The document discusses the relationship between systemic health conditions and periodontal diseases. It provides examples of how conditions like diabetes, hormonal fluctuations, hematological disorders, and medications like bisphosphonates can negatively impact periodontal health. Periodontal diseases are also implicated as risk factors for certain systemic conditions. The relationship between periodontal and systemic health is complex, with potential bidirectional effects.
Influence of Systemic Conditions on periodontal diseases.pptxRoshnaTalibMustafa
Systemic conditions like diabetes and hormonal changes can negatively impact periodontal health. Diabetes is strongly associated with more severe periodontal disease due to factors like impaired immune function and collagen metabolism. Hormonal fluctuations during puberty and pregnancy can also affect the gums. Genetic disorders that reduce neutrophil counts are linked to aggressive periodontal destruction. Diseases involving reduced platelet counts, like leukemia, increase risk of oral bleeding. Certain medications, such as bisphosphonates used to treat osteoporosis, have also been associated with oral health issues.
Diabetes mellitus is a systemic disease characterized by increased blood glucose levels and abnormalities of lipid metabolism due to absence or decreased level of insulin. It affects all the body organs and their functions either directly or indirectly. Every dentist should have a basic understanding of the etiopathogenesis, oral and systemic manifestations of this disease. The periodontal diseases are a consequence of extension of the gingival inflammation into the underlying supporting structures of the periodontium, initiated by the presence of plaque and its products on the surfaces of the teeth and the adjoining structures. The progression of periodontal disease is influenced by variety of factors like microorganisms, host response, systemic background, and genetic makeup of the host. Amongst them, diabetes mellitus tops the list. Diabetes and periodontitis influence the clinical outcome of each other and control of both influences the clinical improvement of each.
Diabetes mellitus is a systemic disease characterized by increased blood glucose levels and abnormalities of lipid metabolism due to absence or decreased level of insulin. It affects all the body organs and their functions either directly or indirectly. Every dentist should have a basic understanding of the etiopathogenesis, oral and systemic manifestations of this disease. The periodontal diseases are a consequence of extension of the gingival inflammation into the underlying supporting structures of the periodontium, initiated by the presence of plaque and its products on the surfaces of the teeth and the adjoining structures. The progression of periodontal disease is influenced by variety of factors like microorganisms, host response, systemic background, and genetic makeup of the host. Amongst them, diabetes mellitus tops the list. Diabetes and periodontitis influence the clinical outcome of each other and control of both influences the clinical improvement of each.
This document discusses the influence of systemic conditions on the periodontium. It begins by introducing periodontitis as a chronic bacterial infection and how host responses can vary between individuals. Systemic disorders can impair the host's immune defenses, creating opportunities for more severe periodontal disease. Several specific systemic factors are then examined in more detail, including hormonal changes, diabetes mellitus, and female sex hormones. The effects of these conditions on the periodontium are explored through their impact on factors like subgingival microbiota, polymorphonuclear leukocyte function, collagen metabolism, and wound healing. Treatment considerations for periodontal disease in systemic disease patients are also briefly addressed.
3.b)diabetes mellitus and periodontal disease iipunitnaidu07
This document provides an overview of diabetes and its relationship to periodontal disease. It begins by outlining various classifications and clinical presentations of diabetes, as well as its complications. It then discusses the oral manifestations that can be seen in diabetics, including infections, burning mouth, and increased dental caries. The document explains that diabetes is a risk factor for periodontal disease, increasing its severity and incidence. It explores various mechanisms by which diabetes may influence periodontitis, such as changes to subgingival flora and microvasculature, as well as defects in host immune response. The relationship between diabetes and periodontal disease is proposed to be bidirectional, with each condition exacerbating the other through chronic inflammation. Prevention, medical management
Diabetes and periodontal disease ,at two way relationshipLobna El Khatib
The document discusses the bidirectional relationship between diabetes and periodontal disease. It begins by providing overviews of diabetes and periodontal disease. It then explains how diabetes can increase the risk and severity of periodontal disease by altering oral microorganisms, the host immune response, blood vessels, and wound healing. Conversely, periodontal disease can negatively impact blood sugar control in diabetes by increasing systemic inflammation. Maintaining good oral hygiene and treating periodontal disease may help manage diabetes and reduce complications.
Diabetes and periodontal disease have a bidirectional relationship. Poorly controlled diabetes increases the risk of developing periodontal disease by impairing the immune response and altering microorganisms, wound healing, and blood vessels in the mouth. Periodontal disease can also negatively impact diabetes by increasing inflammation and impairing insulin sensitivity, making blood sugar control more difficult. Treatment of periodontal disease may help reduce inflammation and improve glycemic control in diabetic patients.
This document discusses the relationship between periodontal disease and systemic health. It provides definitions of periodontal medicine and periodontitis. Periodontitis is caused by pathogenic bacteria in subgingival biofilm interacting with a susceptible host. The subgingival environment provides a reservoir for bacteria and their products like LPS that can enter circulation and impact distant organ systems. The document reviews evidence that periodontitis is associated with increased risks of cardiovascular disease, stroke, diabetes, respiratory disease, and other conditions through acute and chronic pathways.
Influence of Systemic Conditions on periodontal diseases.pptxRoshnaTalibMustafa
Systemic conditions like diabetes and hormonal changes can negatively impact periodontal health. Diabetes is strongly associated with more severe periodontal disease due to factors like impaired immune function and collagen metabolism. Hormonal fluctuations during puberty and pregnancy can also affect the gums. Genetic disorders that reduce neutrophil counts are linked to aggressive periodontal destruction. Diseases involving reduced platelet counts, like leukemia, increase risk of oral bleeding. Certain medications, such as bisphosphonates used to treat osteoporosis, have also been associated with oral health issues.
Diabetes mellitus is a systemic disease characterized by increased blood glucose levels and abnormalities of lipid metabolism due to absence or decreased level of insulin. It affects all the body organs and their functions either directly or indirectly. Every dentist should have a basic understanding of the etiopathogenesis, oral and systemic manifestations of this disease. The periodontal diseases are a consequence of extension of the gingival inflammation into the underlying supporting structures of the periodontium, initiated by the presence of plaque and its products on the surfaces of the teeth and the adjoining structures. The progression of periodontal disease is influenced by variety of factors like microorganisms, host response, systemic background, and genetic makeup of the host. Amongst them, diabetes mellitus tops the list. Diabetes and periodontitis influence the clinical outcome of each other and control of both influences the clinical improvement of each.
Diabetes mellitus is a systemic disease characterized by increased blood glucose levels and abnormalities of lipid metabolism due to absence or decreased level of insulin. It affects all the body organs and their functions either directly or indirectly. Every dentist should have a basic understanding of the etiopathogenesis, oral and systemic manifestations of this disease. The periodontal diseases are a consequence of extension of the gingival inflammation into the underlying supporting structures of the periodontium, initiated by the presence of plaque and its products on the surfaces of the teeth and the adjoining structures. The progression of periodontal disease is influenced by variety of factors like microorganisms, host response, systemic background, and genetic makeup of the host. Amongst them, diabetes mellitus tops the list. Diabetes and periodontitis influence the clinical outcome of each other and control of both influences the clinical improvement of each.
This document discusses the influence of systemic conditions on the periodontium. It begins by introducing periodontitis as a chronic bacterial infection and how host responses can vary between individuals. Systemic disorders can impair the host's immune defenses, creating opportunities for more severe periodontal disease. Several specific systemic factors are then examined in more detail, including hormonal changes, diabetes mellitus, and female sex hormones. The effects of these conditions on the periodontium are explored through their impact on factors like subgingival microbiota, polymorphonuclear leukocyte function, collagen metabolism, and wound healing. Treatment considerations for periodontal disease in systemic disease patients are also briefly addressed.
