones
 Thyroid gland
 Parathyroid gland
 Summary
 Conclusion
 references
 Bacterial plaque has been established as the primary etiologic factor for
the initiation of periodontal disease (Loe et al. 1965).
 However, it has also been shown that without a susceptible host the
periodontal pathogens are necessary but not sufficient for disease to
occur.
 Apart from the microbial etiology for periodontal diseases, a number of
factors, namely, environmental and genetic factors, have been proposed,
to modulate host microbial interactions, which ultimately decide the clinical
picture of periodontal disease.
INTRODUCTION:
 Hormones are specific regulatory molecules that modulate reproduction,
growth and development, maintenance of the internal environment, as well
as energy production, utilization, and storage (Mariotti 1994).
 Hormonal effects reflect physiological/pathological changes in almost all
types of tissues of the body.
 Consequently, systemic endocrine imbalances may have an important
impact in periodontal pathogenesis.
PRINCIPLES OF ENDOCRINOLOGY:
Endocrine
glands
central
Hypothalamus
Pituitary
Peripheral
Pancreas
Parathyroid
Adrenal
thyroid
HYPOTHALAMUS AND PITUITARY GLAND:
PITUITARY GLAND
L-DOPA
Stimulates
dopaminergic
systems in
the anterior
part of
pituitary
Release of
growth
hormone
Promoter of
healing
process
 In a study by Britto et al, the aim was to investigate the
possible associations between isolated growth hormone
deficiency (IGHD) and periodontal attachment loss (PAL) in
adults affected by congenital IGHD and ….
PANCREATIC HORMONES:
Insulin
Dec levels
of glu, FA
and
proteins
Transport
of
proteins
Enzymatic
activity
Glucagon
Inc blood
glucose
Fat
breakdown
Inhibits
protein
synthesis
Somatos
tatin
Inhibits
digestion
Inhibits
absorption
of nutrients
Suppresses
GIT
hormones
In the US National Health and Nutrition Examination Survey (NHANES) III,
adults with an HbA1c level of >9% had a significantly higher prevalence of
severe periodontitis than those without diabetes after controlling for age,
ethnicity, education, sex and smoking
ADRENAL GLAND:
SEX HORMONES AND PERIODONTIUM:
 Sexual hormones have been suggested as important modifying factors that
may influence the pathogenesis of periodontal diseases (Mariotti 1994,
Parkar et al. 1998b, Hofbauer & Heufelder 2001).
Gingival changes during puberty
 Microbial changes have been reported during puberty and can be attributed to changes in the
microenvironment seen in the gingival tissue response to the sex hormones, as well as the
ability of some species of bacteria to capitalize on the higher concentration of hormones
present.
 Clinically, during puberty there may be a nodular hyper plastic reaction of the gingival in areas
where food debris, material alba, plaque, and calculus are deposited.
 The inflamed tissues are deep red and may be lobulated, with ballooning distortion of the
interdentally papillae.
 Bleeding may occur when patients masticate or brush their teeth.
 Histologically, the appearance is consistent with inflammatory hyperplasia.
Hormone Fibroblasts
Androgens (testosterone &
hydrotestosterone)
Decrease proliferation
Decrease IL-6 production
Progesterone Decrease proliferation
Decrease protein synthesis
Decrease cytokine production
Estradiol Increase proliferation
Increase cytokine production
 stimulate matrix synthesis by osteoblasts and periodontal ligament fibroblasts (Ojanotko et al.
1980, Kasperk et al. 1989, Sooriyamoorthy & Gower 1989c)
 stimulate osteoblast proliferation and differentiation (Kasperk et al. 1997, Morley 2000)
 reduce IL-6 production during inflammation (Parkar et al. 1998b, Gornstein et al. 1999)
 inhibit prostaglandin secretion (ElAttar et al. 1982)
 Enhance OPG concentration (Szulc et al. 2001)
Effects of androgens in the periodontium
Effects of estrogen in the Periodontium
increased amount of plaque with no increase of gingival inflammation
(Reinhardt et al. 1999)
 inhibit proinflammatory cytokines release by human marrow cells
(Gordon et al. 2001)
 reduce T-cell-mediated inflammation (Josefsson et al. 1992)
 suppress leukocyte production from the bone marrow (Josefsson et al.
