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.