3.b)diabetes mellitus and periodontal disease iipunitnaidu07
This document provides an overview of diabetes and its relationship to periodontal disease. It begins by outlining various classifications and clinical presentations of diabetes, as well as its complications. It then discusses the oral manifestations that can be seen in diabetics, including infections, burning mouth, and increased dental caries. The document explains that diabetes is a risk factor for periodontal disease, increasing its severity and incidence. It explores various mechanisms by which diabetes may influence periodontitis, such as changes to subgingival flora and microvasculature, as well as defects in host immune response. The relationship between diabetes and periodontal disease is proposed to be bidirectional, with each condition exacerbating the other through chronic inflammation. Prevention, medical management
Diabetes and periodontal disease ,at two way relationshipLobna El Khatib
The document discusses the bidirectional relationship between diabetes and periodontal disease. It begins by providing overviews of diabetes and periodontal disease. It then explains how diabetes can increase the risk and severity of periodontal disease by altering oral microorganisms, the host immune response, blood vessels, and wound healing. Conversely, periodontal disease can negatively impact blood sugar control in diabetes by increasing systemic inflammation. Maintaining good oral hygiene and treating periodontal disease may help manage diabetes and reduce complications.
Diabetes and periodontal disease have a bidirectional relationship. Poorly controlled diabetes increases the risk of developing periodontal disease by impairing the immune response and altering microorganisms, wound healing, and blood vessels in the mouth. Periodontal disease can also negatively impact diabetes by increasing inflammation and impairing insulin sensitivity, making blood sugar control more difficult. Treatment of periodontal disease may help reduce inflammation and improve glycemic control in diabetic patients.
This document discusses the relationship between periodontal disease and systemic health. It provides definitions of periodontal medicine and periodontitis. Periodontitis is caused by pathogenic bacteria in subgingival biofilm interacting with a susceptible host. The subgingival environment provides a reservoir for bacteria and their products like LPS that can enter circulation and impact distant organ systems. The document reviews evidence that periodontitis is associated with increased risks of cardiovascular disease, stroke, diabetes, respiratory disease, and other conditions through acute and chronic pathways.
1. Periodontal medicine is a branch of periodontology that focuses on the relationship between periodontal health and systemic health. Periodontal disease can influence systemic health and vice versa through direct and indirect mechanisms.
2. Periodontal disease is associated with increased risk of adverse pregnancy outcomes like preterm birth and low birth weight. Factors like infection and inflammation are believed to contribute to the onset of preterm labor.
3. Periodontal disease is also linked to increased risk of diabetes and difficulty in controlling blood glucose levels. The chronic inflammatory response associated with periodontal infection contributes to insulin resistance. Periodontal treatment may help in improving glycemic control in diabetic patients.
This document discusses diabetes and periodontitis. It covers oral manifestations of diabetes, how diabetes affects the periodontal flora and increases risk of periodontal disease. It also discusses the effects of advanced glycation end products (AGEs) and their receptor (RAGE), how they contribute to increased inflammation and tissue destruction in diabetics. The dental management of diabetic patients and importance of glycemic control is also covered.
This document reviews oral manifestations and dental management considerations for patients with leukocyte alterations. Key points include:
1. Oral complications of neutropenia can include necrotic ulcers, severe gingivitis, and periodontitis. Agranulocytosis presents as necrotic ulcers without signs of inflammation. Congenital neutropenia risks periodontal disease despite treatment.
2. Dental treatment for patients with neutrophil disorders emphasizes preventive care and controlling infections to minimize surgery. Acceptable blood counts are recommended for oral surgery.
3. Leukemia can cause gingival hyperplasia from infiltration of leukemia cells. This presents as swollen, pale gingiva and
Periodontal medicine is a branch of periodontology that focuses on the relationship between periodontal health/disease and systemic health/disease. Periodontal disease can influence systemic health through direct effects of bacteria or indirect host-mediated inflammatory responses. Common risk factors for periodontitis and systemic diseases like cardiovascular disease and diabetes include smoking and genetic factors. Periodontitis is associated with increased risk of atherosclerosis, myocardial infarction, and stroke potentially through elevated inflammatory markers and direct bacterial effects.
Periodontal disease has a two-way relationship with systemic health conditions. It can influence systemic health while certain systemic conditions can also increase susceptibility to periodontal disease. Periodontal disease is associated with increased risk of cardiovascular disease, cerebrovascular accidents, diabetes and other conditions. Potential mechanisms include direct effects of periodontal pathogens, host inflammatory responses, common risk factors and genetic predispositions. Periodontitis may enhance atherosclerosis through direct bacterial effects, increased inflammatory markers, platelet aggregation and other indirect host responses.
Periodontal medicine is a branch of periodontology that focuses on the relationship between periodontal health/disease and systemic health/disease. Periodontal disease can influence systemic health through direct effects of infectious agents or indirect host-mediated inflammatory responses. Periodontal disease has been linked to increased risk of cardiovascular disease, diabetes, and preterm low birth weight. Treatment of periodontal infection may help reduce systemic inflammation and improve conditions like diabetes and cardiovascular disease.
Periodontal medicine is the study of the relationship between periodontal health and systemic health. Periodontal disease can influence systemic health through direct effects of bacteria or indirect host-mediated inflammatory responses. Periodontitis has been linked to increased risk of cardiovascular disease, diabetes, and preterm low birth weight. Treatment of periodontal infection may help improve glycemic control in diabetic patients and reduce systemic inflammation.
Hyperparathyroidism and diabetes can influence periodontal health in several ways:
1. They can alter immune responses, such as impairing neutrophil function, which helps bacteria evade the immune system and worsen periodontal disease.
2. Chronic hyperglycemia and hyperparathyroidism can impair collagen structure and function, damaging the integrity of the periodontium.
3. They may qualitatively change the subgingival microbiome, promoting pathogens like Porphyromonas and Prevotella that are linked to periodontitis.
This document discusses risk factors, determinants, indicators, and predictors for periodontal disease. It identifies the major risk factors as smoking, diabetes, and pathogenic bacteria. It also discusses genetic factors, age, gender, socioeconomic status, and stress as risk determinants. HIV/AIDS, osteoporosis, and infrequent dental visits are provided as examples of risk indicators. Previous history of periodontal disease and bleeding on probing are given as examples of risk predictors. The document concludes by noting that clinical risk assessment involves collecting data on a patient's medical history, dental history, and clinical presentation and analyzing this using a computer-based tool to identify patients at risk of periodontal disease.
PERIODONTAL MEDICINE 1.pptx DIABETES DIABENitika588942
The term periodontal medicine, as first suggested by Offenbacher, that defines a rapidly emerging branch of periodontology focusing on the wealth of new data establishing a strong relationship between periodontal health or disease and systemic health or disease.
This means a two-way relationship in which periodontal disease in an individual may be a powerful influence on an individual’s systemic health or disease as well as the more customarily understood role that systemic disease may have in influencing an individual’s periodontal health or disease.It would be new diagnostic and treatment strategies that recognize the relationship between periodontal disease and systemic disease.
William Hunter, attesting to the influence of oral sepsis on systemic health and disease.
Recently scientists and clinicians have begun to provide an increasing body of scientific evidence suggesting that moderate untreated periodontitis may affect an individual systemically, and may contribute to cardiovascular disease, diabetes and pre-term low birth weight.This is important new information indeed. It appears that not just teeth are at stake in maintaining good oral health.
Rather, oral health is an important component of general health, and individuals with periodontitis may be at risk for other diseases as well.
Evidence has also shed light on the converse side of the relationship between systemic health and oral health: the potential effects of inflammatory periodontal diseases on a wide range of organ systems.Pathogenesis of periodontitis has changed remarkably over last 30 years.
The non-specific accumulation of bacterial plaque was once thought to be the cause of periodontal destruction, but it is now recognized that periodontitis is an infectious disease associated with a small number of predominantly gram-negative microorganisms that exist in a subgingival biofilm.