1992,Cheleuitte et al. 1998)
 inhibit PMN chemotaxis (Ito et al. 1995)
 stimulate PMN phagocytosis (Hofmann et al. 1986
Effects of progesterone in the periodontium
 increase production of prostaglandins (self-limiting process) (ElAttar 1976b, Smith et
al. 1986)
 increase polymorphonuclear leukocytes and PGE2 in the GCF
 reduce glucocorticoid anti-inflammatory effect (Feldman et al. 1975, Chen et al. 1977)
altered collagen and noncollageneous protein synthesis (Willershausen et al. 1991)
 alter PDL fibroblast metabolism (Nanba et al. 1989b, Sooriyamoorthy & Gower 1989b,
Tilakaratne & Soory 1999a, b)
 increase vascular permeability (Abraham-Inpijn et al. 1996)
areas of increasing interest over the past two
decades. Early detection of these diseases plays a crucial role
Negative emotion
Hypothalamus releases CTRH
Releases adrenocorticotropic hormone
from pituitary
Cortisol released
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
THYROID GLAND:
Location
Hormone
s
produced
• Thyroid, thyroxine and calcitonin
Unique
propertie
s of
hormones
• Contain iodine, constant blood
levels, no specific target tissue
PARATHYROID GLAND:
CONCLUSION
INFLUENCE OF ENDOCRINE SYSTEM ON PERIODONTIUM
INFLUENCE OF ENDOCRINE SYSTEM ON PERIODONTIUM
INFLUENCE OF ENDOCRINE SYSTEM ON PERIODONTIUM
INFLUENCE OF ENDOCRINE SYSTEM ON PERIODONTIUM

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INFLUENCE OF ENDOCRINE SYSTEM ON PERIODONTIUM

  • 1. INFLUENCE OF ENDOCRINE SYSTEM ON PERIODONTIU M DR. MANISHA SINHA 2ND YR DEPT OF PERIODONTOLOGY RAJARAJESWARI DENTAL COLLEGE AND HOSPITAL
  • 2. CONTENTS  Introduction  Hypothalamus and pituitary gland  Pancreatic hormone  Diabetes mellitus  Adrenal gland  Sex hormones  Thyroid gland  Parathyroid gland  Summary  Conclusion  references
  • 3.  Bacterial plaque has been established as the primary etiologic factor for the initiation of periodontal disease (Loe et al. 1965).  However, it has also been shown that without a susceptible host the periodontal pathogens are necessary but not sufficient for disease to occur.  Apart from the microbial etiology for periodontal diseases, a number of factors, namely, environmental and genetic factors, have been proposed, to modulate host microbial interactions, which ultimately decide the clinical picture of periodontal disease. INTRODUCTION:
  • 4.  Hormones are specific regulatory molecules that modulate reproduction, growth and development, maintenance of the internal environment, as well as energy production, utilization, and storage (Mariotti 1994).  Hormonal effects reflect physiological/pathological changes in almost all types of tissues of the body.  Consequently, systemic endocrine imbalances may have an important impact in periodontal pathogenesis.
  • 8.
  • 9. L-DOPA Stimulates dopaminergic systems in the anterior part of pituitary Release of growth hormone Promoter of healing process
  • 10.  In a study by Britto et al, the aim was to investigate the possible associations between isolated growth hormone deficiency (IGHD) and periodontal attachment loss (PAL) in adults affected by congenital IGHD and ….
  • 12. Insulin Dec levels of glu, FA and proteins Transport of proteins Enzymatic activity
  • 15.
  • 16. In the US National Health and Nutrition Examination Survey (NHANES) III, adults with an HbA1c level of >9% had a significantly higher prevalence of severe periodontitis than those without diabetes after controlling for age, ethnicity, education, sex and smoking
  • 17.
  • 18.
  • 20.
  • 21. SEX HORMONES AND PERIODONTIUM:  Sexual hormones have been suggested as important modifying factors that may influence the pathogenesis of periodontal diseases (Mariotti 1994, Parkar et al. 1998b, Hofbauer & Heufelder 2001).
  • 22.
  • 23. Gingival changes during puberty  Microbial changes have been reported during puberty and can be attributed to changes in the microenvironment seen in the gingival tissue response to the sex hormones, as well as the ability of some species of bacteria to capitalize on the higher concentration of hormones present.  Clinically, during puberty there may be a nodular hyper plastic reaction of the gingival in areas where food debris, material alba, plaque, and calculus are deposited.  The inflamed tissues are deep red and may be lobulated, with ballooning distortion of the interdentally papillae.  Bleeding may occur when patients masticate or brush their teeth.  Histologically, the appearance is consistent with inflammatory hyperplasia.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32.
  • 33. Hormone Fibroblasts Androgens (testosterone & hydrotestosterone) Decrease proliferation Decrease IL-6 production Progesterone Decrease proliferation Decrease protein synthesis Decrease cytokine production Estradiol Increase proliferation Increase cytokine production
  • 34.
