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



 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



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)


 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



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