Furthermore, the importance of the host in disease initiation and progression is clearly recognized.
Although pathogenic bacteria are necessary for periodontal disease, they are not sufficient alone to cause the disease.
A susceptible host is also imperative. In a host who has relatively low susceptibility to disease, bacterial pathogens may have no clinical effect.
This may be due to a particularly effective host immunoinflammatory response that eliminates pathogenic organisms while minimizing destruction of native tissues.
Conversely, in a host with relatively high disease susceptibility, marked destruction of periodontal tissues may result.Acc. To William Hunter in 1900,
Oral microorganism- responsible for systemic conditions
Restoration instead of extraction, trapping of infectious agents
Gingivitis & periodontitis- foci of infection .Acc. To William Hunter in 1900,
Oral microorganism- responsible for systemic conditions
Restoration instead of extraction, trapping of infectious agents
Gingivitis & periodontitis- foci of infection
Acc. To William Hunter in 1900,
Oral microorganism
This document discusses the relationship between periodontal disease and various systemic conditions. It covers how diabetes, metabolic syndrome, hormonal factors like pregnancy, and hematologic/immune disorders can influence periodontal health. Specifically, it describes how these conditions can alter the host response and make individuals more susceptible to periodontal pathogens by impairing immune function or increasing inflammation. The document also discusses genetic disorders and stress/psychosomatic factors that predispose to periodontal disease.
1) The document discusses the relationship between periodontal disease and cardiovascular disease (CVS) and diabetes. It explores the focal infection theory and possible pathways linking oral infections to secondary non-oral diseases.
2) Periodontal disease is associated with increased risk of CVS diseases like atherosclerosis, coronary heart disease, and stroke. It may increase susceptibility through inflammation, endothelial injury, lipid peroxidation, molecular mimicry, and elevated antibodies from oral bacteria.
3) Periodontal disease is also linked to increased risk of diabetes through shared risk factors and inflammation. Periodontal bacteria may enter the bloodstream and stimulate liver proteins that amplify systemic inflammation, worsening insulin resistance.
This document discusses the relationship between periodontal disease and cardiovascular disease. It begins by introducing periodontal disease and its prevalence. It then discusses how periodontal disease has been linked to increased risk of cardiovascular disease through several pathways. Specifically, periodontal bacteria and the body's inflammatory response can promote the development of atherosclerosis. Treating periodontal disease through approaches like scaling, root planing, surgery and daily antiseptics has been shown to reduce systemic inflammation and improve endothelial function, thereby reducing cardiovascular risk. The document concludes that preventing and treating periodontal disease can help lower the risk of cardiovascular problems.
Chronic periodontitis is the most common form of periodontitis and is characterized by microbial biofilm formation, periodontal inflammation, and attachment and bone loss. It is diagnosed based on clinical attachment level assessment and radiographs showing bone loss. Risk factors include local factors like plaque and calculus that retain bacteria, and systemic factors like diabetes which impair the immune response and increase the severity of periodontitis. The condition progresses slowly over time with increased attachment and bone loss with age.
Analysis of indexes CPO-D and IHOS in patients with Diabetes Mellitus of Tula...Pedro Macbani Olvera
Objective. To determine the CPO-D indices / IHOS in patient with Diabetes Mellitus of Tulancingo Hidalgo, Mexico.
Material and Methods. A descriptive observational transverse character study was conducted for 10 people of both sexes and aged 30/60 years with a diagnosis of DM, the determination of the plaque plate is performed by means of revealing tablets to calculate the IHOS (index simplified Oral Hygiene) and the CPO-D index was determined by means of descriptive observation, by means of the method of clinical examination.
Results. Of the 10 patients examined, 100% represented dental plaque and cavities, not with the same index relationship existing between two factors such as; visit to the dentist, poor dental hygiene, poor brushing technique and null or inappropriate use of thread dental and mouth rinse.
The document discusses the relationship between systemic and periodontal health, noting that certain systemic conditions can increase susceptibility to periodontal disease by impairing host defenses. It provides examples of conditions that influence periodontal health, such as diabetes, hormonal changes, hematological disorders, stress/psychosocial factors, and nutritional status. For each condition, it describes potential oral manifestations and mechanisms by which the systemic condition can affect the periodontal tissues and alter the host response.
This document discusses the relationship between systemic conditions and periodontal disease. It states that periodontal disease is influenced by factors like diabetes, hormonal changes, hematological disorders, stress, and nutrition. Certain systemic conditions can impair host defenses and increase susceptibility to periodontal infections by reducing barrier integrity and immune response. The relationship between systemic and periodontal health is bidirectional, with systemic factors impacting local periodontal health and vice versa.
This document discusses the different types of hypersensitivity reactions as classified by Gell and Coombs. It provides details on type I (immediate), type II (antibody-mediated), type III (immune complex-mediated), and type IV (delayed) hypersensitivity reactions, including the antibodies or cells involved, examples of diseases, and a brief description of the immunological reaction for each type. It also discusses contact stomatitis as an uncommon allergic reaction affecting the inside of the mouth.
The document provides an overview of lasers in dentistry, including:
1. A definition of lasers and their key characteristics of being monochromatic, coherent, and directional.
2. A brief history of lasers from early phototherapy research to the invention of the laser in 1960.
3. Descriptions of common dental laser types like CO2, Er:YAG, and Nd:YAG lasers and their applications like soft tissue surgery.
4. Advantages of lasers include reduced bleeding, less pain, and faster healing times compared to traditional scalpel procedures.
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Similar to Systemic Health and Periodontal Disease.pptx
1. Periodontal medicine is a branch of periodontology that focuses on the relationship between periodontal health and systemic health. Periodontal disease can influence systemic health and vice versa through direct and indirect mechanisms.
2. Periodontal disease is associated with increased risk of adverse pregnancy outcomes like preterm birth and low birth weight. Factors like infection and inflammation are believed to contribute to the onset of preterm labor.
3. Periodontal disease is also linked to increased risk of diabetes and difficulty in controlling blood glucose levels. The chronic inflammatory response associated with periodontal infection contributes to insulin resistance. Periodontal treatment may help in improving glycemic control in diabetic patients.
This document discusses diabetes and periodontitis. It covers oral manifestations of diabetes, how diabetes affects the periodontal flora and increases risk of periodontal disease. It also discusses the effects of advanced glycation end products (AGEs) and their receptor (RAGE), how they contribute to increased inflammation and tissue destruction in diabetics. The dental management of diabetic patients and importance of glycemic control is also covered.
This document reviews oral manifestations and dental management considerations for patients with leukocyte alterations. Key points include:
1. Oral complications of neutropenia can include necrotic ulcers, severe gingivitis, and periodontitis. Agranulocytosis presents as necrotic ulcers without signs of inflammation. Congenital neutropenia risks periodontal disease despite treatment.
2. Dental treatment for patients with neutrophil disorders emphasizes preventive care and controlling infections to minimize surgery. Acceptable blood counts are recommended for oral surgery.
3. Leukemia can cause gingival hyperplasia from infiltration of leukemia cells. This presents as swollen, pale gingiva and
Periodontal medicine is a branch of periodontology that focuses on the relationship between periodontal health/disease and systemic health/disease. Periodontal disease can influence systemic health through direct effects of bacteria or indirect host-mediated inflammatory responses. Common risk factors for periodontitis and systemic diseases like cardiovascular disease and diabetes include smoking and genetic factors. Periodontitis is associated with increased risk of atherosclerosis, myocardial infarction, and stroke potentially through elevated inflammatory markers and direct bacterial effects.
