Periodontitis As Manifestation On Systemic Diseases

PERIODONTITI
Del Valle, Tristan

Licardo, Jelaiza
Nero, Vanessa
Talan, Ashley Nicole T.
What is PERIODONTITIS?
• AKA “Gum Disease”

• Inflammation of the tissue around the
teeth, often causing shrinkage of the
gums and loosening of the teeth.
FORMS OF
PERIODONTITIS
I. NECROTIZING
PERIODONTAL DISEASES
NECROTIZING ULCERATIVE GINGIVITIS
ETIOLOGY
 caused by specifc bacteria: fusiform bacillus

and spirochetal organism
 characterized by fiery red gingivitis, soft tissue
necrosis with formation of a necrotic surface
layer, severe pain, ulceration of interdental
papillae and fetid color.
RISK FACTORS:
• poor oral hygiene

• nutritional deficiencies
ORAL SIGNS:
Characteristic lesions are punched-out,

craterlike depressions at the crest of the
interdental papillae, subsequently extending to
the marginal gingiva and rarely to the attached
gingiva and oral mucosa.
SIGNS AND SYMPTOMS
• malaise or fever
• excessive salivation and foul breath.
TREATMENT
• local root planning
• oral hygiene instructions
• oral microbial rinses
NECROTIZING ULCERATIVE
PERIODONTITIS
CLINICAL FEATURES
• severe bone loss

• tooth mobility
• tooth loss
• oral malodor
• fever
• malaise
• lymphadenopathy.
PERIODONTITIS
MICROSCOPIC FINDINGS
High levels of yeasts and herpes-like viruses

were observed.
PERIODONTITIS
HIV/AIDS Patients
• Gingival and periodontal lesions
• NUP lesions found in HIV-positive/AIDS
patients can present with similar features to
those seen in HIV-negative patients
PERIODONTITIS
ETIOLOGY
• Mixed fusiform-spirochete bacterial fora
• Predisposing factors:
poor oral hygiene, pre existing periodontal
disease, smoking, viral infections,
immunocompromised status, psychosocial
stress, and malnutrition.
PERIODONTITIS
TREATMENT
 Antimicrobial therapy
 Intrasulcular irrigation with 10% providone-
iodine solution and chlorhexidine
 Local drug delivery system
PERIODONTITIS
NECROTIZING STOMATITIS
is a very severe and aggressive form of
necrotizing periodontal disease showing
extensive oral cavity tissue and bone destruction.
Who gets Necrotizing Stomatitis?
• Individuals with poor immune function

• Young malnourished children in developing
countries
• It can affect both males and females
• No preference for any race or ethnic group is
seen.
RISK FACTORS
Conditions causing immunodeficiency including

HIV infection (or AIDS), blood disorders such as
leukemia and neutropenia, cancer, and poorly-
controlled diabetes mellitus, are the primary risk
factors.
ETIOLOGY
longstanding infection of the gum, teeth, and

surrounding tissue that also involves the
jawbones, as a result of poor dental hygiene.
SIGNS AND SYMPTOMS
• Severe and deep pain in the oral cavity
• Frequent spontaneous bleeding
• Oral mucosal membranes are affected and
destroyed, the entire mouth is involved
• Multiple teeth are affected
• Bone loss and exposed jawbone may occur
• Physical deformity of the oral cavity is observed
• Gums have receded such that teeth appear
• Low-grade fever
• Swollen lymph nodes associated with pain
II. PERIODONTITIS AS
MANIFESTATION OF SYSTEMIC
DISEASES
LEUKEMIA
LOCAL SYMPTOMS & FINDINGS
65% of patients with leukemia, include paleness

of the oral mucosa due to underlying anemia,
with presence of petechiae, ecchymosis and
gingival hemorrhage or gingival bleeding due to
underlying thrombocytopenia.
LEUKEMIA
SYMPTOMS
• gingival enlargement and bleeding
• oral ulceration
• petechia
• mucosal pallor
• trismus
• oral infections
LEUKEMIA
ORAL COMPLICATIONS:
• Gingival enlargement
• Bleeding
• Ulceration
• Mucositis
• Taste Alteration
• Candidiasis
• Xerostomia
• Dysphasia
• Trismus
LEUKEMIA
ORAL ULCERATIONS AND INFECTIONS:
GINGIVA:
• Leukemic gingival enlargement (acute >
chronic)
• Clinically: Swelling, bluish red, cyanotic,
roundness and tenseness of the gingival margin,
spontaneous bleeding.
• Periodontium & Alveolar bone: localised areas of
necrosis due to leukemic infiltration of the
marrow.
LEUKEMIA
DOWN SYNDROME
• AKA Trisomy 21
• it is a genetic disorder due to an extra
chromosome 21.
• causes mental retardation, a characteristic facial
appearance, and multiple malformations.
DOWN SYNDROME
Oral and periodontal disease-related

features:
• Poor oral hygiene

• Destructive periodontitis
• Generalised deep periodontal pockets, gingival
inflammation
• Necrotizing ulcerative gingivitis
DOWN SYNDROME
LEUKOCYTE ADHESION DEFICIENCY
SYNDROMES
Is a rare autosomal recessive disorder
characterized by immunodeficiency resulting in
recurrent infections. Neutrophils are confined to
blood vessels and do not migrate to periodontal
sites, which causes a disruption of
neutrophil‐associated homeostasis.
SYNDROMES
Oral and periodontal disease-related
features:
• Severe gingival inflammation, acute gingival

