This document discusses the influence of various systemic conditions on the periodontium. It covers endocrine disorders like diabetes mellitus and how it can cause oral manifestations such as gingival enlargement and rapid bone loss. It also discusses the effects of female sex hormones during puberty, pregnancy, menopause and use of hormonal contraceptives. Other conditions covered include hematological disorders, genetic disorders like Down syndrome, stress, medications like bisphosphonates, and corticosteroids. It concludes with some multiple choice questions to test understanding.

1. INFLUENCE OF SYSTEMIC
CONDITIONS ON
PERIODONTIUM

2. INTRODUCTION
• Systemic diseases,disorders&conditions
• Altered host tissue&physiology
• Impair the host’s barrier function&immunity
• Creating opportunity –periodontal destruction

3. ENDOCRINE DISORDERS&HARMONAL
CHANGES
DIABETES MELLITUS:
-Complex metabolic disorders-ch. Hyperglycem
-6th complication-Periodontitis
-Type I (IDDM)
-TypeII(NIDDM)
-Gestational diabetes

4. DIABETES MELLITUS Contd…
ORAL MANIFESTATION
-Cheilosis
-Mucosal drying
-Cracking
-Burning mouth&Tounge
-Decrease salivary flow
-Greater predominance of Candida albicance

5. DIABETES MELLITUS Contd…
PERIODONTIUM
-Tendency towards enlarge gingiva
-Sessile/Pedunculated gingival polyps
-Abscess formation/Rapid bone loss
-Mobile teeth
-Function of PMNs/Monocyte/Macrophages
impaired
-Decrease collagen synthesis&Alv bone height
->>AGEs(accumulated glycation end-products)

6. FEMALE SEX HORMONES
PUBERTY
-Pronounced Inflammation
-Edema
-Gingival Enlargement
MENSTRUATION
-Bleeding gums
-Tense feeling of gums

7. FEMALE SEX HORMONES Contd…
PREGNANCY
-Gingivitis due to Bacterial plaque
-Greater senstivity-2nd&3rd trimester
-Raspberry gingiva
-Pregnancy tumor
-P.intermedia increase
HORMOANAL CONTRACEPTIVES
-Increase gingival response to local factors
->>1.5ys – incresaes periodontal destruction

8. FEMALE SEX HORMONES Contd…
MENOPAUSE
-Gingiva&oral mucosa-shiny,dry,paleness to
redness&bleed easily
-Burning sensation
-Excess senstivity to thermal changes
-Abnormal taste sensation
-Ch. Desquamative gingivitis

9. HYPERPARTHYROIDISM
-Generalized demineralization of the skeleton
-Increased osteoclast
-Formation of bone cyst&giant cell tumor
-Loss of lamina dura
ORAL CHANGES
-Malocclusion
-Tooth mobility
-Widening of Pdl
-Brown Tumors (bone cyst+fibrous tissuse+hemosiderin-
laden macrophages&giant cells)

10. HEMATOLOGIC DISORDERS
NEUTROPENIA
-Decrease levels of circulating neutrophils
-<500µl severe –life threting
AGRANULOCYTOSIS
-Ulcerative necrotising lesion-oral/skin/GIT/UTI
-Fever,malaise,weakness&sore throat
-Gingival haemorrage
-Fetid odor

11. HEMATOLOGIC DISORDERS Contd…
LEUKEMIA
ORAL MANIFESTAION:
-Gingival enlargement
-Bleeding gingiva
-Oral ulceration
-Petechiae&Ecchymosis
-Infection

12. HEMATOLOGIC DISORDERS Contd..
ANEMIA
-Glossitis(painful&burning lingual sensatiion)
-Craked/fissure at the corner of mouth
-pallor skin
-Dysphagia
-Koilonychia
THROMBOCYTOPENIA
-Focal hemorrhages-various tissues&organs
-Petechiae/echymosis

13. GENETIC DISORDERS
DOWN SYNDROME
-Trisomy of 21,mangolism
-Growth retardation
-Mental deficiency
-Increase prevalence of periodontal diseases
-Deep periodontal pocket
-Poor PMNs chemotaxis,phagocytosis

14. STRESS
-ANUG(Trench mouth)
-Desquamative lesions
-Decreasse level of IL-1&MMP-9
-Influence outcomes of periodontal therapy
-Grinding&clenching –teeth&periodontium

15. MEDICATIONS
BISPHOSPHONATES
-Cancer&osteoporesis
-Inhibit osteoclasic activity
-BRON
-BION
-Pathologic fracture
CARTICOSTEROIDS
-Osteoporesis of alv bone
-Capillary dilatation
-Hemorrhage Pdl&gingival CT
-Reduction collagen fibers

16. MCQ-1
Which of the following ulteration can be
observed in the Periodontium due to Chronic
hyperglycemia
(a)Gingival polyp
(b)Gingival bleeding
(c)Widening Periodontal ligament
(d)Necrotic gingiva

17. MCQ-2
Which of the following is related with poorly
controlled diabetic patients
(a)Impaired functions of PMNs
(b)Increase collagen synthesis
(c)Normal AGEs formation
(d)Impaired bone loss

18. MCQ-3
In which of the following condition Raspberry
like gingiva can be seen
(a)Puberty
(b)Pregnancy
(c)Menopause
(d) Menstruation

19. MCQ-4
The following is a clinical picture of gingiva in
leukemic patients
(a)Gingival bleeding
(b)Gingival necrosis
(c)Gingival abscess
(d)Gingival atrophy

20. MCQ-5
Radiographic widening of periodontal ligament
space and loss of lamina dura are the
important findings of
(a)Diabetes mellitus
(b)Hyperparathyroidism
(c)Leukemia
(d)Agranulocytosis