Periodontal disease has a two-way relationship with systemic health conditions. It can influence systemic health while certain systemic conditions can also increase susceptibility to periodontal disease. Periodontal disease is associated with increased risk of cardiovascular disease, cerebrovascular accidents, diabetes and other conditions. Potential mechanisms include direct effects of periodontal pathogens, host inflammatory responses, common risk factors and genetic predispositions. Periodontitis may enhance atherosclerosis through direct bacterial effects, increased inflammatory markers, platelet aggregation and other indirect host responses.
Periodontal medicine is a branch of periodontology that focuses on the relationship between periodontal health/disease and systemic health/disease. Periodontal disease can influence systemic health through direct effects of infectious agents or indirect host-mediated inflammatory responses. Periodontal disease has been linked to increased risk of cardiovascular disease, diabetes, and preterm low birth weight. Treatment of periodontal infection may help reduce systemic inflammation and improve conditions like diabetes and cardiovascular disease.
Periodontal medicine is the study of the relationship between periodontal health and systemic health. Periodontal disease can influence systemic health through direct effects of bacteria or indirect host-mediated inflammatory responses. Periodontitis has been linked to increased risk of cardiovascular disease, diabetes, and preterm low birth weight. Treatment of periodontal infection may help improve glycemic control in diabetic patients and reduce systemic inflammation.
Hyperparathyroidism and diabetes can influence periodontal health in several ways:
1. They can alter immune responses, such as impairing neutrophil function, which helps bacteria evade the immune system and worsen periodontal disease.
2. Chronic hyperglycemia and hyperparathyroidism can impair collagen structure and function, damaging the integrity of the periodontium.
3. They may qualitatively change the subgingival microbiome, promoting pathogens like Porphyromonas and Prevotella that are linked to periodontitis.
This document discusses risk factors, determinants, indicators, and predictors for periodontal disease. It identifies the major risk factors as smoking, diabetes, and pathogenic bacteria. It also discusses genetic factors, age, gender, socioeconomic status, and stress as risk determinants. HIV/AIDS, osteoporosis, and infrequent dental visits are provided as examples of risk indicators. Previous history of periodontal disease and bleeding on probing are given as examples of risk predictors. The document concludes by noting that clinical risk assessment involves collecting data on a patient's medical history, dental history, and clinical presentation and analyzing this using a computer-based tool to identify patients at risk of periodontal disease.
PERIODONTAL MEDICINE 1.pptx DIABETES DIABENitika588942
The term periodontal medicine, as first suggested by Offenbacher, that defines a rapidly emerging branch of periodontology focusing on the wealth of new data establishing a strong relationship between periodontal health or disease and systemic health or disease.
This means a two-way relationship in which periodontal disease in an individual may be a powerful influence on an individual’s systemic health or disease as well as the more customarily understood role that systemic disease may have in influencing an individual’s periodontal health or disease.It would be new diagnostic and treatment strategies that recognize the relationship between periodontal disease and systemic disease.
William Hunter, attesting to the influence of oral sepsis on systemic health and disease.
Recently scientists and clinicians have begun to provide an increasing body of scientific evidence suggesting that moderate untreated periodontitis may affect an individual systemically, and may contribute to cardiovascular disease, diabetes and pre-term low birth weight.This is important new information indeed. It appears that not just teeth are at stake in maintaining good oral health.
Rather, oral health is an important component of general health, and individuals with periodontitis may be at risk for other diseases as well.
Evidence has also shed light on the converse side of the relationship between systemic health and oral health: the potential effects of inflammatory periodontal diseases on a wide range of organ systems.Pathogenesis of periodontitis has changed remarkably over last 30 years.
The non-specific accumulation of bacterial plaque was once thought to be the cause of periodontal destruction, but it is now recognized that periodontitis is an infectious disease associated with a small number of predominantly gram-negative microorganisms that exist in a subgingival biofilm.
Furthermore, the importance of the host in disease initiation and progression is clearly recognized.
Although pathogenic bacteria are necessary for periodontal disease, they are not sufficient alone to cause the disease.
A susceptible host is also imperative. In a host who has relatively low susceptibility to disease, bacterial pathogens may have no clinical effect.
This may be due to a particularly effective host immunoinflammatory response that eliminates pathogenic organisms while minimizing destruction of native tissues.
Conversely, in a host with relatively high disease susceptibility, marked destruction of periodontal tissues may result.Acc. To William Hunter in 1900,
Oral microorganism- responsible for systemic conditions
Restoration instead of extraction, trapping of infectious agents
Gingivitis & periodontitis- foci of infection .Acc. To William Hunter in 1900,
Oral microorganism- responsible for systemic conditions
Restoration instead of extraction, trapping of infectious agents
Gingivitis & periodontitis- foci of infection
Acc. To William Hunter in 1900,
Oral microorganism
This document discusses the relationship between periodontal disease and various systemic conditions. It covers how diabetes, metabolic syndrome, hormonal factors like pregnancy, and hematologic/immune disorders can influence periodontal health. Specifically, it describes how these conditions can alter the host response and make individuals more susceptible to periodontal pathogens by impairing immune function or increasing inflammation. The document also discusses genetic disorders and stress/psychosomatic factors that predispose to periodontal disease.
1) The document discusses the relationship between periodontal disease and cardiovascular disease (CVS) and diabetes. It explores the focal infection theory and possible pathways linking oral infections to secondary non-oral diseases.
2) Periodontal disease is associated with increased risk of CVS diseases like atherosclerosis, coronary heart disease, and stroke. It may increase susceptibility through inflammation, endothelial injury, lipid peroxidation, molecular mimicry, and elevated antibodies from oral bacteria.
3) Periodontal disease is also linked to increased risk of diabetes through shared risk factors and inflammation. Periodontal bacteria may enter the bloodstream and stimulate liver proteins that amplify systemic inflammation, worsening insulin resistance.
This document discusses the relationship between periodontal disease and cardiovascular disease. It begins by introducing periodontal disease and its prevalence. It then discusses how periodontal disease has been linked to increased risk of cardiovascular disease through several pathways. Specifically, periodontal bacteria and the body's inflammatory response can promote the development of atherosclerosis. Treating periodontal disease through approaches like scaling, root planing, surgery and daily antiseptics has been shown to reduce systemic inflammation and improve endothelial function, thereby reducing cardiovascular risk. The document concludes that preventing and treating periodontal disease can help lower the risk of cardiovascular problems.
Chronic periodontitis is the most common form of periodontitis and is characterized by microbial biofilm formation, periodontal inflammation, and attachment and bone loss. It is diagnosed based on clinical attachment level assessment and radiographs showing bone loss. Risk factors include local factors like plaque and calculus that retain bacteria, and systemic factors like diabetes which impair the immune response and increase the severity of periodontitis. The condition progresses slowly over time with increased attachment and bone loss with age.
Analysis of indexes CPO-D and IHOS in patients with Diabetes Mellitus of Tula...Pedro Macbani Olvera
Objective. To determine the CPO-D indices / IHOS in patient with Diabetes Mellitus of Tulancingo Hidalgo, Mexico.
Material and Methods. A descriptive observational transverse character study was conducted for 10 people of both sexes and aged 30/60 years with a diagnosis of DM, the determination of the plaque plate is performed by means of revealing tablets to calculate the IHOS (index simplified Oral Hygiene) and the CPO-D index was determined by means of descriptive observation, by means of the method of clinical examination.
Results. Of the 10 patients examined, 100% represented dental plaque and cavities, not with the same index relationship existing between two factors such as; visit to the dentist, poor dental hygiene, poor brushing technique and null or inappropriate use of thread dental and mouth rinse.
The document discusses the relationship between systemic and periodontal health, noting that certain systemic conditions can increase susceptibility to periodontal disease by impairing host defenses. It provides examples of conditions that influence periodontal health, such as diabetes, hormonal changes, hematological disorders, stress/psychosocial factors, and nutritional status. For each condition, it describes potential oral manifestations and mechanisms by which the systemic condition can affect the periodontal tissues and alter the host response.
