What are the other Names for this Condition? (Also known as/Synonyms)

• Periodontal Disease and Systemic Conditions
• Periodontal Manifestations of Systemic Disease
• Periodontitis as a Manifestation of Systemic Diseases

What is Periodontitis related to Systemic Disorders? (Definition/Background Information)

• Periodontitis related to Systemic Disorders indicate a host of systemic conditions that increases the risk and contributes to the development of periodontitis. It is also referred to as Periodontal Manifestations of Systemic Disease
• Periodontitis is a common, but severe form of gum disease that develops due to an infection. It affects the teeth, gums, and surrounding tissues in the mouth, causing the area to swell. The condition causes damage to the gums and tissues, which in turn leads to deterioration of the teeth
• Conditions that are epidemiologically correlated with periodontitis should not be considered as a type of Periodontitis related to Systemic Disorders. For example coronary artery disease (such as heart attack), cerebrovascular disease (such as stroke), and erectile dysfunction show statistical correlation with periodontitis, but not cause-effect relationship
• Certain systemic conditions cause decreased immunity resulting in increased risk for infection, or abnormal immune system causing increased inflammation within the periodontal tissue. These factors contribute to the development of Periodontitis as a Manifestation of Systemic Diseases
• Systemic disorders/conditions associated with “Periodontitis related to Systemic Disorders” may be grouped into the following types:
  • Genetic disorders such as Down syndrome and glycogen storage disorders
  • Blood-related disorders
  • Diabetes
• The common risk factors that predispose an individual to periodontitis include inadequately treating early gum diseases, smoking, reduced immunity, and the use of certain medication
• A dental professional may be able to diagnose the infection and weakened gums during a dental examination. Some imaging techniques may be used to ascertain the damage extent to the teeth, gums, and surrounding tissue. Additionally, diagnostic tests to identify the underlying condition is essential
• The treatment for Periodontitis related to Systemic Disorders may involve oral cleaning, removal of plaque, to medication for bacterial infection, and surgery (if necessary). Along-with this, suitable treatment of the associated systemic disorder is also taken
• The prognosis of the condition depends upon the severity of the symptoms of periodontitis and also upon the underlying systemic condition. Typically, the prognosis of Periodontitis related to Systemic Disorders is difficult to predict; but, it may be improved with early and appropriate treatment

Who gets Periodontitis related to Systemic Disorders? (Age and Sex Distribution)

• Periodontitis related to Systemic Disorders may be seen in individuals of any age group; both children and adults may be affected
• It can affect both males and females
• Currently, no studies report the condition to be more prevalent among a particular racial or ethnic group

What are the Risk Factors for Periodontitis related to Systemic Disorders? (Predisposing Factors)

The major categories of conditions associated with Periodontitis related to Systemic Disorders include:

• Poorly-controlled diabetes
• Blood (hematological) disorders such as:
  • Leukemia
  • Lymphoma
  • Decreased number of white blood cells (or leukopenia)
• Genetic disorders such as:
  • Chédiak–Higashi syndrome
  • Chronic granulomatous disease
  • Cohen syndrome
  • Crohn's disease (inflammatory bowel disease)
  • Cyclic and inherited forms of neutropenia
  • Down syndrome
  • Ehlers-Danlos syndrome
  • Glycogen storage diseases
  • Hypophosphatasia
  • Infantile genetic agranulocytosis
  • Klinefelter syndrome
  • Langerhans cell disease (histiocytosis syndromes)
  • Leukocyte adhesion deficiency disorder
  • Marfan syndrome
  • Papillon-Lefèvre syndrome

In addition to the above, the common risk factors for periodontitis include:

• Poor oral habits: This facilitates bacterial growth in the mouth thereby increasing the risk for developing periodontitis
• Smoking and tobacco use: Heavy and chronic tobacco use increases the risk of developing periodontitis to a great extent
• Generally, older the age, the greater is the risk
• Early form of gum disease (or gingivitis), which is left untreated
• Changes in hormonal levels due to various health conditions
• Weakened immune system: Individuals affected by diseases, such as HIV or AIDS, which decrease one’s immunity are at an increased risk
• Individuals with cancer
• Certain medications can increase the risk for periodontitis
• Some individuals can have abnormal teeth structure that may place the individual at a higher risk; this feature may run in certain families

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Periodontitis related to Systemic Disorders? (Etiology)

Periodontitis related to Systemic Disorders develop as a consequence of increased susceptibility to oral infections and/or oral cavity structure injury, or dysfunction of oral tissue, contributed by the presence of systemic disorders that include certain genetic conditions, diabetes, and blood disorders.

The main cause of periodontitis is longstanding infection of the gum, teeth, and surrounding tissue that also involves the jawbones, typically as a result of poor dental hygiene.

• Severe gum infection leads to plaque buildup on the affected teeth (or tooth). When this plaque is left on the teeth for extended periods of time, it hardens, and (usually gram-negative) bacteria in the mouth start to release toxins that damage the gums
• Over time as the plaque builds up, pockets form between the teeth and gums that lead to deeper infection of the gums. Eventually, this infection spreads to the ligaments and bone in the mouth causing degradation of these structures leading to periodontitis

What are the Signs and Symptoms of Periodontitis related to Systemic Disorders?

