GENERAL FACTORS AND PERIODONTAL DISEASES

GENERAL FACTORS AND PERIODONTAL DISEASES

I – INTRODUCTION  :

Etiologically, gingivitis and periodontitis are multifactorial conditions caused by bacterial biofilm (direct local factor), however other factors have an impact on the progression and evolution of the disease, among these factors: systemic or general factors.

Indeed, any factor capable of altering the inflammatory or immune response and thus the balance between the host and bacteria at the local level will have an effect on periodontal health. Some act by promoting the growth of certain bacterial species and others influence the immunoregulation mechanisms or directly affect the periodontal tissues.

In no case are these factors triggers of periodontal disease; they can play a role in the etiology by lowering the resistance of periodontal tissues, making them more vulnerable to the effects of local factors.

II-REMINDER ON THE ETIOLOGIES OF PERIODONTAL DISEASE  :

In 1936 WESKI described the main causes of periodontal diseases in the form of a triad:

• Local etiology: direct local triggering factor which is the bacterial biofilm, direct local promoting factor these are all the factors which promote the retention of the bacterial biofilm namely tartar, dental malpositions, mouth breathing, orthodontic devices, prosthesis hooks, etc.  
• Indirect local factors are the co-factors which will act on the deep periodontal tissues.
• Constitutional etiology: age, heredity, sex; race, geographical location, intellectual level and socio-economic factors.
• General etiology: – cases where the general disease always co-exists with the periodontal disease
• -cases where general disease frequently coexists with periodontal disease
• – focal infection.

3.  CASES WHERE GENERAL DISEASE ALWAYS CO-EXISTS WITH PERIODONTAL DISEASE:
4. PAPILLON LEFEVRE syndrome:

It is a recessive genotypic condition, it appears early and is characterized by the association of dermatological and oral signs: – keratosis affecting the palms of the hands and the soles of the feet, with thickening of the skin, yellowish in color, sometimes complicated by cracks.

• A sudden periodontal disease of both sets of teeth; the child was toothless at the age of 15.

2. CHEDIAK HIGASHI SYNDROME  :

It is a recessive genotypic condition, it appears early in childhood, its prognosis is severe.

It is marked by frequent albinism with photophobia, a particular susceptibility to infections and oral signs 

– severe periodontitis

-ulceration of the cheeks, floor, tongue and hard palate.

GENERAL FACTORS AND PERIODONTAL DISEASES

C – DOWN SYNDROME (TRISOMY 21 or MANGOLISM):

It is a congenital disease caused by a chromosomal abnormality and characterized by mental deficiency and growth retardation.

At the oral level, it is characterized by severe and generalized periodontitis.

4. HISTIOCYTOSIS X:

It is a group of diseases characterized by the proliferation of eosinophilic and mononuclear cells that infiltrate the bone marrow and other tissues.

The associated oral manifestations are: severe gingival inflammation, severe periodontitis leading to tooth loss.

5. ACRODYNIAS:

Rare disease, usually occurring in children aged 3 or 4 years 

The skin on the hands, feet, nose, ears and cheeks turns pink or red.

Pruritus and arthralgia

Oral manifestations are:

-profuse salivation

– ulcerated and painful gums

-mobilization then exfoliation of the teeth

4. CASES WHERE GENERAL AND PERIODONTAL DISEASE FREQUENTLY CO-EXIST:
5. HORMONAL DISORDERS:

Women experience hormonal changes throughout their lives, which are observed at puberty, during pregnancy and when taking oral contraceptives. There is an increase in the level of progesterone, which influences periodontal blood microcirculation with an exaggeration of the inflammatory response.

2. ENDOCRINE PATHOLOGIES : 
3. PATHOLOGIES OF THE THYROID GLAND:
4. The pituitary gland  : The thyroid is an unpaired gland, located on the front of the neck, it secretes 2 main hormones: thyroxine (T4) and triothyronine (T3), these hormones are necessary for the growth of the child.