  • 35.
  • 36.  stimulate matrix synthesis by osteoblasts and periodontal ligament fibroblasts (Ojanotko et al. 1980, Kasperk et al. 1989, Sooriyamoorthy & Gower 1989c)  stimulate osteoblast proliferation and differentiation (Kasperk et al. 1997, Morley 2000)  reduce IL-6 production during inflammation (Parkar et al. 1998b, Gornstein et al. 1999)  inhibit prostaglandin secretion (ElAttar et al. 1982)  Enhance OPG concentration (Szulc et al. 2001) Effects of androgens in the periodontium
  • 37. Effects of estrogen in the Periodontium increased amount of plaque with no increase of gingival inflammation (Reinhardt et al. 1999)  inhibit proinflammatory cytokines release by human marrow cells (Gordon et al. 2001)  reduce T-cell-mediated inflammation (Josefsson et al. 1992)  suppress leukocyte production from the bone marrow (Josefsson et al. 1992,Cheleuitte et al. 1998)  inhibit PMN chemotaxis (Ito et al. 1995)  stimulate PMN phagocytosis (Hofmann et al. 1986
  • 38. Effects of progesterone in the periodontium  increase production of prostaglandins (self-limiting process) (ElAttar 1976b, Smith et al. 1986)  increase polymorphonuclear leukocytes and PGE2 in the GCF  reduce glucocorticoid anti-inflammatory effect (Feldman et al. 1975, Chen et al. 1977) altered collagen and noncollageneous protein synthesis (Willershausen et al. 1991)  alter PDL fibroblast metabolism (Nanba et al. 1989b, Sooriyamoorthy & Gower 1989b, Tilakaratne & Soory 1999a, b)  increase vascular permeability (Abraham-Inpijn et al. 1996)
  • 39.
  • 40. areas of increasing interest over the past two decades. Early detection of these diseases plays a crucial role Negative emotion Hypothalamus releases CTRH Releases adrenocorticotropic hormone from pituitary Cortisol released
  • 41.
  • 42. 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
  • 43.
  • 44.
  • 45. THYROID GLAND: Location Hormone s produced • Thyroid, thyroxine and calcitonin Unique propertie s of hormones • Contain iodine, constant blood levels, no specific target tissue
  • 46.
  • 47.
  • 48.
  • 50.
  • 51.
  • 52.
  • 53.
  • 54.
  • 55.

Editor's Notes

  1. Hence, the systemic factors/conditions of the host must be understood since they may affect disease prevalence, progression, and severity Bacteria alone cannot cause disease – host immune system impairment or function plays role – systemic dis / conditions influence the host defense mechanism Endo – directy affect tissue, modify their response to local factors and prduce anatomic changes in gingiva
  2. Targets for a number of hormones such as androgens, estrogen, and progesterone have also been localized in periodontal tissues (Gornstein et al. 1999).
  3. Hyothalamus is located on the undersurface of brain. It lies just below thalamus and above the pituitary gland to which it is attached by a stalk. Major function is to maintain homeostasis. To keep the human body in stable condition.
  4. Pituitary gland / hypophysis lies at the base of brain in sella turcica. Physiologically the pituitary gland is divided into 2 portions namely, the anterior pituitary or adenohyphysisand posterior pituitary or neurohypophysis. Pituitary hormones are essential for growth, reproduction, blood volume regulation, response to stressors. The secretion of both anterior and posterior pituitar is controlled by hypothalamus.
  5. Hyothalamus releases various releasing hormones like gonadotropin releasing hormone, corticotropin releasing hormone, thyroid releasing hormone, prolactin releasing hormone, growth hormone reeasing hormone, antidiurettic hormone, oxytocin.
  6. Local mitogenic effect In this study, the direct effect of L-dopa was investi- gated on human periodontal ligament fibroblast (HPLF) cells. These results suggest that L-dopa can also have a direct local effect on the growth of HPLF cells. l-DOPA is the precursor to the neurotransmitters dopamine, norepinephrine (noradrenaline), and epinephrine (adrenaline), which are collectively known as catecholamines.
  7. to compare the periodontal status of the acromegalic patients to the healthy subjects selected from a population-based cohort. And they conclded that periodontal disease severity did not differ between acromegalic patients and healthy SHIP-1 controls.
  8. The endocrine function of pancreas is performed by islet of langerhans. Four types of cells are present in islets namely: alpha – glucagon, beta- insulin, delta- somatostatin, pp cells- pancreatic polypeptide. Insulin and glucagon are the important panceatic hormones, which regulate the various metabolic processes of carbohydrates , proteins and fats. -induced degradation, synthesis and ⁄ or transformation of protein, carbohydrate and fat from nutrients occurs between the blood and cells.
