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Endocrine influence on periodontium
Dr. Guru Ram (P.G)
Dept of Periodontics
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Introduction Endocrine system
Central endocrine glands
Hypothalamus
Pituitary gland
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Hypothalamus
Homeostasis
Regulation
Hormones
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Pituitary gland
Regulation
Hormones
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Source Hormone Target tissue Principle function Periodontium
Hypothalamus Prolactin inhibiting hormone(dopamine)
Anterior pituitary gland Inhibits prolactin release
Stimulates periodontal ligament cell proliferation
Anterior pituitary
Growth hormone (somatotropin)
Bone, soft tissues and liver
Promotes growth, affects lipids and carbohydrate metabolism
Presence of growth hormone associated with protective effect on periodontium
Thyroid Thyroid hormones (tri iodothyrosine, thyroxine)
Most cells of body Regulators of numerous tissues including cardiac and brain involved with growth and metabolism
Deficiency may be associated with destructive periodontal diseases
Adrenal Cortisol,Weak androgens and estrogens
Most tissues of bodySex accessory tissues
Important for glucose, protein and lipid metabolismLow potency of secreted hormones diminishes effects on target tissues
Excess cortisol associated with destructive periodontal diseasesKnown effects on periodontal tissues including growth as well as disease progression
Pancreas Insulin (β cells) Skeletal muscle, liver, adipose tissue
Lowers the blood glucose, fatty acid and amino acid levels
Decreased insulin production associated with destructive periodontal diseases
Parathyroid Parathyroid hormone Bone, kidneys, intestine
Increases plasma calcium
Decreased cortical bone density and increased PDL width no effect on periodontal parameters
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Effects of central endocrine gland hormones on the periodontium
Britto et al 2011- LIMITED EVIDENCE
M. Partovi et al in 2002
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Mechanism proposedL- DOPA
Stimulates
Dopaminergic systems in the anterior position of hypophysis
To release
Growth hormone
Promoter of healing process
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Peripheral Endocrine glands
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Peripheral endocrine glands
ADRENAL GLAND
THYROID GLAND
PARATHYROID GLAND
GONADS
PANCREAS
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Peripheral endocrine glands
Adrenal gland hormones
The hormones produced by the adrenal cortex include mineralo-
carticoid hormones e. g., Aldosterone, Glucocorticoid, hormones e.
g., cortisol, gonodal hormones e. g., dehydro-epi-androsterone
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Effects of adrenal gland hormones on the periodontium
Association between elevated cortisol levels and periodontitis were demonstrated by clinical studies by Rosania et al and Rai et al in 2009 and 2011.
ByPotential psycho-neuro-immunologic mechanism
Potential behavioural mechanism
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Potential psycho-neuro-immunologic mechanism
Negative emotion
Polypeptides from sympathetic nor adrenaline transmitting and sensory nerve fibres and from endocrine glands
+
Bacterial antigens trigger immune responses
Hypothalamus release corticotropic hormone
Adreno-carticotropic hormone from pituitary
Adrenal cortex release
Cortisol
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Short term elevations of cortisol reduce inflammation and mobilize immune components
Glucocorticoids(cortisol)
Decreases immunocompetency by inhibition of IgA, IgG and neutrophil function.
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Potential behavioural mechanism
The higher cortisol and β endorphin concentrations significantly up regulates expression of MMP-1,2,7,11 and TIMP-1 in human
gingival fibroblasts
Increased periodontal breakdown
Periodontitis
Patricia et al 2007
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• Various kinds of psychologic stress activate HPA(hypothalamus
Pituitary Aderno cortical) system and SM(sympathetic aderno
medullary) system and consequently induce significant increases in
salivary cortisol and catecholamine levels respectively
• Chromagranin A released by exocytosis from the sympathetic nerve
endings
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Thyroid hormoneEffect of thyroid hormone on periodontium:
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Parathyroid gland hormoneHormones- parathormone
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Ca- Regulation
The resorption of calcium from bones by PTH is by
Rapid phase
Slow phase
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Rapid phaseAfter reaching bone
PTH gets activated to receptors on cell membrane of osteoblasts and osteoclasts
Hormone receptor complex
Increases permeability of membranes of these cells for ca-ions
Accelerates ca-pump mechanism
Ca-ions move to bone cells into blood at faster rate
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Slow phaseWhen Osteoclasts are activated by PTH
Lysosomes release enzymes and citric acid and lactic acid
These substances dissolve organic matrix of bone releasing ca ions
Ca ions release to plasma
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Effect of parathyroid gland hormone on periodontium
Primary hyperthyroidism
Secondary hyperthyroidism
Suggested as therapeutic aid
Lindhe et al
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Sex steroid hormones
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Action of sex steroid hormones on periodontium
Sex steroid hormones
Microbiota immune cells
Cells of the periodontium
Altered gene expression
Changes in clinical phenotype
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Proposed mechanisms
Sex steroid induced increase in specific microbiota
kumare et al in 2013
Immune endocrine interactions exaggerate periodontal
responses
Shiau, Reynolds in 2010
Specific populations of fibroblasts and epithelial cells are
modulated by sex steroid hormones:
Mariotti. In 1994
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Sex steroid hormones and the cells of periodontium
Hormone Fibroblasts Androgens
(testosterone & hydrotestosterone)
Decrease proliferationDecrease IL-6 production
Progesterone Decrease proliferationDecrease protein synthesisDecrease cytokine production
Estradiol Increase proliferationIncrease cytokine productionIncrease growth factor
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Factors influencing sex hormones on periodontium
Gender
Age
Hormone supplements
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Gender
Studies by Lau et al 2001 showed that gender plays an
important role in changes associated with bone density
throughout the entire skeleton.
