Periodontal Therapy in Female Patients PDF

21.11.2023 PERIODONTOLOGY Periodontal Therapy In Female Patients Assist. Prof. Ece RAKUNT TOPTAŞ Department of Periodontology [email protected] 1 Resources Newman and Carranza’s Clinical Periodontology 2 1 21.11.2023 Periodontal Therapy in Female Patients • Puberty • Menses • Pregn...

21.11.2023 PERIODONTOLOGY Periodontal Therapy In Female Patients Assist. Prof. Ece RAKUNT TOPTAŞ Department of Periodontology [email protected] 1 Resources Newman and Carranza’s Clinical Periodontology 2 1 21.11.2023 Periodontal Therapy in Female Patients • Puberty • Menses • Pregnancy • Oral contraceptives • Menopause 3 Puberty Immune function Sex steroids (Estrogen, Progesterone) Bone metabolism 4 2 21.11.2023 Puberty Maturation of gingival epithelium Significant impact on periodontium ESTROGEN Osteoblastic differentiation of PDL cells Bone formation 5 Puberty •Periodontal tissues à exaggerated response to local factors!!! à hyperplastic reaction of the gingiva can occur •Erythematous Histologically: •Lobulated •Retractable •Bleed easily INFLAMED TISSUES Inflammatory hyperplasia 6 3 21.11.2023 Puberty Management: • Preventive care!!! (oral hygiene intructions to parents and teenager) • Periodontal problemsà frequent maintanence appointments 7 Menstruration Ovarian hormones à • inflamation in gingival tissues • Response to local irritants 8 4 21.11.2023 Mensturation • Gingival inflammation à aggravated by an imbalance or increase in sex hormones. vMenstrual cycle irregularity is a risk indicator for periodontal disease before menopause. 9 Mensturation Progesterone Prostoglandin (PG) production Mediate body response to inflammation 10 5 21.11.2023 Mensturation Manegement: • PMS( Premenstural syndrome) mood swings, tenderness, more sensitive etc. • Gingival bleeding • Tenderness Close periodontal 3-4 month recall monitoring (in problematic visits cases) 11 Pregnancy • Pregnancy gingivitis!! (%30%100) • Pyogenic granulomas !!! (0.2% to 9.6%) 12 6 21.11.2023 Role of pregnancy hormones Subgingival Plaque Composition: • Increase in anaerobic / aerobic ratio • Higher concentrations of Prevotella intermedia • Higher concentrations of Bacteroides melaninogenicus • Higher concentrations of Porphyromonas gingivalis 13 Role of pregnancy hormones Maternal Immunoresponse : • Depression of cell-mediated immunity • Decrease in neutrophil chemotaxis • Depression of antibody and T-cell responses • Decrease in ratio of peripheral helper T cells to suppressor- cytotoxic T cells (i.e., CD4/CD8 ratio) • Cytotoxicity directed against macrophages and B cells can diminish immunoresponsiveness • Decrease in absolute numbers of CD3+, CD4+, and CD19+ cells in peripheral blood during pregnancy versus postpartum • Stimulation of prostaglandin production 14 7 21.11.2023 Role of pregnancy hormones Estrogen •Increase cellular proliferation in blood vessels Progesteron • Increase vascular dilatation and permeability • Increase bleeding tendency (new capillaries) • Decrease keratinization • Collagen production changes • Increase epithelial • Increase breakdown of folate glycogen specific • İncrease tissue proteolysis receptors 15 Role of pregnancy hormones ESTROGEN Affect ground substance of connective tissue by increasing fluidity PROGESTERON 16 8 21.11.2023 Periodontal Disease and Preterm, LowBirth-Weight Infants Low-Birth Weight (<2500 g) Periodontal Disease 1.By oral m.o (directly) Preterm (<37 weeks’ gestation) 2.By bacterial products (indirectly) 3.By maternally produced inflammatory mediators (indirectly) 17 Pregnancy Clinical Management: • Excellent medical history! -pregnancy complications -previous miscarriages -recent history of crampimg, spotting or pernicious vomitting • Contact to patient’s obstetrician. -discuss medical status -periodontal or dental needs -treatment plan 18 9 21.11.2023 Pregnancy Clinical Management: Primary objective: vEstablish healthy oral environment vMaintain optimal oral hygiene Preventive periodontal program! 19 Pregnancy Treatment: Avoid elective dental care 1st Trimester ORGANOGENESIS Last half of the 3rd Trimester VULNERABLE TO PREMATURE DELIVERY 20 10 21.11.2023 Pregnancy Treatment: • Early in the 2nd Trimester is the safest period! • Scaling, polishing and root planing can be performed whenever necessary during pregnancy (consult to obstetrician) 21 22 11 21.11.2023 23 Menopause • Menopause ßàsymptoms of estrogen deficiency • Estrogen • FSH, LH • Levels of sex hormones fluctuate 24 12 21.11.2023 Menopause • Oral changes: v Thining of the oral mucosa v Oral discomfort (burning mouth) v Gingival recession v Xerostomia v Altered taste sensation v Alveolar bone loss v Alveolar ridge resorption 25 Menopause • Fluctuations of sex hormones à inflammatory changes in the gingiva, hypertrophy or atrophy • Estrogenà gingival epithelium ( cellular proliferation, differentiation, keratinization) • Sex steroids à connective tissue (increasing intracellular fluid content) • Estrogen deficiency à reduce collagen formation!!!! 26 13 21.11.2023 Menopause • Menopauseà osteopenia ,osteoporosis • The effects of osteoporosis and osteopenia on periodontal diseases and alveolar bone loss are inconclusive 27 Menopause • Clinical Management: • Possible alterations in oral soft and osseos tissueà questioning regarding hormonal changes • Brushing with soft brushes • Using less abrasive dentifrices Thin oral mucosa • Rinses low alcohol consantration 28 14 21.11.2023 Menopause • Clinical Management: • During periodontal trerapy à debride with min. soft tissue trauma • HRT (Hormone replacement therapy) can reduce symptoms. • No data are available regarding success or failure of periodontal regeneration procedures in osteoporotic and nonosteoporotic individuals. 29 Oral Contraceptives • Women may have responses to oral contraceptives (OCs) similar to those seen in pregnant patients. • An exaggerated response to local irritants occurs in gingival tissues. 30 15 21.11.2023 Oral Contraceptives • OC-associated gingival inflammation may become chronic (versus the acute inflammation of pregnancy) because of the extended periods that women are exposed to elevated levels of estrogen and progesterone !!!! 31 Oral Contraceptives • Management: • The medical history should include OCs along with other medications. • The patient should be informed of the oral and periodontal side effects of OCs and the need for meticulous home care and compliance with periodontal maintenance • During long-term antibiotic therapy, women should consult their physician about using high-dose OC preparations. 32 16 21.11.2023 Thank you for listening… 33 17