Aetiology of Periodontal Disease: Systemic Factors

• What do systemic factors do?

  - Modify the presentation of periodontal disease

  - may also determine the susceptibility to periodontitis
• What are some examples of systemic factors which increase the susceptibility of a patient developing periodontal disease?

  Smoking

  Diabetes

  Pregnancy

  Medications which cause gingival enlargement

  Genetic factors
• What are smokers more likely to do?

  To develop periodontitis than non-smokers

  To experience greater bone loss

  To develop periodontal pockets

  To lose teeth
• What does smoking mask?

  Gingivitis & the effects of periodontitis, so there's less bleeding (due to less blood flow in gingiva)
• What is the effect of uncontrolled diabetes/poor glycaemic control on periodontal disease?

  It increases the risk of periodontal disease & disease progression
• What do people with diabetes also have?

  Impaired immune response

  Impaired wound healing

  Recurrent/multiple periodontal abscesses
• Why is pregnancy a systemic factor?

  Pregnancy increases gingival response to plaque

  Increased progesterone results in increased gingival blood flow

  Similar effects also seen at puberty & associated with contraceptive pill

  
• Why is medication a systemic factor?

  Because drug induced gingival overgrowth increases plaque retention

  
  

  These drugs include:

  Ca channel blockers for hypertension (nifedipine, amlodipine, felodipine)

  
  

  Phenytoin for epilepsy

  
  

  Cyclosporin: immunosuppressant prescribed for some autoimmune disorders

  
• How do genetic factors contribute to periodontal disease?

  There is evidence that genetics play an important role when determining susceptibility to periodontitis

  
  

  The evidence comes from:

  Familial tendency, especially in severe periodontal disease

  Racial predilection, especially in severe periodontal disease

  Twin studies

  Association with specific genetic polymorphisms
• What are genetic polymorphisms?


  Normal variations in gene structure, may occur in regulatory or coding regions of gene
• Are genetic polymorphisms common?

  Yes
• Are hereditary neutropenic conditions common?

  No, they're rare
• What do hereditary neutropenic conditions result from?

  Single point genetic mutations
• What are some examples of hereditary neutropenic conditions?

  Papillon Lefevre syndrome

  Chediak Higashi syndrome

  Leukocyte Adhesion syndrome