It was showed that 80% of decreased bone density patients
were females.( 80% osteoporotic patients were females)
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Regarding periodontal anatomic differences:
Residual ridge height was lower in women compared
to men + decreased amount of estrogen in post menopausal
women was associated with decreased crestal/subcrestal bone
density
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Age
With regard to age, females undergo more biologic changes
(hormonal imbalances) compared to males such as during
puberty, menstrual cycle, pregnancy, menopause
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Hormone supplementsThese are common used drugs that stimulates a state of pregnancy to prevent ovulation.
HRT has helped in overcoming bone loss in menopausal women, it also has been associated with side effects like thromboembolism, irregular bleeding, fear of cancer,.
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Longitudinal studies have examined the transformation of
subgingival flora from pre puberty to puberty and have
demonstrated a significant increase in the frequency of
Eikenella corrodens,
Prevotella intermedia,
Bacteroides melaninogenicus ,
Prevotella nigrescens,
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Etiology of gingival responses to elevated estrogen & progesterone
during pregnancy
Subgingival plaque composition
Maternal immuno-response.
Sex hormone concentration
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Pancreatic hormones
Effect of pancreatic hormones on periodontium
The metabolic disturbances and the resulting disease sequallae of diabetes mellitus are ultimately the result of a complete or partial reduction in insulin secretion from the β cells
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Oral manifestations
Oral changes described in diabetic patients including
Cheilosis
Mucosal drying
Cracking
Burning mouth and tongue
Diminished salivary flow
Altered oral cavity flora
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Complications of diabetes mellitus
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Mechanisms of diabetic influence on periodontium
These are primarily related to changes in
GCF glucose level
Periodontal vasculature
Collagen metabolism.
The subgingival microbiota
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CONCLUSION
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References Newmann, Takei, Klokkevold, Fermin A Carranza: Carranza’s clinical Periodontology: 10th Ed: Saunders, Elsevier
Britto IM et al , JCP 2011 :38:525-531
Partovi et al. Mitogenic effect of L dopa on human periodontal ligament fibroblast cells: Jour of Endodontics. Vol 28(3): 193-196
Eriksen. Cellular mechanism of bone remodelling: Rev Endocr. Metab Disord 2010: 11: 219-227
Amy Romania et al: stress, depression, cortisol and periodontal disease. J periodontol 2009: 80: 260-266
Depression: Psychiatric clinics of North America. March 2012: 35: 1
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references…Glassman et al: where there is depression there is inflammation. Biol Psychiatry 2007: 62: 280
Kaufman et al: Analysis of saliva for periodontal diagnosis- A review: JCP 2000: 27: 453-465
Johanssen et a: Dental plaque, gingival inflammation and elevated levels of IL-6 and cortisol in GCF from women with stress related depression and excusion: J Periodontol 2006:77: 1403
Balwanth Rai et al: salivary stress markers, stress and periodontitis: A pilot study . J Periodontol 2011: 82: 287-292
Patricia R Cury et al: hydrocortisone affects the expression of MMP-1,2,3,7,11 and tissue inhibitor of matrix metalloproteinases TIMP-1 in human gingival fibroblasts: J Periodontol 2007: 78: 1309-1315
Peruzzo et al. Systemic review of stress and psychological factors as possible risk factors for periodontal disease. J Periodontol 2007: 78: 1491-1504
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references…Persson RE, Hollender et al. assessment of periodontal conditions and systemic disease in older subjects. Focus on osteoporosis: J Clin Periodontol 2002: 29: 796-802
Frankenthal S et al: the effect of the secondary hyperthyroidism and hemodialysis therapy on alveolar bone and periodontium: J Clin Periodontol 2002: 29: 479-483
Barros et al: parathyroid hormone protects against periodontitis associated bone loss: J Dent Res 2003: 83: 791
Marriotti A: Sex steroid hormones and cell dynamics in the periodontium. Crit Rev Oral Biol Med 1994:5:27-53
Liang et al: effect of estrogen receptor β on osteoblasticdifferentiation function of human periodontal ligament cells: Arch Oral Biol 2008: 53: 553-557
Tang et al: Up regulation of estrogen receptor β expression during osteogenic differentiation of human periodontal ligament cells. J Periodontol Res ;2008: 43: 311-321
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Lindhe et al : influence of sex hormones on gingival exudation in dogs with chronic gingivitis: J Periodontol Res: 3 :279-283
Kumare et al: sex and the subgingival microbiome: do female sex steroids effect periodontol bacteria Perio 2000: 2013: 103
Shiau, Reynolds: sex differences in destructive periodontal disease: exploring the biologic basis. J Periodontol 2010: 81: 1505-1517
Mariotti. Sex steroid hormones and cell dynamics in the periodontium: Crit Rev Oral Biol Med 1994: 5: 27-53
Mariotti AJ. Estrogen and extracellular matrix influence human gingival fibroblast proliferation and protein production. J Periodontol 2005: 76: 1391-1397
Lapp CA, Thomas et al. Modulation by progesterone of Interleukin-6 production by gingival fibroblasts. J Periodontol 1995: 66: 279-284
Loe H: Periodontal disease: the sixth complication of diabetes mellitus: Diabetes Care: 1993: 16: 329
references…
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