Gingivitis aggravated by systemic disease

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Gingivitis aggravated by systemic disease:

Gingivitis aggravated by systemic disease

Endocrine Disturbance and Hormonal Changes:

Endocrine Disturbance and Hormonal Changes Diabetes Mellitus Complex metabolic disorder: diminished insulin production, impaired insulin action or combination of both result inability of glucose to be transported from blood to tissue resulting in high blood glucose level & secretion of glucose in urine

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Lipids and proteins metabolism are disturbed as well Type I: insulin dependant: cell mediated autoimmune destruction of beta cells of islets of langerhans in pancreas. Children & young adults, difficult to control, unstable, ketosis & coma

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Type II (NIDDM): peripheral resistance to insulin action, impaired secretion & increased glucose production, adult onset, obese individuals, can be controlled by diet & oral hypoglycemic agents

Long term complications of Diabetes:

Long term complications of Diabetes Microvasculature Macro vasculature Increased liability to infection Poor wound healing

Oral manifestations:

Oral manifestations Chelosis Dry mucosa Burning mouth and tongue Diminished salivary flow Altered oral flora: Candida albicans, hemolytic streptococcus Increased caries

Gingival inflammation, bleeding, and mobile teeth: A&B :

Gingival inflammation, bleeding, and mobile teeth: A&B Tendency toward enlarged gingiva: fig C & D Abscess formation: fig E

Periodontitis in type I:

Periodontitis in type I Start after age of 12 (9%) Prevalence increased with age (39%) at age of 19 Sever inflammation, deep pockets, rabid bone loss & frequent periodontal abscess

Higher Incidence of Periodontal Disease in Diabetes:

Higher Incidence of Periodontal Disease in Diabetes Well controlled studies showed higher incidence of periodontal diseases in diabetic patients. 1- Bacterial pathogens: increased glucose in blood & gingival fluid change the environment of microbiota ( Capnocytophaga , anaerobic vibrios , actinomyces species)

2-Polymorphonuclear leukocyte function:

2-Polymorphonuclear leukocyte function Increased susceptibility of diabetic patients to infection may be related to: Decreased number of neutrophyles impaired chemotaxis defective phagocytosis, or impaired adherence

3-Altered Collagen Metabolism:

3-Altered Collagen Metabolism Chronic hyperglycemia adversely affects the synthesis, maturation and maintenance of collagen and extracellular substance 1- Decreased collagen activity 2-Increased collagenase activity 3-Excessive accumulated glycation end products (AGEs)

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AGE cross linked collagen leading to less soluble, which is less liable to repair and leads to impaired cellular migration, impaired tissue integrity and less resistance to infection

Hormonal Imbalance:

Hormonal Imbalance Female sex hormone: 1- The gingiva in puppetry : Puppetry is associated with an exaggerated response of the gingiva to plaque Pronounced inflammation, bluish red discoloration, edema and gingival enlargement

Gingiva in puppetry:

Gingiva in puppetry

2-Gingival changes associated with Menstrual cycle:

2-Gingival changes associated with Menstrual cycle Prevalence of gingivitis increased in some patients with bleeding & tense feeling in the gum

3- Gingival Changes during pregnancy:

3- Gingival Changes during pregnancy Pregnancy affects the severity of previously inflamed areas; it does not alter healthy gingiva The severity increased during second or third month and become more severe by the 8 th month Partial reduction of severity occurs by 2 month postpartum

Clinical features of pregnancy gingivitis:

Clinical features of pregnancy gingivitis Bright red to bluish color (vascularity) Edema that pits on pressure Smooth & shiny Bleeding tendency Enlargement All these changes can be generalized or localized

Etiologic significance:

Etiologic significance Possibility of bacterial hormonal interaction that may change bacterial composition P intermedia was found to be associated with elevated levels of estradiol & progesterone It has also been reported that a depression of maternal T-lymphocyte response

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The aggravated response in pregnancy has been attributed principally to increased level of progesterone, which produce dilatation of gingival microvasculature, circulatory stasis and increased susceptibility to mechanical irritation

4-Hormonal contraceptives & the gingiva:

4-Hormonal contraceptives & the gingiva Increased periodontal destruction after about one & half year of taking contraceptives was reported

5-Menoposal Gingivostomatitis:

5-Menoposal Gingivostomatitis Also termed “ senile atrophic stomatitis ” During menopause hormonal fluctuations of female cycle are ended as estradiol ceases to be major circulating estrogen Gingiva & oral mucosa are dry and vary in color from pale to red, fissuring of mucobuccal folds, ulcerations may be seen

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