  9. The action of insulin on carbohydrate metabolism are: transport and uptake of glucose, peripheral utilization of glucose, storage of glucose and inhibition of glycogenolyis, inhbition of gluconeogenesis. Transport of aminoa cid into the cell from blood is facilitated by insulin. It inhibits protein catabolism and prevents formation of glucose from proteins. Insulin facilitates the transport of fatty acid into the adipose tissue. And storage of fat in adipose tissue by inhibiting the enzymes. Along with growth hormone insulin promotes growth of body.
  10. Glucagon increases the blood glucose by brek down of glycogen into glucose. It increases release of free fatty acids from adipose tissue and available for peripheral utilization. It also increases glucose from proteins.
  11. Also known as GH inhibiting hormone and somatotropin Release Inhibiting H Action is negative feedback – prevents excess plasma nutrient by –products It inhibits secretion of both glucagon and insulin. Decreases motility of stomach , duodenum amd gall bladder. Reduces the secretion of gastrc inhibitory polypeptide and vasoactive intestinal plypeptide.
  12. Advanced glycation end products (AGEs) are proteins or lipids that become glycated as a result of exposure to sugars
  13. There are two adrenal glands siuated on the upper pole of each kidney. It is madeup of 2 distinct parts, adrenal cortex and adrenal medulla. It has 3 different layers Zona glomerulosa, zona fasiculata, zona reticularis.
  14. Hormonal influences associated with reproductive process alter periodontal and oral tissue responses to local factors. A number of studies have shown that periodontium is a target tissue for female sex hormones. The effect of hormones may be amplified by the inflammatory response to bacteria.
  15. Gingival tissues and the subgingival microflora respond with a variety of changes to the increasing hormone level at the onset of puberty.
  16. If local factors are absent then there are no changes seen
  17. Pronounced ease of bleeding is the most striking clinical feature
  18. Studies have shown a high prevalence of P. intermedia and P. gingivalis at the 2nd trimester of pregnancy due to progesterone and/or estradiol being present in high concentrations, which contribute to bacterial growth
  19. gingival tissues that are shiny and dry, bleed readily, and may range from pale to erythematous in color
  20. Directly and indirectly exert influence on cellular proliferation, differentiation, and growth in target tissues, including keratinocytes and fibroblasts in the gingiva. (Mariotti A, 1999). Estrogens stimulate epithelial proliferation and increase keratinization ….
  21. TIMP TISSUE INHIBITOR OF METALLOPROTEINASE
  22. May be found on the gingiva , palate , tongue and lips
  23. Stress has been implicated in reducing gingival blood flow which in turn, could increase the possibility of necrosis of tissues, with subsequent reduced resistance to plaque.
  24. THYROID gland is situated at the root of the neck on either side of the trachea. It has two lobes which are connected in the middle by an isthumus. It is larger in females than in males. The structure and the function of the thyroid gland change in different stages of the sexual cycle in females. It function is slightly increased during pregnancy and lactation and is decreased during menopause. It secretes 3 hormones namely, tetraiodothyonine, triiodothyronine, calcitonin.
  25. thyroid hormones affect many physiological processes, and optimal functioning of body systems requires the circulating thyroxine and triiodothyronine levels to be maintained within a relatively narrow range The effects of thyroid hormones on the basal metabolic rate reflect their actions on catabolic and anabolic metabolic pathways affecting lipids, carbohydrates and proteins
  26. MYXOEDEMA- SEVERE HYPOTHYROIDISM
  27. 4 parathyroid glands which are located immediately behind thyroid gland at upper and lower poles. Each parathyroid gland is madeup of chief cells and oxyphil cells. The chief cells have secretory function and secrete parathormone.
  28. In an effort to elucidate the relationship of parathyroid hormone with destructive periodontal disease, recent clinical studies have examined the effects of parathyroid hormone on the periodontium.
  29. The influence of hormones from the endocrine system on health or disease is colossal. even as our understanding expands regarding how the disruption of hormone production and ⁄ or function affects different organs, the current understanding of the effects of these powerful chemical messengers remain largely unknown in the periodontium. For example, diabetes mellitus has been identified as one of the few known risk factors for destructive periodontal diseases, yet the direct effects of insulin on periodontal tissues, at any time in the life cycle, continues to be obscure. Thus a thorough understanding of the hormones and their influence is essential for carrying out a successful treatment protocol for patients.