Hormonal changes associated with gingivitis
puberty, pregnancy, Diabetes
Puberty gingivitis peak
arises around initial menses (9-14)
puberty gingivitis decline
12-17 years
Pregnancy gingivitis
Due to increased levels of progesterone
Diabetes Mellitus-related gingivitis
caused by peripheral vascular disease/compromised blood flow (gets blocked by sugar deposited in vessels)
clinical manifestations of diabetes gingivitis
diffuse erythematous gingival enlargement and pyogenic granuloma…poor healing and lots of blood
Genetic factors associated with gingivitis
- Down syndrome
- chediak-higashi syndrome
- papillon-lefevre syndrome
- Leukocyte Adhesion Deficiency (Type 1)
- cyclic neutropenia
- plasminogen deficiency
Down syndrome
- susceptible to gingival and perio disease with low caries index
- defective neutrophil chemotaxis with release of enzymes
- reduced salivary flow (low levels of Abs)
- actinobacillus actinomycetemcomitans higher
- accelerated bone (more osteoclast activity and MMPs)
Chediak-higashi syndrome
- autosomal recessive defect…abnormal intracellular protein transport
- lack of tyrosinase–>albinism
- Advanced periodontitis
- defects in chemotaxis and degranulation
Papillon-Lefevre syndrome
- autosomal recessive
- Cathepsin C gene loss–>chemotaxis defect b/c of leukocyte adhesion defect–>skin lesions and loss of sulcular integrity
- Juvenile periodontitis
- gram negative bacilli–same as Down syndrome
clinical features of Papillon-lefevre syndrome
- 4/million
- begins in early childhood
- palmar-plantar keratosis (white-yellow karatotic)
- dramatic accelerated periodontitis (see floating teeth)
P-L syndrome=
JP+plantar and palmar keratosis
Leukocyte Adhesion Deficiency (type 1)
- autosomal recessive with primary immunodeficiency
- leukocyte can’t be recruited
- localized infection, impaired pus production
- gingivitis and periodontitis
Cyclic Neutropenia
- idiopathic hematologic disorder–>periodic reduction of PMNs
- most are non-inherited
Ligneous gingivitis (plasminogen deficiency)
- destructive membrane disease
- equal with males/females any age
- nodular enlargement, ulceration with pseudomembrane and Perio disease
- commonly affects eyes=ligneous conjunctivitis
Pathogenic mechanism of ligneous gingivitis
- congenital cases from mutation of PLG gene
- acquired cases come from anti-fibrinolytic drugs–>build up of fibrin
Type 1 plasminogen deficiency
quantitative
type 2 plasminogen deficiency
qualitative
Neoplastic causes of gingivitis
- Leukemia
- Kaposi Sarcoma
- carcinoma
Leukemia
- malignant WBC proliferation
- Oral manifestations: anemia (pale mucosa), susceptible to infections–>erythema and ulcers, tends to bleed, monocytic leukemia in gingiva
Kaposi Sarcoma
- idiopathic hemorrhagic sarcoma (bruises)
- etiology: HHV-8 (herpes)
- mostly found in southern Africa
Epidemiologic groups of kaposi sarcoma
- classic western indolent type (italian, jewish, slavic)
- HIV/AIDS (KS=defining lesion)
- People that are immunosuppresed
- Endemic in Africa