This document discusses the relationship between systemic conditions and periodontal disease. It states that periodontal disease is influenced by factors like diabetes, hormonal changes, hematological disorders, stress, and nutrition. Certain systemic conditions can impair host defenses and increase susceptibility to periodontal infections by reducing barrier integrity and immune response. The relationship between systemic and periodontal health is bidirectional, with systemic factors impacting local periodontal health and vice versa.
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This document discusses the different types of hypersensitivity reactions as classified by Gell and Coombs. It provides details on type I (immediate), type II (antibody-mediated), type III (immune complex-mediated), and type IV (delayed) hypersensitivity reactions, including the antibodies or cells involved, examples of diseases, and a brief description of the immunological reaction for each type. It also discusses contact stomatitis as an uncommon allergic reaction affecting the inside of the mouth.
The document provides an overview of lasers in dentistry, including:
1. A definition of lasers and their key characteristics of being monochromatic, coherent, and directional.
2. A brief history of lasers from early phototherapy research to the invention of the laser in 1960.
3. Descriptions of common dental laser types like CO2, Er:YAG, and Nd:YAG lasers and their applications like soft tissue surgery.
4. Advantages of lasers include reduced bleeding, less pain, and faster healing times compared to traditional scalpel procedures.
This document discusses various toothbrushing techniques and provides guidance on selecting the appropriate technique based on a patient's age, oral health status, and other factors. It describes techniques like rolling, Bass, Stillman, Charters, and Watanabe's method. The rolling technique is generally recommended, while Fones' is for preschoolers, Bass for gingivitis, Stillman for widespread gingivitis, and Charters for bridge wearers. Proper toothbrushing removes plaque and massages gums to improve oral health.
This document discusses the different types of hypersensitivity reactions as classified by Gell and Coombs. It provides details on type I (immediate), type II (antibody-mediated), type III (immune complex-mediated), and type IV (delayed or cell-mediated) hypersensitivity reactions. Key points include the antibodies or cells involved, the immunologic reactions that occur, examples of diseases associated with each type of hypersensitivity, and confirmation that the Mantoux test elicits a type IV delayed hypersensitivity reaction to tuberculosis.
This document provides an introduction to regenerative endodontics and minimally invasive endodontics. It discusses the goals of regenerative endodontics, which include eliminating symptoms, promoting bone healing, and increasing root length. Regenerative endodontics aims to replace damaged pulp and root structures using stem cells. The document reviews the history and terminology of regenerative endodontics. It also examines the tissue outcomes of regenerative procedures, discussing that repair rather than regeneration often occurs. The principles of regeneration and repair in endodontics are explored, as well as pulp biology and the use of bioactive materials to promote healing.
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The document provides an overview of lasers in dentistry, including:
1. A definition of lasers and their key characteristics of being monochromatic, coherent, and directional.
2. A brief history of lasers from early phototherapy research to the invention of the laser in 1960.
3. Descriptions of common dental laser types like CO2, Er:YAG, and Nd:YAG lasers and their applications like soft tissue surgery.
4. Advantages of lasers include reduced bleeding, less need for sutures, and faster surgery times.
This document contains the answers to multiple choice questions about the bones that make up the human skull. It lists various skull bones, sutures, and landmarks, identifying each part labeled in a diagram. These include the frontal bone, parietal bone, occipital bone, sphenoid bone, temporal bone, zygomatic bone, maxilla, mandible, and others.
Radiographic interpretation involves analyzing radiographic images to diagnose dental issues. Radiographs provide diagnostic information and are used alongside clinical exams. Proper interpretation requires evaluating images for normal anatomy and any abnormalities. It is important to systematically examine radiographs for things like bone structure, teeth, and lesions. Any abnormalities detected must be carefully described based on their size, shape, location, density, and other characteristics to determine the potential issue. Radiographic interpretation is a key part of dental diagnosis.
This document provides definitions and details about the anatomy and microscopic structure of gingiva. It begins with definitions of gingiva from several sources and discusses the development, macroscopic anatomy including the different types of gingiva, and microscopic anatomy. The microscopic anatomy section describes the layers of the gingival epithelium and cell types present. It also discusses the different types of gingival epithelium including oral, sulcular, and junctional epithelium. In summary, the document provides a comprehensive overview of the definitions, structures, and histology of gingival tissues.
This document discusses the anatomy, histology, and clinical significance of the attached gingiva. It defines attached gingiva as the portion of gingiva firmly bound to the underlying alveolar bone. The normal width of attached gingiva is described to be greater in the anterior regions. Inadequate width is associated with increased risk of recession and plaque formation. Methods for measuring width and increasing width through surgery are presented. The importance of keratinized tissue for protection and force distribution is explained.
This document provides information on periodontal disease, including its etiology, pathogenesis, histopathology, classification, and prevalence. It discusses how periodontal disease is commonly known as gum disease, which is a gum infection that can damage the soft tissues and bone supporting the teeth. If left untreated, it can lead to tooth loosening and loss. The document also provides statistics on the prevalence of periodontal disease in the Philippines and United States. It outlines the histopathology of periodontal disease in four stages from initial lesion to advanced lesion. Classification schemes for different types of periodontitis are also presented.
A Rationale for Postsurgical Laser Use to Effectively Treat Dental Implants_F...DrCarlosIICapitan
This document describes two case reports that demonstrate how using a laser after regenerative surgery for peri-implantitis can lead to improved outcomes. In the first case, the initial surgery was only partially successful in treating advanced peri-implant bone loss. Five months later, the area was treated with an Nd:YAG laser, along with soft tissue curettage and antibiotics. One year later, the clinical outcomes had greatly improved with reduced soft tissue inflammation and probing depths within normal limits. The second case similarly showed improved results after using a CO2 laser following an initial unsuccessful regenerative surgery. The cases suggest that lasers may help treat peri-implantitis by removing titanium particles and cement remnants that can persist after other
Dental calculus, or tartar, is a hardened deposit that forms on teeth. It begins as dental plaque, which mineralizes on the tooth surface. Calculus forms in two locations: supragingival calculus forms above the gumline and is whitish in color, while subgingival calculus forms below the gumline and is dark in color. Several factors influence calculus formation, including saliva composition and bacterial activity. Calculus promotes the retention of dental plaque and can contribute to periodontal disease if not removed.
This document provides an overview of radiographic interpretation for periapical and panoramic dental x-rays. It discusses the objectives of understanding normal dental anatomy and interpreting pathology under radiographs. Key views covered include periapical and panoramic x-rays. The document outlines the normal radiographic anatomy seen in periapical and panoramic views and provides guidance on interpreting radiographs, including steps to localize, observe, consider generally, interpret, and correlate findings. Common dental structures and conditions that can be evaluated on radiographs are described, such as caries, pulp calcification, bone loss, restorations, and lesions.
This document provides a report on Division 8 of the Kiwanis International Philippine South District. It includes information on district governors, membership numbers and growth for each club, a list of activities conducted at both the division and club levels from October 2022 to March 2023, and service projects implemented by individual clubs. Key events mentioned include Kiwanis One Day, leadership education, installations, relief operations, feeding programs, and health initiatives focused on children and communities.
1) Advances in digital radiographic techniques have provided alternatives to conventional film-based radiography. Two-dimensional digital imaging modalities include intraoral and extraoral techniques like periapical, panoramic, and cephalometric imaging.
2) Digital intraoral imaging can be achieved indirectly by scanning conventional films, semi-directly using photo-stimulable phosphor plates, or directly with solid-state sensors like CCD and CMOS devices. Extraoral imaging uses CCD sensors in panoramic and cephalometric units.
3) Digital images allow for enhancements like adjustments to contrast and brightness as well as measurements not possible with conventional radiography. However, two-dimensional imaging can
Digital imaging has advantages over conventional radiography. Digital images can be enhanced by adjusting contrast and brightness or applying filters. Measurements can also be performed directly on digital images. This allows for image analysis functions like linear measurements. Digital imaging also decreases radiographic working time as images are available immediately and there is no film processing. However, digital images have less contrast compared to conventional films.
