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Questions and Answers
Which of the following disorders is associated with neutrophil defects?
Which of the following disorders is associated with neutrophil defects?
Patients with neutrophil defects do not experience oral health issues.
Patients with neutrophil defects do not experience oral health issues.
False
Name one hormonal modifying factor related to systemic disorders.
Name one hormonal modifying factor related to systemic disorders.
Diabetes
___ play a key role in the host defense against extracellular bacteria.
___ play a key role in the host defense against extracellular bacteria.
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Match the disorder with its associated risk factor:
Match the disorder with its associated risk factor:
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Which drug is associated with inducing hormonal disorders?
Which drug is associated with inducing hormonal disorders?
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Aging is considered a systemic modifying factor that affects periodontal health.
Aging is considered a systemic modifying factor that affects periodontal health.
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What is one example of a condition that may cause leukocyte abnormalities?
What is one example of a condition that may cause leukocyte abnormalities?
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What is a contributing factor to the thickening of blood vessel walls in diabetes mellitus?
What is a contributing factor to the thickening of blood vessel walls in diabetes mellitus?
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Hyperglycemia enhances the phagocytic ability of neutrophils.
Hyperglycemia enhances the phagocytic ability of neutrophils.
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Name one anaerobic microorganism that is commonly found in patients with diabetes mellitus and periodontitis.
Name one anaerobic microorganism that is commonly found in patients with diabetes mellitus and periodontitis.
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What is the primary characteristic of Papillon-Lefevre syndrome?
What is the primary characteristic of Papillon-Lefevre syndrome?
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The formation of AGEs makes collagen less soluble and decreases its ability to be __________.
The formation of AGEs makes collagen less soluble and decreases its ability to be __________.
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Reduced resistance to infections is a factor associated with generalized periodontal disease.
Reduced resistance to infections is a factor associated with generalized periodontal disease.
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Match the following conditions with their effects on immune response in diabetes mellitus:
Match the following conditions with their effects on immune response in diabetes mellitus:
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What is the primary cause of the increase in Prevotella intermedia during pregnancy?
What is the primary cause of the increase in Prevotella intermedia during pregnancy?
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What effect does chronic hyperglycemia have on collagen synthesis?
What effect does chronic hyperglycemia have on collagen synthesis?
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What genetic trait is associated with generalized periodontal disease?
What genetic trait is associated with generalized periodontal disease?
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The defect in neutrophil __________ causes failure to migrate from peripheral circulation to injury sites.
The defect in neutrophil __________ causes failure to migrate from peripheral circulation to injury sites.
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Bleeding on brushing is a common feature during pregnancy gingival inflammation.
Bleeding on brushing is a common feature during pregnancy gingival inflammation.
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The presence of AGEs leads to an increased blood flow to the gingiva.
The presence of AGEs leads to an increased blood flow to the gingiva.
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What is the recommended periodontal procedure during pregnancy?
What is the recommended periodontal procedure during pregnancy?
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What is one effect of high levels of AGEs on periodontal tissues?
What is one effect of high levels of AGEs on periodontal tissues?
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What chromosomal abnormality is associated with a congenital disease that includes mental deficiency?
What chromosomal abnormality is associated with a congenital disease that includes mental deficiency?
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The localized growths in the gingiva during pregnancy are commonly referred to as __________.
The localized growths in the gingiva during pregnancy are commonly referred to as __________.
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Match the diseases with their characteristics:
Match the diseases with their characteristics:
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Increased proliferative rates of fibroblasts in gingival tissue lead to reduced collagen production.
Increased proliferative rates of fibroblasts in gingival tissue lead to reduced collagen production.
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Which period is considered the safest for dental treatment during pregnancy?
Which period is considered the safest for dental treatment during pregnancy?
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Trisomy of chromosome 21 is commonly associated with __________ disorders and recurrent infections.
Trisomy of chromosome 21 is commonly associated with __________ disorders and recurrent infections.
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Metronidazole can be safely prescribed to females taking oral contraceptives during periodontal therapy.
Metronidazole can be safely prescribed to females taking oral contraceptives during periodontal therapy.
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During menopause, the gingiva and oral mucosa may become dry, shiny, and bleed easily, showing colors ranging from __________ to __________.
During menopause, the gingiva and oral mucosa may become dry, shiny, and bleed easily, showing colors ranging from __________ to __________.
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Match the condition or factor with its influence on periodontal tissues:
Match the condition or factor with its influence on periodontal tissues:
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What percentage of patients taking Phenytoin experience gingival enlargement?
What percentage of patients taking Phenytoin experience gingival enlargement?
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Gingival enlargement due to Phenytoin is more commonly observed in patients over 40 years of age.
Gingival enlargement due to Phenytoin is more commonly observed in patients over 40 years of age.
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What is a common treatment to prevent gingival enlargement in patients taking Phenytoin?
What is a common treatment to prevent gingival enlargement in patients taking Phenytoin?