The signs and symptoms associated with periodontitis may be mild, moderate, or severe, and may include:

• Swollen, painful gums that appear red
• Bleeding during brushing or flossing
• Pus buildup between the teeth and gum
• Mild or dull toothache
• Abnormal taste in the mouth 
• Bad breath

Additionally, the signs and symptoms associated with the specific underlying systemic disorder may be observed. This may vary from one individual to another.

How is Periodontitis related to Systemic Disorders Diagnosed?

In order for the condition to be diagnosed as “Periodontitis related to Systemic Disorders”, the associated systemic condition should be diagnosed. The diagnostic tests for periodontitis may involve the following:

• An oral specialist (dentist) will examine the symptoms and perform a physical exam on the mouth
• The specialist will look for plaque and tartar buildup and check how tender and how easily the gums bleed
• A thorough analysis of the individual’s medical history
• X-rays of the jaw, head, and neck area can be taken to detect the extent of bony involvement, which is caused by the inflammation
• An MRI scan or CT scan of the head and neck region can be used to detect the extent of the damage to the jaw, head, and neck
• Moreover, diagnostic tests, imaging scans, and biopsies (when necessary), to diagnose the underlying systemic condition are necessary

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Periodontitis related to Systemic Disorders?

The possible complications associated with Periodontitis related to Systemic Disorders include:

• Severe emotional stress from cosmetic concerns
• Permanent and irreversible injury to the dental cavity and supporting structures
• Loss of teeth
• Increased susceptibility to other heart and lung related conditions
• Recurrence of the condition

Complications that arise as a consequence of the underlying/associated condition may be noted.

How is Periodontitis related to Systemic Disorders Treated?

The main goal of treatment for Periodontitis related to Systemic Disorders is to avoid further damage to the teeth structure and address the symptoms of the underlying systemic disorder.

Treatment related to periodontitis may include:

• Scaling and polishing: Oral cleansing treatment by the dental professional and removal of the plaque. However, moderate to severe cases may require a sealant to level the surface of the teeth and avoid further plaque buildup
• Root surface debridement procedure (removal of food debris using abrasion)
• Administering systemic antibiotics (amoxicillin and metronidazole); or doxycycline, for those with penicillin allergy. Medications are required to combat bacterial infection
• Use of laser therapy and photodynamic therapy (for disinfection and elimination of bacteria)
• Periodontal surgery: Typically, for localized destruction and poor response to therapy, invasive procedures may be necessary. An open flap debridement procedure or pocket reduction surgery may be performed. If necessary, regenerative surgical procedures (bone or tissue grafting) are used to correct destruction of periodontal tissue and bone
• Regular visits for dental health checkups and maintaining good oral hygiene, such as brushing and flossing after each meal, are generally recommended

Therapy may include conservative measures including proper oral hygiene, stopping smoking, professional cleaning and removing plaque and addressing any factor (such as misaligned tooth or prosthetic dental device) that causes retention of plaque.

Treatment related to systemic disorder varies from one individual to another depending on the cause. The treatment measures may include:

• In cases of diabetes, the condition is brought under control via administration of drugs to lower blood sugar levels, diet control, and exercises, as appropriate
• Hematological disorders should be treated using a combination of measures including chemotherapy, radiation therapy, and surgery
• Symptomatic treatment is typically provided for genetic disorders

How can Periodontitis related to Systemic Disorders be Prevented?

Currently, Periodontitis related to Systemic Disorders may not be preventable; although an early diagnosis and recognition of the underlying systemic disorder may be beneficial. If the condition is a genetic disorder, then:

• Genetic testing of the expecting parents (and related family members) and prenatal diagnosis (molecular testing of the fetus during pregnancy) may help in understanding the risks better during pregnancy
• If there is a family history of the condition, then genetic counseling will help assess risks, before planning for a child
• Active research is currently being performed to explore the possibilities for treatment and prevention of inherited and acquired genetic disorders
• Controlling diabetes through food and lifestyle changes

Currently, the best approach to prevent the development of periodontitis is to maintain good oral hygiene.

• Create an awareness of the importance of oral health in children, from an early age
• Good oral hygiene can be achieved by brushing the teeth twice daily and by flossing at least once a day
• Studies indicate that flossing before brushing is beneficial and recommended. Flossing loosens food particles in the teeth, making it easier to remove them with brushing
• Using recommended oral rinses and antiseptic mouthwashes
• Stopping smoking or chewing tobacco and substance abuse
• Parents and caregivers are asked to periodically  check the mouth of children for detecting any early signs of gum disease or other dental health issues
• Have a well-balanced diet with lots of fruits and vegetables to avoid any nutritional imbalances
• Avoidance of sweets, sugary or carbonated drinks
• Be physically active and exercise regularly to remain healthy and stress-free; meditation and yoga may be beneficial
• Early and prompt treatment of mild gum disease or any dental health conditions can help prevent periodontitis (the advanced stage of gum disease)

Undertake regular visits to a dental health professional for a proper dental check-up and to prevent any tooth-related issues early.

What is the Prognosis of Periodontitis related to Systemic Disorders? (Outcomes/Resolutions)

• The prognosis of Periodontitis related to Systemic Disorders is not only dependent upon the severity of the signs and symptoms of periodontal disease, but also on the severity of the underlying systemic disorder
• Individuals with mild conditions have better prognosis than those with severe symptoms and complications. Typically, the prognosis may be assessed only on a case-by-case basis

Additional and Relevant Useful Information for Periodontitis related to Systemic Disorders:

In order to prevent periodontitis, gingivitis or gum disease needs to be treated in the early stages.