This document provides an introduction to regenerative endodontics, which aims to replace damaged dental structures through biological procedures rather than traditional root canal treatments. It defines key concepts like regeneration versus repair and discusses the history and components of regenerative endodontics. Specifically, it outlines sources of stem cells in the dental pulp, papilla, and periapical tissues that can be recruited to sites of injury and differentiated to produce new tissues. Growth factors and scaffolds provide signaling and structure to guide the stem cells in regeneration. The ultimate goals are to eliminate symptoms, enhance bone healing, and potentially increase root length, though complete regeneration of the original pulp-dentine complex is difficult to achieve.
This case report describes a 52-year-old female patient with hypertension who presented with gingival bleeding during toothbrushing. Clinical examination revealed poor oral hygiene, gingivitis, deposits, and generalized chronic periodontitis. Radiographs showed horizontal and vertical bone loss throughout the mouth. The treatment plan included nonsurgical scaling and root planing followed by possible periodontal surgery and extractions. The patient underwent supragingival scaling initially and was medically cleared for nonsurgical SRP, which was performed under local anesthesia. Follow up nonsurgical and possible surgical treatment was planned.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
2. Many systemic diseases, disorders, and conditions
have been implicated as risk indicators or risk factors
in periodontal disease.
Evidence also suggests that periodontal infections
can adversely affect systemic health with
manifestations such as coronary heart disease,
stroke, diabetes, preterm labor, low-birth-weight
delivery, and respiratory disease.
3. ENDOCRINE DISORDERS
AND
HORMONAL CHANGES
Endocrine diseases and hormonal
fluctuations that are associated with
puberty and pregnancy are well-
known examples of systemic
conditions that adversely affect the
condition of the periodontium.
4. ENDOCRINE DISORDERS
AND
HORMONAL CHANGES
During pregnancy, your progesterone hormone
levels are high. This increase makes you more
susceptible to developing the bacterial plaque that
can attack your gums.
Symptoms of gingivitis include:
swollen gums
tender, puffy gums
bleeding gums
receding gums
red gums
bad breath
5. Fig. 1 Periodontal condition in patients with diabetes. (A) Adult with diabetes. (B)
The same patient. (C)Adult patient with uncontrolled diabetes. (D) The same patient
as shown in C. (E)Adult patient with uncontrolled diabetes.
6. Severe gingival inflammation, deep periodontal pockets, rapid bone
loss, and frequent periodontal abscesses often occur in patients with
poorly controlled diabetes and poor oral hygiene (Figs. 2 and 3).
Children with type I diabetes tend to have more destruction
around the first molars and incisors, but this destruction becomes
more generalized at older ages.
In patients with juvenile diabetes, extensive periodontal destruction
often occurs as a consequence of having more severe disease at a
younger age.
7. Fig. 2 patient with a long-term history of
type 2 diabetes
Severe gingival inflammation, deep periodontal pockets, rapid bone loss, and
frequent periodontal abscesses often occur in patients with poorly controlled
diabetes and poor oral hygiene (Figs. 2 and 3).
Fig. 3 Periodontal abscess in type 1 diabetes.
8. The glucose content of gingival fluid and blood is higher in individuals
with diabetes than in those without diabetes with similar plaque and
gingival index scores.
BACTERIAL PATHOGENS
The increased glucose in the gingival fluid and blood of patients with diabetes
could change the environment of the microflora, thereby inducing qualitative
changes in bacteria that may contribute to the severity of periodontal disease
observed in those with poorly controlled diabetes.
9. It has been reported that the prevalence of periodontal disease in diabetic patients is >85% (27.3% of
patients had gingivitis and 59.5% had periodontitis) whereas the prevalence of periodontitis in the general
population is 46% (1,7).
Epidemiological data confirm that diabetes is a major risk factor for periodontitis; susceptibility to
periodontitis is increased by approximately threefold in people with diabetes
Source: Diabetologia. 2012; 55(1): 21–31.
Published online 2011 Nov 6. doi: 10.1007/s00125-011-2342-y
There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with
diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control.
Incidences of macroalbuminuria and end-stage renal disease are increased twofold and threefold, respectively, in diabetic
individuals who also have severe periodontitis compared to diabetic individuals without severe periodontitis.
Furthermore, the risk of cardiorenal mortality (ischaemic heart disease and diabetic nephropathy combined) is three
times higher in diabetic people with severe periodontitis than in diabetic people without severe periodontitis. Treatment
of periodontitis is associated with HbA1c reductions of approximately 0.4%. Oral and periodontal health should be
promoted as integral components of diabetes management.
10. POLYMORPHONUCLEAR LEUKOCYTE FUNCTION
In patients with poorly controlled diabetes, the functions of
PMNs, monocytes, and macrophages are impaired.
As a result, the primary defense mounted by PMNs against
periodontal pathogens is diminished, and bacterial proliferation
is more likely.
No alteration of immunoglobulinA(IgA), G (IgG), or M (IgM)
has been found in patients with diabetes.
11. ALTERED COLLAGEN METABOLISM
Chronic hyperglycemia impairs collagen structure and
function, which may directly impact the integrity of the
periodontium.
Collagen in the tissues of patients with poorly controlled
diabetes is older and more susceptible to pathogenic
breakdown (i.e., less resistant to destruction by periodontal
infections).
12. INTERACTION BETWEEN DIABETES & PERIODONTAL DISEASE
Figure 3. Illustration of the mechanisms of interaction between diabetes and periodontal diseases. The most
widely accepted hypothesis is that diabetes increases inflammatory responses of the peridontal tissues. Exacerbated
and dysregulated inflammatory responses are the key to the proposed two-way relationship between diabetes and
periodontal diseases. AGE: advanced glycosylation end-products; MMP: extracellular matrix metalloproteinases;
PMN: polymorphonuclear leukocytes; RAGE: receptor of advanced glycosylation end-products.
13. METABOLIC
SYNDROME
Obesity is associated with increased cytokine production as well as T-
cell and monocyte/macrophage dysfunction, factors known to contribute
to periodontitis.
Female Sex Hormones
Gingival alterations during puberty, pregnancy, and menopause are
associated with physiologic hormonal changes in the female patient.
Oral changes during menopause may include thinning of the oral
mucosa, gingival recession, xerostomia, altered taste, and burning
mouth.
14. HEMATOLOGIC DISORDERS
AND
IMMUNE DEFICIENCIES
Abnormal bleeding from the gingiva or other areas of the oral
mucosa that is difficult to control is an important clinical sign that
suggests a hematologic disorder.
Petechiae (Fig. 4) and ecchymosis (Fig. 5), observed most often
in the soft palate area, are signs of an underlying bleeding
disorder.
It is essential to diagnose the specific etiology to appropriately
address any bleeding or immunologic disorder.
15. Fig. 4 Petechiae evident on the soft palate of a patient with an underlying bleeding
disorder (thrombocytopenia).
16. Fig. 5 Ecchymosis that is evident on the lateral aspects of the soft palate and
tonsillar pillars of a patient with chemotherapy-induced thrombocytopenia.
17. Disorders that affect the production or function of leukocytes may result in severe
periodontal destruction.
A quantitative deficiency of leukocytes (e.g., neutropenia, agranulocytosis) is
typically associated with a more generalized periodontal destruction that affects
all teeth.
LEUKOCYTE (NEUTROPHIL)
DISORDERS
18. Systemic conditions that are associated with or that predispose an individual to periodontal destruction
include genetic disorders that result in an inadequate number or reduced function of circulating
neutrophils.