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Nifedipine is commonly used to treat _____ and _____ .
Nifedipine is commonly used to treat _____ and _____ .
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Which of the following statements about gingival enlargement caused by Nifedipine is true?
Which of the following statements about gingival enlargement caused by Nifedipine is true?
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The connective tissue in gingival overgrowth exhibits fewer fibroblasts than normal tissue.
The connective tissue in gingival overgrowth exhibits fewer fibroblasts than normal tissue.
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What surgical procedure may be performed to eliminate hyperplastic tissues?
What surgical procedure may be performed to eliminate hyperplastic tissues?
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Match the drug with the corresponding feature:
Match the drug with the corresponding feature:
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Which type of leukemia is characterized by diffuse replacement of bone marrow with immature leukemic cells?
Which type of leukemia is characterized by diffuse replacement of bone marrow with immature leukemic cells?
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Leukemic gingival enlargement can occur in patients with chronic leukemia.
Leukemic gingival enlargement can occur in patients with chronic leukemia.
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What is one of the main causes of gingival bleeding in leukemia?
What is one of the main causes of gingival bleeding in leukemia?
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The gingiva in acute leukemia appears ____ and cyanotic.
The gingiva in acute leukemia appears ____ and cyanotic.
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Match the following conditions with their characteristics:
Match the following conditions with their characteristics:
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Which of the following is NOT a characteristic feature of acute leukemia?
Which of the following is NOT a characteristic feature of acute leukemia?
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What condition may arise from the infiltration of leukemic cells into the alveolar bone?
What condition may arise from the infiltration of leukemic cells into the alveolar bone?
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Cyclic agranulocytosis occurs with periodic decrease in the neutrophil count.
Cyclic agranulocytosis occurs with periodic decrease in the neutrophil count.
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Study Notes
Systemic Predisposing Factors
- Systemic factors can affect the periodontium, including hematological disorders, genetic disorders associated with other conditions, hormonal imbalances, drug-induced disorders, nutritional deficiencies, psychosomatic conditions, aging, and viral infections.
I. Hematologic Disorders
- All blood cells play a role in maintaining a healthy periodontium.
- White blood cells (WBCs) are involved in peripheral and inflammatory reactions.
- Disorders of blood elements profoundly affect the periodontium.
- Neutrophils are crucial in host defense against extracellular bacteria.
- Patients with neutrophil defects frequently experience oral mucosal ulceration, gingivitis, and/or periodontitis.
- Primary leukocyte disorders causing severe periodontal disease include leukemia, neutropenia, Chediak-Higashi syndrome, and early-onset periodontitis.
- Secondary leukocyte abnormalities emerge due to underlying systemic disease, including diabetes mellitus and AIDS.
- Leukemia is a malignant neoplasia of white blood cell precursors.
- Acute monocytic and myelocytic leukemias are the most prevalent types, marked by diffuse bone marrow replacement with immature leukemic cells, abnormal white blood cells circulating in the blood, and wide-spread infiltrates in organs.
- In acute leukemia, the gingiva appears bluish-red and cyanotic.
- Interdental papillae are enlarged, spongy, friable, and bleed with slight or spontaneous provocation.
- Bacterial infection leads to marginal gingiva ulceration and necrosis, pseudomembrane formation.
- Alveolar bone resorption and teeth looseness result from leukemic cell infiltration.
- Leukemic gingival enlargement isn't observed in edentulous or chronic leukemia patients.
- Gingival bleeding in leukemia stems from reduced red blood cell and platelet production (anemia and thrombocytopenia), respectively.
- Leukemic cell infiltration into the gingiva creates pockets, attracting plaque accumulation, and contributing to gingiva enlargement.
II. Associated with Genetic Disorders
- Familial and cyclic neutropenia involves periodic, monthly (3–5 days) decline in neutrophils during infancy and childhood.
- The gingiva may manifest as edematous, friable, and hyperplastic with foul odor.
- Deep periodontal pockets and generalized periodic alveolar bone loss (rapidly destructive periodontitis) characterize the disease.
- Gingiva regains normal appearance when neutrophil counts normalize.
- Down syndrome, a congenital disease caused by chromosomal abnormality (Trisomy 21), is marked by mental deficiency and growth retardation.
- Generalized periodontal disease is more prevalent in the lower anterior region, due partially to reduced resistance to infections and a defect in cell maturation and chemotaxis.
- Lazy Leukocyte Syndrome: defect in neutrophil chemotaxis, so neutrophils fail to migrate to tissue injury sites.
- Phagocytosis and intracellular killing aren't affected.
- Papillon-Lefèvre syndrome: autosomal recessive trait with hyperkeratotic skin lesions (palms and soles) and severe periodontium destruction, leading to early loss of deciduous and permanent teeth.
III. Hormonal Imbalances
- Diabetes Mellitus: A complex metabolic disorder characterized by chronic hyperglycemia, is crucial regarding periodontitis.