In the case of hypothyroidism: insufficient secretion of hormones T3 and T4.

In children we have – psychomotor delay

-a decrease in bone maturation

-delayed development of temporary and permanent teeth

-enamel hypoplasia

-periodontal disease

-polycaries

 In the case of hyperthyroidism  : from the oral point of view, we have 

-premature eruption of teeth 

-bone lysis 

-polycaries 

-demineralization of alveolar bone

2. parathyroid gland  : we can have 

-hypoparathyroidism

Enamel hypoplasia

Delayed tooth eruption

Malformation 

Impacted teeth

– hyperparathyroidism:

Bone turnover disorder

Bone demineralization

Alveolysis and tooth loss

2. DIABETES:

It is a chronic condition due to an imbalance in insulin production and a disorder of carbohydrate metabolism; there are several types: insulin-dependent diabetes or type 1 (in young people and children) and non-insulin-dependent diabetes or type 2.

In insulin-dependent type 1 diabetes, an increased frequency of periodontitis is often observed, especially when diabetes is poorly controlled. However, such correlations are not always found. 

Oral manifestations:

-increased frequency of periodontal diseases

-the functional activity of neutrophil granulocytes would be depressed

-reduced resistance to bacterial aggression

-dry mouth

-decrease in pH, cervical caries.

GENERAL FACTORS AND PERIODONTAL DISEASES

C-DERMATOLOGICAL PATHOLOGIES:

1. LUPUS ERYTHEMATOSUS:

It is a skin condition that has an invasive and destructive tendency.

General signs: fever, asthenia, and weight loss; red spots in the shape of butterfly wings on the face.

Oral signs: extensive and painful erosion with ulceration surrounded by a whitish or reddish area.

2. Scleroderma:

Chronic connective tissue disease, characterized by collagen accumulation and vascular lesions of the skin and various organs, as well as the face and oral cavity, localized in spots or diffuse areas.

Oral manifestations: thin and pale oral mucosa; induration of the tongue with a defect in phonation, effacement of the pillars of the soft palate, limitation of mouth opening.

3. BEHCET’S DISEASE  : chronic disease progressing through recurrent attacks 

Genital and oral mucosal ulcers and ulcerations

4. PSORIASIS  : :

It is a chronic, benign, highly recurring dermatosis of immunological origin. 

Men are more affected than women 

 The disease begins around the age of 25 

Skin lesions are characterized by scaly erythematous plaques

Oral manifestations:

 Oral lesions are rare and appear after skin lesions

  Erythema; with white or grayish areas

 Circular or semi-circular lesions identical to those of geographic tongue

With xerostomia scaly erythematous lesions may appear on the dorsal surface of the tongue

touches the tongue; gingiva; jugal mucosa; floor of the mouth; and lips 

4. HEMATOLOGICAL DISEASES:
5. ANEMIA:

Disease characterized by a lowering of the red blood cell count and hemoglobin level.

General signs: pallor of the skin and mucous membranes, particularly visible in the conjunctiva and nails; dyspnea on exertion with tachycardia.

Pallor of the oral mucosa and predisposition to ulceration

2. HEMOPHILIA:

  A recessive hereditary disease transmitted by the female sex chromosome, it is due to a deficiency in plasma prothromboplastic factors.

  At the oral level; frequent and spontaneous hemorrhage and purpura.

3. LEUKEMIA:

It is an irreversible, malignant proliferation of all tissues capable of producing white blood cells. 

Oral manifestations:

Hypertrophic gingiva

Paleness of the mucous membranes

Mouth swelling and ulceration

5. DIGETIVE DISORDERS:
6. GASTRITIS

• Inflammation of the stomach lining
• Dry mouth; bad breath 
• Paleness of the mucous membranes
• Generalized gingival inflammation 

2. CROHN’S DISEASE:

• Chronic inflammation of the digestive tract 

From the mouth to the anus in segments, of unknown cause but an immune process participates in its development.