Severe periodontitis has been observed in individuals with primary neutrophil disorders such as cyclic
neutropenia (Fig. 6), agranulocytosis, Chédiak–Higashi syndrome, and lazy leukocyte syndrome, secondary
neutrophil impairment, such as those with Down syndrome, Papillon– Lefèvre syndrome, and
inflammatory bowel disease.
GENETIC DISORDERS
19. Fig. 6 Aggressive periodontitis with cyclic neutropenia and agammaglobulinemia.
(A) Clinical presentation of the periodontal condition. (B) Panoramic radiograph
demonstrating severe bone.
20. LEUKEMIA
The leukemias are malignant neoplasias of WBC
precursors. According to their evolution,
leukemias can be acute (which is rapidly fatal),
subacute, or chronic.
Oral and periodontal manifestations of leukemia
may include leukemic infiltration, bleeding, oral
ulcerations, and infections.
21. Fig. 7. Spontaneous bleeding from the gingival sulcus in a patient with thrombocytopenia. Normal
coagulation is evident by the appearance of the large clot that forms in the mouth. However, platelets
are inadequate to establish hemostasis at the site of hemorrhage.
Thrombocytopenia leads to bleeding tendency, which can occur in any
tissue but which in particular affects the oral cavity, especially the gingival
sulcus.
22. LEUKEMIC INFILTRATION
It consists of a basic infiltration of the gingival corium by leukemic cells that
increases the gingival thickness and creates gingival pockets in which bacterial
plaque accumulates, thereby initiating a secondary inflammatory lesion that
contributes to the enlargement of the gingiva.
23. Fig. 8 Leukemic infiltration that causes localized gingival
swelling of the interdental papillae between the maxillary
lateral and central incisors. Note the tense induration of
the area.
Fig. 9 Adult male with acute myelocytic leukemia. (A) A view of
the patient’s face.(B) Close-up view of skin lesions. (C) Gingival
enlargements of the entire gingival margin and interdental papilla
areas of both arches. (D) Occlusal view of the maxillary anterior
teeth.
24. Bleeding
Gingival haemorrhage is a common finding in leukemic patients even in
the absence of clinically detectable gingivitis. Bleeding gingiva can be
an early sign of leukemia.
25. ORAL ULCERATION AND INFECTION
Acute gingivitis and lesions that resemble necrotizing
ulcerative gingivitis are more frequent and more severe in
patients with terminal cases of acute leukemia (Figs. 10).
This greatly altered and degenerated tissue is extremely
susceptible to bacterial infection, which can be so severe as to
cause acute gingival necrosis with pseudo-membrane formation
or bone exposure.
26. Fig. 10Adult female with acute myelocytic leukemia. (A)Anterior view of a patient
with acute myelocytic leukemia. (B) Palatal view demonstrating extensive necrosis
of the interdental and palatal tissues behind the maxillary incisors.
27. Individuals under stress may have poorer oral hygiene; they may start or
increase the clenching and grinding of their teeth; and they may smoke more
frequently.
All of these behavioral changes increase their susceptibility to periodontal
disease destruction. Likewise, individuals who are under stress may be less
likely to seek professional care.
STRESS-INDUCED
IMMUNOSUPPRESSION
28. MEDICATIONS
Bisphosphonates
Bisphosphonate medications are primarily used to treat cancer and
osteoporosis or bone thinning—which occurs when the bones lose
calcium and other minerals that help keep them strong and compact.
They act by inhibiting osteoclastic activity, which leads to less bone
resorption, less bone remodeling, and less bone turnover.
During the treatment of osteoporosis, the goal is simply to harness
osteoclastic activity to minimize or prevent bone loss and, in many cases,
to increase bone mass by creating an advantage for osteoblastic activity.
Figure 11.
29. Bisphosphonate-induced osteonecrosis of the jaws (BIONJ) refers to a
condition characterized by exposure of bone in mandible or maxilla
persisting for more than 8 weeks in patient who has taken or is currently
taking bisphosphonate and who has no radiation therapy to the jaws.
Among cancer patients receiving high-dose
intravenous bisphosphonates, osteonecrosis of
the jaw is dependent on dose and duration of
therapy,17–20 and has an estimated incidence
of 1% to 12%. Fig. 11 exposed bone of the maxilla with
bisphosphonate-induced osteonecrosis of the bone
(maxilla).
30. Radiographic evidence of treatment with bisphosphonates
Panoramic radiograph of osteoporotic patient treated with bisphosphonates,
demonstrating marked increase in depth and density of mandibular inferior
border, periapical osteosclerosis, and increased number and density of
trabeculae in the body and symphaseal areas of the mandible
Panoramic radiograph: Patient: 77 years old, male, metastatic
prostate cancer, ibandronic acid & later another antiresorptive drug:
denosumab. Red arrows point to the necrotic area. Artefact due to
thyroid shield.
Bisphosphonate-induced osteonecrosis of the jaws (BIONJ)
31. The systemic administration of cortisone and adreno- corticotropic
hormone appears to have no effect on the incidence or severity of
gingival and periodontal disease.
However, renal transplantation patients receiving immunosuppressive
therapy have significantly less gingival inflammation than control subjects
with similar amounts of plaque.
CORTICOSTEROIDS
32. Malignancy
Earlier literature review showed that chronic periodontitis is an independent
clinical high-risk profile for head and neck squamous cell carcinoma (HNSCC),
especially in the oral cavity, followed by the oropharynx and larynx.[In a
prospective cohort study by Michaud et al., a significant association was found
between the history of periodontitis and risk of developing lung, kidney,
pancreas, and hematological cancers. These associations are said to persist in a
number of studies, after adjustment for major risk factors, including cigarette
smoking and socioeconomic status. However, the most consistent increased risk
was noted in the studies of oral and esophageal cancers and periodontal disease.
Reference: Med Oral Patol Oral Cir Bucal. 2021 Jul; 26(4): e430–e436. Published online 2020 Dec 19. doi: 10.4317/medoral.24270
PMCID: PMC8254889 PMID: 33340075 Periodontitis as a risk factor for head and neck cancer
Letícia Miquelitto Gasparoni,1 Fábio Abreu Alves,1,2 Marinella Holzhausen,1 Cláudio Mendes Pannuti,1 and Marianna Sampaio Serpacorresponding author2
Gastric and pancreatic cancers had an association in most, but not all studies.
Lung, hematological, and other cancers were less consistently associated or did
not have sufficient studies to determine a predictable pattern. Furthermore,
Tezal et al. reported that patients with periodontal disease were more likely to
have poorly differentiated oral cavity squamous cell carcinoma (SCC) than those
without periodontitis. These findings were said to have implications for practical
and safe strategies for prevention, diagnosis, and treatment of HNSCC . The
possible link between periodontitis and malignancy is not clear, but lifetime
cumulative infection exposure is being queried.
What causes puberty gingivitis?
Puberty gingivitis is most common in preadolescent boys and girls between the ages of 11 and 13. It is typically the result of a combination of elevated hormone levels, which increase the response of gingival tissues to accumulated dental plaque, and poor oral hygiene habits.
Symptoms
Symptoms of puberty gingivitis are most commonly bleeding and inflammation of the gums. The gum tissue may also become swollen, red, and less firm to the touch. The production of sex hormones (oestrogen and progesterone) increases, then remains relatively constant during the remainder of the reproductive phase.1 Kronman and Loesch2 postulated that anaerobic organisms may use ovarian hormone as a substitute for vitamin K growth factor. During puberty, periodontal tissues may have an exaggerated response to local factors. A hyperplastic reaction of the gingiva may occur in areas where food debris, material alba, plaque and calculus are deposited. The inflamed tissues becomes erythematous, lobulated and retractable.1 During puberty, education of the parent or care giver is a part of successful periodontal therapy. Preventive care, including a vigorous program of oral hygiene, is also vital. Milder gingivitis cases respond well to scaling and root planning, with frequent oral hygiene reinforcement. Severe cases of gingivitis may require microbial culturing, antimicrobial mouthwashes and local site delivery or antibiotic therapy. Periodontal maintenance appointments may need to be more frequent when periodontal instability is noted.3
Treatment
You will probably not be too surprised to learn that the best treatment for puberty gingivitis is prevention!
