Influence of systemic disorders and stress on the periodontium
Many systemic diseases and disorders have been implicated as risk indicators or risk factors in periodontal disease. The individual host immune response to periodontal pathogens is very important and likely explains much of the differences in disease severity observed from one individual to another. Furthermore, certain systemic disorders and conditions alter host tissues and physiology, which may impair host barrier integrity and host defense to periodontal infection, resulting in more destructive disease
I. Endocrine Disorders Affect the periodontal tissues directly Modify the tissue response to local factors
Diabetes mellitus is a chronic metabolic disease characterized by dysregulation of carbohydrate, protein and lipid metabolism. During digestion, most foods are broken down into glucose, which then enters the circulatory system and is subsequently used by tissue cells for energy and growth . Insulin is produced by β cells of the pancreas, and increased insulin secretion occurs in response to increased blood glucose concentration. Insulin binds to specific cellular receptors to exert its effects . With the secretion of insulin and its binding to its cellular receptors, glucose is able to enter the tissue, thus decreased blood glucose concentrations . 1. Diabetes Mellitus
Excess glucose is stored in the liver in the form of glycogen, which serves as a ready reservoir for future use. When energy is required, glycogen stores in the liver are converted into glucose via glycogenolysis, elevating blood glucose levels and providing the needed cellular energy source. The liver also produces glucose from fat (fatty acids) and proteins (amino acids) through the process of gluconeogenesis. Glycogenolysis and gluconeogenesis both serve to increase blood glucose levels . Diminished insulin production, impaired insulin action, or a combination of both result in the inability of glucose to be transported from the bloodstream into the tissues, which in turn results in high blood glucose levels (hyperglycemia) and excretion of sugar in the urine .
Insulin is the only hormone that lowers blood glucose levels. Glucagon, catechol amines (epinephrine), growth hormone, thyroid hormone, and glucocorticoids all act to increase blood glucose levels. Uncontrolled diabetes (chronic hyperglycemia) is associated with several long-term complications, including microvascular diseases (retinopathy, nephropathy, and neuropathy), macrovascular diseases (cardiovascular, cerebrovascular), and an increased susceptibility to infections, poor wound healing and periodontal diseases.
Classification of diabetes Insulin-dependent type 1 non-insulin-dependent type II Etiology Cell-mediated autoimmune destruction of the insulin- producing beta cells of the islets of Langerhans in the pancreas viral infection (mumps) or genetics (.
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- Fall '19
- Gingiva, Periodontitis, Periodontal disease