periodontal conditions of medically comprmised patients
TRANSCRIPT
INTRODUCTION
Toxins produced changes in inflammatory &
immunologic in the periodontal tissues at both
cellular and molecular level.
Certain systemic disorders can have direct effect
on periodontal tissues.
These systemic diseases DONOT initiate
CHRONIC DESTRUCTIVE PERIODONTITIS .
But still they can accelerate its progression and
increase tissue destruction.
Types of Systemic conditions:
Dietary and Nutritionary aspects.
Hematological disorders.
Metabolic and Endocrine disorders.
Cardiovascular diseases.
Antibody Deficiency disorders.
Other Systemic disorders.
Psychosomatic disorders.
DIETARY & NUTRITIONAL
ASPECTS
Fibrous diet is more beneficial than intake of soft
and loose-textured food.
Soft diet(high proportion of sucrose) – Inc plaque.
Fibrous diet – Natural cleansing to teeth &
periodontium.
Coarse diet – vigorous mastication – plaque over
the buccal and lingual surface.
Course and granular diet – direct trauma to
supporting tissue.
1. Protein Deficiency.
PROTEIN – constituent of organic matrices of
dental tissues including alveolar bone.
Integrity of periodontal ligament dependent on
protein (amino acids)
2. Vitamins Impact.
VITAMIN – C: (Scurvy)
Low ascorbic acid affects the ability of the tissue to
regenerate and repair itself.
Interferes Bone formation.
Inc. permeability of oral mucosa – endotoxin.
Inc. Ascorbic acid enhances chemotactic &
migratory action of leukocytes without phagocytic
activity.
Depletion of Vit c causes increase in pathogenicity.
Gingiva becomes brilliant red, tender and
swollen, bone resorption, mobility and dark blue
hue in long standing cases.
VITAMIN – D:
Needed for absorption of calcium from the
gastrointestinal tract and maintenance of calcium –
phosphorous balance.
Deficiency – Complete lamia dura and reduced
density of supporting bone, loss of trabeculae.
VITAMIN – E:
Acts as antioxidant and in maintaining the stability
of the cell membranes and protecting against
hemolysis.
VITAMIN – Bcomplex:
Gingivitis, glossitis, glossodynia, angular chelitis
and inflammation of entire oral muccosa.
HEMATOLOGICAL DISORDERS
WBC and RBC disorders.
The WBC disorders have the most pronounced
effect on the periodontal tissues.
Haemostasis – due to vascular constriction,
Platelet adhesion and Aggregation, Coagulation,
Fibrinolysis.
WBC disorders…
Neutropenias:
Persistent severe gingivitis.
Cherry red gingiva
Edematous and Hypertrophic.
Occasional desquamation.
TREATMENT:
Strict oral hygiene programme
Sccaling & regular prophylaxis.
Antiseptic irrigation and Antibiotic prophylaxis before any
treatment.
LEUKEMIA:
Gingival enlargement
Massive leukemic cell infiltration into connective tissue.
Difficult to remove the plaque.
Gingival Bleeding (profuse).
TREATMENT:
Medical evaluation.
Complete periodontal trt before Chemotherapy.
In chronic leukemia cases scaling and root planning can be
done but periodontal surgery is contraindicated.
THROMBOCYTOPENIC PURPURA:
Low platelet count
Spontaneous bleeding.
Petechiae and Hemorrhagic vesicles in oral cavity.
Soft, Swollen and Friable gingiva.
TREATMENT:
Medial evaluation.
OHI
Prophylactic trt.
NO SURGICAL PROCEDURES.
Careful scaling and root planning.
RBC disorder…
FANCONI’S ANEMIA:
Familial bone marrow hypoplasia , manifested in frst
deccade.
Loss of several teeth.
Pocketing more than 10mm.
Bluish red Gingiva
Bleeding and Suppuration on mild pressure.
METABOLIC & ENDOCRINE dis.
DIABETES MELLITUS:
Extensive bone loss.
Widening of periodontal ligament.
Suppuration and abscess formation.
TREATMENT:
In Uncontrolled cases treatment is contraindicated.
Lab reports analysis.
Continuous monitoring of sugar levels.
GUIDELINES ??
THYROID GLAND: No notable changes in periodontium.
TREATMENT: Thyrotoxicosis and improper medical mgmt patient must not
be treated periodontally until their condition is stabilized.
Epinephrine, atropine etc must be used with caution.
Hypothyroid pts need careful administration of sedatives and narcotics because of their diminished ability to tolerate drugs.
PITUITARY GLAND: Enlarged lips, Hyperpigmentation on nasolabial
folds.
Food impaction and hypercementosis-Hyperpituitarism.
Crowding and Malposition – Hypopituitarism.
PARATHYROID GLAND:
Hyper secretion – demineralization of skeleton.
Malocclusion, alveloar osteoporosis, absence of lamina dura.
TREATMENT: Routine periodontal therapy. Dentist must be aware tof the oral
changes occurring in that patient in particular.
GONADS:
PUBERTY and PREGNANCY: Bleeding, Bright to Bluish red color.
Edematous gingiva.
Increased progesterone leads to dilatation and tortusity of microvasculature , circulatory stasis.
Increased pocket depth, Mobilty.
CARDIOVASCULAR DISEASES
CONGENITAL HEART DISEASE:
Purplish red discoloration of lips and gingiva.
Tongue appears to be coated, Fissured,
edematous.
Reddening of fungiform and filliform papillae.
GUIDELINE ???
ANTIBIOTIC DEFICIENCY
DISORDER
AIDs:
HIV gingivitis:
Linear bleeding, erythematous gingivitis, necrotizing
ulcerartive stomatitis.
TREAMTMENT : Meticulous oral care.(metronidazole)
HIV periodontitis:
Rapid periodontal destruction, Interproximal bone loss,
painful at onset.
TREATMENT : Scaling, root planning, Betadine irrigation,
Severe NUP metronidazole 400mg TD 5-7days.
OTHER SYSTEMIC
BISMUTH INTOXICATION:
Ulcerative gingivostomatitis, nausea, vomitting.
Metallic taste, burning sensation of oral mucosa.
Narrow Bluish black discoloration of gingival
margin.
LEAD INTOXICATION:
Inc salivation.
Coated tongue.
Peculiar sweetish taste.
Ulcerations.
BURTONIAN LINE (steel grey liner pig) + local
irritation.
MERCURY INTOXICATION:
Linear pigmentation.
Ulcerations.
Destruction of alveolar bone.
OTHER:
Phosphorus, Arsenic, Chromium – Necrosis of
alveolar bone, loosening & exfoliation of teeth.
PSYCHOSOMATIC DISORERS:
Two ways of impact :
Direct effect of ANS.
Developmental habits injurious to periodontium.
Under comditions of Mental and Emotional stress
oral cavity may be subconsciously an outlet for
the gratification of basci drives in adult.
GRATIFICATION derived from neurotic habits are
very harmful to the periodontitium.