As your child gets older, he or she may be less inclined to listen to mom and dad about good oral hygiene practices. However, it’s important to remain firm on this theme to prevent gum disease from developing.
Make sure your teen is brushing thoroughly for 2 full minutes at least twice a day, and flossing carefully at least once a day.
If a child has already developed gingivitis, it’s best to get it under control as soon as possible, by way of periodontal therapy in the form of scaling and root planing. Mouthwashes containing chlorhexidine can be used to control the infection as well.
Pregnancy gingivitis most commonly develops between months 2 and 8. It may reach a peak during the third trimester. Pregnant women also face an increased risk of both tooth decay and loose teeth. More than 50% of all pregnant women experience some form of pregnancy gingivitis. Pregnancy gingivitis is an hyperplastic reaction to microbial plaque. Elevated estrogen or progesterone levels resulting from hormonal shifts enhance tissue vascularity, which permits an exaggerated inflammatory reaction to plaque. Pregnancy gingivitis produces fiery red, swollen and tender marginal gingiva and compressible and swollen interdental papilla. If pregnancy gingivitis progresses to periodontal disease, it can increase your risk of going into preterm labor.
Fig. 2 patient with a long-term history of type 2 diabetes. (A) Anterior view of the patient’s dental and periodontal condition. (B) Periapical radiographs of the remaining teeth. (C) Clinical photograph of the maxillary premolar area presenting with abscess. (D) Periapical radiograph of the maxillary premolar showing extensive bone loss associated with abscess. Fig. 3 Periodontal abscess in type 1 diabetes. (A) The patient presented with pain and abscess a few weeks after scaling and root planning of the area. (B) severe localized destruction of bone in the area of periodontal abscess. (C) Radiograph of the mandibular right premolar area taken 2 months before the presentation of the abscess.
How does diabetes mellitus cause periodontitis?
If diabetes isn't controlled well, higher blood sugar levels in saliva will help bacteria grow. This can cause gum disease. Poor blood sugar control makes it harder for the immune system to fight gum disease. And gum disease may make it harder to control the diabetes.
It has been reported that the prevalence of periodontal disease in diabetic patients is >85% (27.3% of patients had gingivitis and 59.5% had periodontitis) whereas the prevalence of periodontitis in the general population is 46% (1,7).
Figure 3 illustrates schematically the mechanisms of interaction between DM and periodontitis.
it is well known that diabetic patients present defects in polymorphonuclear leukocyte (PMNL) activity, including chemotaxis, phagocytosis and bactericidal function disorders. Shetty et al. studied PMN functions in 15 diabetic patients with chronic generalized periodontitis, and found that chemotaxis, superoxide production, phagocytosis and killing of Porphy- romonas gingivalis by diabetic PMNs were impaired significantly in comparison with healthy control subjects [58] . Similarly, other studies have shown that diabetic patients with severe periodontitis present reduced chemotaxis in comparison with diabetic subjects with only slight periodontitis, as well as defective apoptosis, which can lead to an increase in PMN retention in the periodontal tissues, which will be accompanied by greater tissue destruction due to continuous MMP and reactive oxygen species (ROS) secretion [56] [57] .
A second element for consideration in this two-way relationship is the role of Ad- vanced Glycation End-products (AGEs). AGEs are composites derived from the non- enzymatic, irreversible glycosylation of proteins and lipids that accumulate in plasma, on the walls of blood vessels and tissues in diabetic patients, which are the main element responsible for the development of the micro and macrovascular complications characteristic of DM [59] . It is known that gingival macrophages present receptors with high affinity for AGEs (RAGE), so that they accumulate in the periodontal tissues of diabetics. A study by Schmidt et al. [60] showed that the gingival tissue of adult patients diagnosed with DM who were subjected to surgical periodontal treatment, presented higher quantities of AGEs than that of non-diabetic subjects. This finding is important as the accumulation of AGEs in the periodontal tissues of diabetic patients favors frequent pro-inflammatory episodes. When AGE binds to its receptor, this produces an overproduction of inflammatory mediators such as IL-1b, TNF-a and IL-6 [56] [57] [61] . The formation of these molecules provokes ROS production, which increases oxidative stress, and the consequent cellular changes that take place contribute to the vascular damage involved in many DM complications [62] - [66] . AGEs also increase the respiratory burst of PMNs, which has the potential to increase tissue damage localized in the periodontium. In addition, AGEs have a harmful effect on bone metabolism, producing an alteration to the bone formation and repair mechanisms, together with reduced production of extracellular matrix. Apoptosis may play a role in the increased susceptibility to periodontal diseases among diabetics, and the death of matrix-pro- ducing cells could limit the possibility of repair in inflamed tissues; it is known that AGEs have harmful effects on extracellular matrix formation, in relation to apoptosis of the cells most involved in its formation such as fibroblasts [57] .
A third element for consideration is the changes that DM may cause in the composition of subgingival microbiota. Compared with the large number of studies that have investigated the role of inflammatory mechanisms in the relation between DM and periodontal diseases, relatively few have focused on the changes triggered by changes to oral microbiota. The few that exist indicate that in general there are more similarities than differences between diabetic and non-diabetic subjects. Nevertheless, some significant differences have been detected, such as the greater prevalence of Porphyromonas gingivalis [67] and Prevotella intermedia [67] [68] in diabetic subjects. These studies indicate that there are probably subtle differences between diabetics and non-diabetics, although the clinical relevance of these differences is not clear. The origins of these differences could lie in the previously observed effects on periodontal tissues that could favor the growth of more pathogenic species.
Cytokines are regulators of host responses to infection, immune responses, inflammation, and trauma. Some cytokines act to make disease worse (proinflammatory), whereas others serve to reduce inflammation and promote healing (anti-inflammatory). Cytokines are produced in response to invading pathogens to stimulate, recruit, and proliferate immune cells. Cytokines includes interleukins (IL), chemokines, interferons, and tumor necrosis factors (TNF). Cytokines play an important role in normal immune responses, but having a large amount of them released in the body all at once can be harmful. This so-called CYTOKINE STORM happens when the immune system produces too many inflammatory signals. This can can cause serious symptoms that in some cases can lead to organ failure and death
Can bleeding gums be a sign of leukemia?
Yes. Your blood platelets help your body stop bleeding. If you have Leukemia, a type of cancer, your platelet count will be low. This makes it harder for you to stop bleeding in different parts of your body, including your gums.
Make an appointment with your doctor if your notice symptoms including unusual bleeding of your gums or nosebleeds.
It may be localized to the interdental papilla area (Fig. 8), or it may expand to include the marginal gingiva and partially cover the crowns of the teeth (Fig. 9C and D). GINGIVAL LEUKEMIC INFILTRATION AS THE FIRST MANIFESTATION OF ACUTE MYELOID LEUKEMIA. The leukemic infiltration of the gingival tissue associated or not with gingival enlargement could be the first manifestation of acute leukemia, and it has rarely been reported in the literature.
The Modifiable Risk factors for periodontitis and cancer: Modifiable (smoking, diabetes mellitus, psychological factors, and lifestyle factors - such as diet and alcoholism) and non-modifiable risk factors are host response and genetic factors.
Therefore, patients should be encouraged to change their lifestyle and adopt healthy habits (healthy eating, regular physical exercise), eliminate risk factors that may predispose them to cancer (smoking and alcohol), practice good oral hygiene, and visit regularly health professionals. Thus, the health multidisciplinary team must act together to reduce or eliminate potential risks that may affect the oral and systemic overall health of patients.