Dr. R. Seshan Rakkesh

B.D.S

PERIODONTAL CONDITIONS OF

MEDICALLY COMPRMISED

PATIENTS

INTRODUCTION

Toxins produced changes in inflammatory &

immunologic in the periodontal tissues at both

cellular and molecular level.

Certain systemic disorders can have direct effect

on periodontal tissues.

These systemic diseases DONOT initiate

CHRONIC DESTRUCTIVE PERIODONTITIS .

But still they can accelerate its progression and

increase tissue destruction.

Types of Systemic conditions:

Dietary and Nutritionary aspects.

Hematological disorders.

Metabolic and Endocrine disorders.

Cardiovascular diseases.

Antibody Deficiency disorders.

Other Systemic disorders.

Psychosomatic disorders.

DIETARY & NUTRITIONAL

ASPECTS

Fibrous diet is more beneficial than intake of soft

and loose-textured food.

Soft diet(high proportion of sucrose) – Inc plaque.

Fibrous diet – Natural cleansing to teeth &

periodontium.

Coarse diet – vigorous mastication – plaque over

the buccal and lingual surface.

Course and granular diet – direct trauma to

supporting tissue.

1. Protein Deficiency.

PROTEIN – constituent of organic matrices of

dental tissues including alveolar bone.

Integrity of periodontal ligament dependent on

protein (amino acids)

2. Vitamins Impact.

VITAMIN – C: (Scurvy)

Low ascorbic acid affects the ability of the tissue to

regenerate and repair itself.

Interferes Bone formation.

Inc. permeability of oral mucosa – endotoxin.

Inc. Ascorbic acid enhances chemotactic &

migratory action of leukocytes without phagocytic

activity.

Depletion of Vit c causes increase in pathogenicity.

Gingiva becomes brilliant red, tender and

swollen, bone resorption, mobility and dark blue

hue in long standing cases.

VITAMIN – D:

Needed for absorption of calcium from the

gastrointestinal tract and maintenance of calcium –

phosphorous balance.

Deficiency – Complete lamia dura and reduced

density of supporting bone, loss of trabeculae.

VITAMIN – E:

Acts as antioxidant and in maintaining the stability

of the cell membranes and protecting against

hemolysis.

VITAMIN – Bcomplex:

Gingivitis, glossitis, glossodynia, angular chelitis

and inflammation of entire oral muccosa.

HEMATOLOGICAL DISORDERS

WBC and RBC disorders.

The WBC disorders have the most pronounced

effect on the periodontal tissues.

Haemostasis – due to vascular constriction,

Platelet adhesion and Aggregation, Coagulation,

Fibrinolysis.

WBC disorders…

Neutropenias:

Persistent severe gingivitis.

Cherry red gingiva

Edematous and Hypertrophic.

Occasional desquamation.

TREATMENT:

Strict oral hygiene programme

Sccaling & regular prophylaxis.

Antiseptic irrigation and Antibiotic prophylaxis before any

treatment.

LEUKEMIA:

Gingival enlargement

Massive leukemic cell infiltration into connective tissue.

Difficult to remove the plaque.

Gingival Bleeding (profuse).

TREATMENT:

Medical evaluation.

Complete periodontal trt before Chemotherapy.

In chronic leukemia cases scaling and root planning can be

done but periodontal surgery is contraindicated.

THROMBOCYTOPENIC PURPURA:

Low platelet count

Spontaneous bleeding.

Petechiae and Hemorrhagic vesicles in oral cavity.

Soft, Swollen and Friable gingiva.

TREATMENT:

Medial evaluation.

OHI

Prophylactic trt.

NO SURGICAL PROCEDURES.

Careful scaling and root planning.

RBC disorder…

FANCONI’S ANEMIA:

Familial bone marrow hypoplasia , manifested in frst

deccade.

Loss of several teeth.

Pocketing more than 10mm.

Bluish red Gingiva

Bleeding and Suppuration on mild pressure.

METABOLIC & ENDOCRINE dis.

DIABETES MELLITUS:

Extensive bone loss.

Widening of periodontal ligament.

Suppuration and abscess formation.

TREATMENT:

In Uncontrolled cases treatment is contraindicated.

Lab reports analysis.

Continuous monitoring of sugar levels.

GUIDELINES ??

THYROID GLAND: No notable changes in periodontium.

TREATMENT: Thyrotoxicosis and improper medical mgmt patient must not

be treated periodontally until their condition is stabilized.

Epinephrine, atropine etc must be used with caution.

Hypothyroid pts need careful administration of sedatives and narcotics because of their diminished ability to tolerate drugs.

PITUITARY GLAND: Enlarged lips, Hyperpigmentation on nasolabial

folds.

Food impaction and hypercementosis-Hyperpituitarism.

Crowding and Malposition – Hypopituitarism.

PARATHYROID GLAND:

Hyper secretion – demineralization of skeleton.

Malocclusion, alveloar osteoporosis, absence of lamina dura.

TREATMENT: Routine periodontal therapy. Dentist must be aware tof the oral

changes occurring in that patient in particular.

GONADS:

PUBERTY and PREGNANCY: Bleeding, Bright to Bluish red color.

Edematous gingiva.

Increased progesterone leads to dilatation and tortusity of microvasculature , circulatory stasis.

Increased pocket depth, Mobilty.

CARDIOVASCULAR DISEASES

CONGENITAL HEART DISEASE:

Purplish red discoloration of lips and gingiva.

Tongue appears to be coated, Fissured,

edematous.

Reddening of fungiform and filliform papillae.

GUIDELINE ???

ANTIBIOTIC DEFICIENCY

DISORDER

AIDs:

HIV gingivitis:

Linear bleeding, erythematous gingivitis, necrotizing

ulcerartive stomatitis.

TREAMTMENT : Meticulous oral care.(metronidazole)

HIV periodontitis:

Rapid periodontal destruction, Interproximal bone loss,

painful at onset.

TREATMENT : Scaling, root planning, Betadine irrigation,

Severe NUP metronidazole 400mg TD 5-7days.

OTHER SYSTEMIC

BISMUTH INTOXICATION:

Ulcerative gingivostomatitis, nausea, vomitting.

Metallic taste, burning sensation of oral mucosa.

Narrow Bluish black discoloration of gingival

margin.

LEAD INTOXICATION:

Inc salivation.

Coated tongue.

Peculiar sweetish taste.

Ulcerations.

BURTONIAN LINE (steel grey liner pig) + local

irritation.

MERCURY INTOXICATION:

Linear pigmentation.

Ulcerations.

Destruction of alveolar bone.

OTHER:

Phosphorus, Arsenic, Chromium – Necrosis of

alveolar bone, loosening & exfoliation of teeth.

PSYCHOSOMATIC DISORERS:

Two ways of impact :

Direct effect of ANS.

Developmental habits injurious to periodontium.

Under comditions of Mental and Emotional stress

oral cavity may be subconsciously an outlet for

the gratification of basci drives in adult.

GRATIFICATION derived from neurotic habits are

very harmful to the periodontitium.