- Uncontrolled diabetes is associated with microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (cardiovascular, cerebrovascular) diseases, increased susceptibility to infections, and poor wound healing.
- Oral manifestations of uncontrolled diabetes include diminished salivary flow (xerostomia, burning mouth/tongue), increased dental caries and periodontal disease.
- Increased glucose content in gingival fluid may elevate microorganisms.
- Advanced glycation end products (AGEs) thickens blood vessels, reducing gingival blood supply.
- Infections, impaired chemotaxis, phagocytosis, intracellular killing, and altered collagen synthesis occur due to hyperglycemia.
- AGEs render periodontium more vulnerable to degradation.
- Increased susceptibility to infection (candidiasis and periodontitis) due to hyperglycemia.
- Ketoacidosis, reduced phagocytic ability and chemotaxis; vascular wall disease, reduced blood flow and neutrophil mobilization, decreased oxygen tension.
- Hyperlipidemia affects macrophage function and cytokine release, contributing to poor wound healing.
- Bacterial pathogens include Capnocytophaga, anaerobic vibrios, actinomyces, Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans.
- Diabetes may not cause gingivitis/periodontal pockets but worsens the response to local irritants, hastening bone loss and slowing post-therapy healing.
- Advanced periodontal disease (severe gingival inflammation, deep pockets, rapid bone loss, frequent abscess formation) often occurs, especially in diabetics with inferior oral hygiene.
- In type I diabetes, extensive periodontal destruction occurs initially around the first molars and incisors.
- Normal tissue responses, no caries or periodontal disease increase with proper diabetes control.
IV. Drug-Induced Disorders
- No drug has proven to initiate periodontal disease, but some medications impact periodontal tissues and responses to irritants.
- Phenytoin (Dilantin) often results in mild to moderate gingival enlargement, more common in younger patients and less observed over 40.
- Dihydropyridine (Nifedipine), a calcium channel blocker used to treat angina pectoris and hypertension, can cause gingiva overgrowth in 20% of cases, commonly affecting anterior teeth. No age/sex specific preference is noted.
- Cyclosporine, immunossupressant, displays increased correlation between administered dose/duration and severity of gingiva enlargement in 25% of cases.
V. Nutritional Disorders
- Nutrition's role in chronic periodontitis is debatable.
- Malnutrition indirectly influences by changing the existing disease rather than initiating it.
- Deficiency states don't affect inflammatory response in the absence of local triggers like plaque.
- Vitamin C is essential for collagen maintenance, cell respiration, and capillary integrity.
- Ascorbic acid deficiency may exhibit gingivitis changes and tooth mobility that usually don't improve with supplements unless existing condition triggers are removed.
VI. Psychosomatic Disorders
- Psychological disturbances affect periodontium.
- Lack of plaque control in psychologically disturbed patients frequently associates with gingivitis and periodontitis.
- Physiologic tissue balance can be directly affected by the autonomic nervous system.
- Habits that damage the periodontium (grinding, clenching) emerge due to psychological reasons.
- Stress increases adrenal hormone secretion (corticosteroids, catecholamines), impacting periodontal tissue and making it more susceptible to destruction, and having immunosuppressive effects.
- Additional variables can include eating habits, smoking, lack of sleep, etc.
VII. Aging
- Age and initial disease duration are essential factors in periodontal disease.
- Incidence and severity of periodontal disease increase with cumulative plaque effects over time, causing both incidence and severity to increase.
VIII. Viral Infections
- Acquired Immunodeficiency Syndrome (AIDS): HIV has a strong affinity for immune cells (T-helper lymphocytes, monocytes, macrophages, Langerhans cells), hindering the immune system, leaving patients prone to opportunistic infections and malignancies.
- HIV gingivitis: Characterised by a persistent linear easily bleeding erythematous gingivitis, localized or generalized, involving the marginal and attached gingiva.
- HIV periodontitis: Painful, rapidly progressive, necrotizing, ulcerative periodontitis (NUP) with notable interproximal bone loss. Exposed and necrotic alveolar bone occurs with subsequent sequestration.
Other Systemic Factors
- Hormonal fluctuations (puberty, pregnancy, menstruation, menopause) can cause hormonal imbalances leading to exaggerated gingival responses to irritant with inflammation, bluish-red discoloration, edema, and gingival enlargement frequently during mixed dentition. -Pregnancy affects previously inflamed areas without affecting healthy areas; increased gingival inflammation peaks during the second to eighth months of gestation then decreases after labor alongside hormonal decrease.
IX. Steroids
- Steroids are not found to be a direct initiator to periodontal disease or alveolar process.
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Description
Explore the impact of systemic factors on periodontal health, focusing on hematological disorders and their effects on the periodontium. This quiz examines the roles of blood cells, particularly white blood cells, in maintaining oral health and the implications of various disorders. Test your understanding of how these systemic conditions influence periodontal disease.
