association between periodontology and oral...
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Association between
Periodontology and
Oral Medicine
All diseases which have
gingival symptoms
You can find the phrase
„all diseases”
in the headline, because
we speak about not only
oral diseases, but we
have a lot of systemic
diseases with oral
symptoms.
Lupus Vulgaris
(TBC)
Blistering diseases
Diseases belongs to this
group:
Pemphigus
Bullous Pemphigoid
Benigne Mucosal
Pemphigoid
Erythaema Exudativum
multiforme
Bullous Pemphigoid
Benigne Mucosal
Pemphigoid
Erythaema Exudativum
Multiforme
Other Autoimmune Diseases
Except of Sjögren,s
syndrom (where missed
the sIgA) by this way
caries and oral ulcers
develop.
There is a common sign
nearly all autoimmune
diseases:
Desquamative Gingivitis
Oral Lichen Planus
Oral Medicine will be
educated in the X.
semester for dental
students, but I show you
pictures about gingival
manifestation of lichen
oris, which could be
either lichen or
desquamativ gingivitis.
Desquamative Gingivitis
associated to Lichen
Oris
Herpes Virus Infections
There are two diseases
in this group as a
consequence gingivitis
or periodontitis can
develop:
Herpetic
gingivostomatitis
(primary)
Herpes zoster (single)
Herpes zoster (Singel)
AIDS
AIDS also belongs to this
group. It has many
important oral and
periodontal signs.
The AIDS is over the topic
of this section.
Hairy Leukoplakia
In these diseases the
cause of the Gingival
and Periodontal diseases
not direct consequence
of the general medicine
diseases, but the result
of the dingy oral hygiene
because of the serious
oral pain.
There are some
immunological action, by
which the situation
become worse, but only
in a long period of time.
Kaposi,s sarcoma
There are direct association between
endocrine diseases and Periodontitis
There are two endocrine
organs, play role in
Periodontitis:
Parathyroid glands
Diabetes Mellitus
Axis
When we are speaking
about the special
function of the endocrine
system, we thinking
about the
AXIS
switch the hypothalamus-
pituitary gland and the
other endocrine glands.
All endocrine function
produce a close loop.
The endocrine gland send a
message to the
hypothalamus and then
pituitary gland.
Most of the endocrine feed-
back produces negative
signals.
(this is the regulation of
the axis).
The Calcium Metabolism
The hormone of the
parathyroid gland(PTH)
regulates the calcium
reabsorption from the
distal tubuli of kidney.
As a result of parathormon
the calcium release from
the bone increase.
In the human body bones
are calcium reservoir.
It needs for the muscle
function and the
production of blood cells
in the bone marrow.
Calcium Homeostase
There is no connection
between calcium
regulation and
hypothalamus-
hypophisis axis.
(There is 1 kg calcium in
the human body: in bone,
in the muscles and
in all the cells).
It is absorbed from the
intestine.
Papillon-Lefevre syndrome
In menopause the quantity of
bones decrease 7-10% in
every 5-7 years.
(Not only females, but males
too).
Milk, cheese, yogurt and
fishes contains the highest
level of calcium.
Calcium.
In pregnancy patients needs
1000 mg, but in menopause
1500 mg daily.
Some medicine block the
calcium absorption (ex.
laxatives),
they produce chelates with
calcium.
Vitamine D (mainly D3)
increase the ATPase
activity in the intestine.
By this way enhances
the calcium absorption.
Diabetes Mellitus
Oral aspects
Beta cells of Pancreatic
gland (Langerhans
islands) produce
INSULIN.
As a result of absolute or
relative decrease of this
hormone
HYPEGLICEMIA
will develop.
The name of this disease
developed in the XV.
century, when doctors
recognized more and
sweet urine in the
patients.
Classification of the disease
(according to the Data Bank of International
Diabetes Commity)
I./ Primary Diabetes
A type: IDDM
B type: NIDDM
a./ non-fatty
b./ fatty
Mature: immediately develop
in young age.
II. Secondary Diabetes
A./ Disease of the
Pancreatic gland
B./ Other endocrine disease
C./ Caused by Medicine
D./ Gestational Diabetes
E./ Caused by Genetic
problems
III. Bad sacchrose
tolerance.
Pathogenesis
type: IDDM
on the second decade of
the life, ketacidosis,
insulinopenia develop.
Immediate destroy the
cells of Langerhans
Island.
Most of the patients
belongs to the HLA-DQ
group.
Environmental effects:
viruses (mumps,
Coxacie rubella, B4).
In Australia 20% of the
patients have had
intrauterine rubella.
II. type: NIDDM
in other name: adult age
diabetes rather in elder
people.
On the surface of cells the
number of insulin
receptors decrease
(could be covered by
auto antibodies)
Diabetes frequency in
twins:
100%.
(in the case of NIDDM
50%).
Secondary diabetes develop
as a result of:
Destructive Pancreas
disease
Alcohol abusers
In combination with
other neuroendocrine
diseses (Chusing,
acromegalie,
pheochromocytoma)
Gestation Diabetes (in
Pregnancy)
Diagnosis
There are two diagnostic
tools accepted by the
International Diabetes
Committee
Plasma sugar level in
empty stomach (strip is
a fast test) over 5,9
mmol/l.
Loading test and
tolerance test.
Clinical symptoms
Ocular problems: the
vision of diabetic
patients decrease fast
Atherosclerosis: most
fast than in normal
Diabetic nephropathy:
the most frequent cause
of death.
Neuropathy: pain and
dyasthesis
Most frequent Oral Diseases in
Diabetes
Gingivitis
Periodontitis (hormonal
background)
Dry socket
Burning of the tongue
Median Rhombic
Glossitis
Candidasis
Lichen oris
Type I.: IDDM:
the periodontal alterations
in this type much more
aggressive than in
normal.
(in this patients the oral
hygiene worsened)
The number of Gram
negative bacteria are
higher than in non-
diabetic people.
Periodontal alterations
If severe inflammation
develop do not hesitate
give to the patients
ANTIBIOTICS.
If there is any problem
consult with family
doctor or specialist.
If the patients need
general anesthesia could
be done.
Oral Mucosal Aspects of
Diabetes
There are data
Median Rhombic Glossitis
are frequent in Diabetes
(a specific form),
but it is sure that this oral
diseases frequently
develop together with
diabetes.
This form is not
characteristic to
diabetes.
Candida Infection
This infection is more
frequent in diabetes,
because the lower lobe
of Parotid gland excrete
the sugar from the blood.
This is a culture material of
the fungi.
The immune
responsiveness
decreasing in diabetes.
The cause of dry socket:
atherosclerosis.
Oral Lichen Planus
The association between
Lichen Oris and Diabetes
Mellitus was described
by
Grynspan (1976).
The third symptom of the
Grynspan syndrome is
hypertension.
Grynspan syndrome
Blistering form of Lichen
Dental Management of
Diabetes Patients
The dentist do not
unbalanced of the
patients metabolism.
The diabetes patients are
more sensitive to
bacterial infections.
In the case of
hypoglycemia give to the
patients saccharose to
drink.
If in IDDM any problem
develop look for the
family doctor.
Decrease the epinephrine
in the anesthetic. The
epinephrine decrease
the serum sugar level.
The epinephrine helps to
develop dry socket.
The patients need not
antibiotic prevention.
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