• Swelling of the lips is noted. 
• Ulcerations of the oral mucosa
• Nonspecific aphthous ulceration of the oral mucosa

6. INFECTIOUS DISEASES  :
7. AIDS  : ( Acquired Immune Deficiency Syndrome )

It is an infectious disease caused by the HIV virus which attacks T lymphocytes.

Ulcerative-necrotic gingivitis and ulcerative-necrotic periodontitis are often early clinical signs of HIV infection.

7. NUTRITIONAL DISORDERS:

Food is an essential need for the body which ensures its growth, repairs its losses and maintains its temperature to meet its functions.

1. Vitamin C deficiency  : causing scurvy

Vitamin C plays an important role in the synthesis of specific amino acids of collagen, an essential component of the periodontium. We will have 

-an aggravation of the gingival response to local irritants

-histologically: degeneration of collagen fibers and edema of the connective tissue.

-clinically: hypertrophic gingiva, soft consistency, smooth and shiny appearance and an increased tendency to bleed.

2- vitamin A deficiency  : we will have:

-growth disorders

-predisposition to infection 

-hyperplasia and hyperkeratinization of the gum 

-the life cycle of cells is shortened

8. IRRADIATION:

      Radiotherapy is a curative treatment for tumors located in the cervico-facial region based on ionizing radiation, which has multiple complications:

-reversible radiomucositis after stopping treatment.

-hyposialia and xerostomia, tendency to candidiasis infections

– erosions and ulcerations covered with a whitish coating

-osteoradionecrosis is the most feared complication.

GENERAL FACTORS AND PERIODONTAL DISEASES

9. DRUG FACTORS:

   Some medications can have side effects on periodontal tissues:

 A – cyclosporins :

 Immunosuppressants used during organ transplants

 Inhibitory effect on lymphocytes

 Between the 1st and 4th month we observe:

 Increased gum volume

 Spontaneous hemorrhages 

 Dental mobility

2. Hydontoinates  :

Are antiepileptics.

DI HYDAN causes firm, painless pink gingival hypertrophy beginning at the papillae and gradually extending to involve the marginal and then free gingiva, which can cover the dental surfaces.

        Acting on fibroblasts which increase collagen production.

V – FOCAL INFECTION  :

It is a remote attack on an organ by microorganisms or their toxins through the blood or lymphatic system.

   1 – Infectious endocarditis : ( Osler’s disease )  

• Grafting a germ onto the endothelial walls of a weakened heart
• 40% of cases oral-dental entry point
• 50% of PB streptococcus cases (less frequently AAC)

2. Respiratory infection :

• Aspiration of oral pharyngeal bacteria
• Adult bacterial pneumonia
• Streptococcus aureus

3. Gastrointestinal disease :

The preferred oral site for Helicobacter pylori is subgingival plaque

4. Rheumatoid arthritis:

– It has several characteristics in common with periodontitis: 

     – inflammatory bone resorption

  – Presence of proteinase

  – However, there is no evidence to establish a direct link between these two diseases.

5. Alopecia of dental origin :

– appears on the same side as the periodontal  lesion

– hair removal follows the dental episode

   VI- CONCLUSION

Given the link between general illness and oral disease, particularly periodontal disease, the role of the practitioner in screening for these diseases and their collaboration in therapeutic success remains essential.

GENERAL FACTORS AND PERIODONTAL DISEASES

  Cracked teeth can be healed with modern techniques.
Gum disease can be prevented with proper brushing.
Dental implants integrate with the bone for a long-lasting solution.
Yellowed teeth can be brightened with professional whitening.
Dental X-rays reveal problems that are invisible to the naked eye.
Sensitive teeth benefit from specific toothpastes.
A diet low in sugar protects against cavities.
 

GENERAL FACTORS AND PERIODONTAL DISEASES