lesions, early‐onset and rapidly progressive
alveolar bone loss
• Early loss of the primary and permanent teeth
SYNDROMES
PAPILLON-LEFEVRE SYNDROME
Characterized by diffuse palmoplantar

keratoderma and precocious aggressive
periodontitis, leading to premature loss of
deciduous and permanent dentition at a very
young age.
ORAL MANIFESTATION:
Rapid generalized periodontal destruction of

alveolar bone (primary and secondary dentition)
CHEDIAK-HIGASHI SYNDROME
It is a rare, lysosomal storage disorder, caused

by mutations in LYST which leads to decrease of
phagocytosis. Primarily effects the neutrophils.
CLINICAL FEATURES
• Partial albinism, mild bleeding disorders,

recurrent bacterial infections, rapidly
destructive periodontitis
• Bone loss is usually generalized and severe.
• Patients do not respond to periodontal therapy,
leading to premature loss of both deciduous and
permanent dentitions.
HYPOPHOSPHATASIA
Mutations in the alkaline phosphatase (ALPL)
gene are associated with:
• impaired bone and tooth mineralization
• defects in root cementum, which result in
compromised periodontal attachment and
reduction in alveolar bone height.
• teeth are not adequately anchored to the alveolar
bone via the PDL
HYPOPHOSPHATASIA
III. PERIODONTITIS
STAGES: Based on Severity
and Complexity of
Management
STAGE I: INITIAL PERIODONTITIS
1-2 mm clinical attachment loss, less than 15%
bone loss around root, no tooth loss due to
periodontal disease, and has a probing depth of
4mm or less, mostly bone loss.
STAGE II: MODERATE PERIODONTITIS
3-4 mm clinical attachment loss, 15%-33%bone

loss, tooth loss, probing depth 5mm or less, and
mostly horizontal bone loss.
STAGE III: SEVERE PERIODONTITIS
with potential for additional tooth loss
SYMPTOMS
• pain when chewing

• halitosis (bad breath)
• unpleasant taste in your mouth
STAGE III: SEVERE PERIODONTITIS
with potential for additional tooth loss
5mm or more clinical attachment loss, bone loss

beyond 33%, tooth loss of four teeth or less, with
complex issues such as probing depth 6mm or
more, vertical bone loss 3mm or more, class II –
III furcations, and or moderate ridge defects.
STAGE IV: SEVERE PERIODONTITIS
with potential loss of the dentition
Encompasses all of stage three (3) with

additional features that will require the need for
complex rehabilitation due to masticatory
dysfunction, secondary occlusal trauma, severe
ridge defects, bite collapse, pathologic migration
of teeth, less than 20 remaining teeth (10
opposing pairs).
Extent and Distribution
LOCALIZED FORM
• BL is around less than 30% of teeth in mouth.
• Circumpubertal onset of disease.
• Localized first molar or incisor disease with
proximal attachment loss on at least two
permanent teeth, one of which is a first molar.
• Robust serum antibody response to infecting
agents.
GENERALIZED FORM
• BL is around more than 30% of teeth in mouth.
• Usually affecting persons under 30 years of age
(however, may be older).
• Generalized proximal attachment loss affecting
at least three teeth other than first molars and
incisors.
• Pronounced episodic nature of periodontal
destruction.
• Poor serum antibody response to infecting
agents.
MOLAR-INCISOR DISTRIBUTION
BL is found around molar (usually first) and

anterior incisors
GRADES: Evidence or risk of rapid
progression, anticipated
treatment response
Grade A (slow progression)
No BL or CAL over five years, no smoking, no

diabetes, heavy biofilm but no destruction.
Grade B (moderate progression)
Less than 2 mm BL or CAL over five years, half

pack or less per day smoking, HbA1c less than
7%, biofilm commensurate with destruction.
Grade C (rapid progression)
Greater than 2 mm of BL or CAL over five years,

half pack or more per day smoking, HbA1c 7% or
higher, destruction exceeds amount of biofilm.
THANK YOU 

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PERIODONTITI

Del Valle, Tristan

• AKA “Gum Disease”

 caused by specifc bacteria: fusiform bacillus

• poor oral hygiene

Characteristic lesions are punched-out,

• severe bone loss

High levels of yeasts and herpes-like viruses

• Individuals with poor immune function

Conditions causing immunodeficiency including

longstanding infection of the gum, teeth, and

LOCAL SYMPTOMS & FINDINGS

65% of patients with leukemia, include paleness

Oral and periodontal disease-related

• Poor oral hygiene

• Severe gingival inflammation, acute gingival

Characterized by diffuse palmoplantar

Rapid generalized periodontal destruction of

It is a rare, lysosomal storage disorder, caused

• Partial albinism, mild bleeding disorders,

3-4 mm clinical attachment loss, 15%-33%bone

• pain when chewing

5mm or more clinical attachment loss, bone loss

Encompasses all of stage three (3) with

BL is found around molar (usually first) and

No BL or CAL over five years, no smoking, no

Less than 2 mm BL or CAL over five years, half

Greater than 2 mm of BL or CAL over five years,

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