this presentation reveals briefly about endocrine system and endocrinal influence on periodontium

2. Endocrine influence
on periodontium
Dr. Guru Ram (P.G)
Dept of Periodontics

3. Introduction
Endocrine system
Central endocrine glands
Hypothalamus
Pituitary gland

4. Hypothalamus
Homeostasis
Regulation
Hormones

5. Pituitary gland
Regulation
Hormones

6. Source
Hypothalamus
Anterior
pituitary
Thyroid
Adrenal
Pancreas
Parathyroid
Hormone
Target tissue
Principle function Periodontium
Prolactin inhibiting hormone Anterior pituitary gland Inhibits
prolactin Stimulates periodontal ligament
(dopamine)
release
cell proliferation
Growth
hormone Bone, soft tissues and Promotes growth, Presence of growth hormone
(somatotropin)
liver
affects lipids and associated with protective
carbohydrate
effect on periodontium
metabolism
Thyroid
hormones
(tri Most cells of body
Regulators
of Deficiency may be associated
iodothyrosine, thyroxine)
numerous
tissues with destructive periodontal
including
cardiac diseases
and brain involved
with growth and
metabolism
Cortisol,
Most tissues of body
Important
for Excess cortisol associated with
Weak androgens and estrogens Sex accessory tissues glucose, protein and destructive periodontal diseases
lipid metabolism
Known effects on periodontal
Low potency of tissues including growth as
secreted hormones well as disease progression
diminishes effects
on target tissues
Insulin (β cells)
Skeletal muscle, liver, Lowers the blood Decreased insulin production
adipose tissue
glucose, fatty acid associated with destructive
and amino acid periodontal diseases
levels
Parathyroid hormone
Bone,
kidneys, Increases
plasma Decreased cortical bone density
intestine
calcium
and increased PDL width no
effect
on
periodontal
parameters

7. Effects of central endocrine gland
hormones on the periodontium
Britto et al 2011- LIMITED EVIDENCE
M. Partovi et al in 2002

8. Mechanism proposed
L- DOPA
Stimulates
Dopaminergic systems in the anterior position of hypophysis
To release
Growth hormone
Promoter of healing process

9. Peripheral Endocrine glands

10. Peripheral endocrine glands
ADRENAL GLAND
THYROID GLAND
PARATHYROID GLAND
GONADS
PANCREAS

11. Peripheral endocrine glands
Adrenal gland hormones
The hormones produced by the adrenal cortex include mineralo-
carticoid hormones e. g., Aldosterone, Glucocorticoid, hormones e.
g., cortisol, gonodal hormones e. g., dehydro-epi-androsterone

12. Effects of adrenal gland hormones
on the periodontium
Association between elevated cortisol levels and periodontitis were
demonstrated by clinical studies by Rosania et al and Rai et al in 2009
and 2011.
By
Potential psycho-neuro-immunologic mechanism
Potential behavioural mechanism

13. Potential psycho-neuro-immunologic
mechanism
Negative emotion
Polypeptides from sympathetic nor adrenaline transmitting and
sensory nerve fibres and from endocrine glands
+
Bacterial antigens trigger immune responses
Hypothalamus release corticotropic
hormone
Adreno-carticotropic hormone from pituitary
Adrenal cortex release
Cortisol

14. Short term elevations of cortisol reduce inflammation and mobilize
immune components
Glucocorticoids(cortisol)
Decreases immunocompetency by inhibition of IgA, IgG and
neutrophil function.

15. Potential behavioural mechanism
The higher cortisol and β endorphin concentrations significantly
up regulates expression of MMP-1,2,7,11 and TIMP-1 in human
gingival fibroblasts
Increased periodontal breakdown
Periodontitis
Patricia et al 2007

16. • Various kinds of psychologic stress activate HPA(hypothalamus
Pituitary Aderno cortical) system and SM(sympathetic aderno
medullary) system and consequently induce significant increases in
salivary cortisol and catecholamine levels respectively
• Chromagranin A released by exocytosis from the sympathetic nerve
endings

17. Thyroid hormone
Effect of thyroid hormone on periodontium:

18. Parathyroid gland hormone
Hormones- parathormone

19. Ca- Regulation
The resorption of calcium from bones by PTH is by
Rapid phase
Slow phase

20. Rapid phase
After reaching bone
PTH gets activated to receptors on cell membrane of osteoblasts
and osteoclasts
Hormone receptor complex
Increases permeability of membranes of these cells for ca-ions
Accelerates ca-pump mechanism
Ca-ions move to bone cells into blood at faster rate

21. Slow phase
When Osteoclasts are activated by PTH
Lysosomes release enzymes and citric acid and lactic acid
These substances dissolve organic matrix of bone
releasing ca ions
Ca ions release to plasma

22. Effect of parathyroid gland hormone on
periodontium
Primary hyperthyroidism
Secondary hyperthyroidism
Suggested as therapeutic aid
Lindhe et al

23. Sex steroid hormones

24. Action of sex steroid hormones on
periodontium
Sex steroid hormones
Microbiota
immune cells
Cells of the periodontium
Altered gene expression
Changes in clinical phenotype

25. Proposed mechanisms
Sex steroid induced increase in specific microbiota
kumare et al in 2013
Immune endocrine interactions exaggerate periodontal
responses
Shiau, Reynolds in 2010
Specific populations of fibroblasts and epithelial cells are
modulated by sex steroid hormones:
Mariotti. In 1994

26. Sex steroid hormones and the cells of
periodontium
Hormone
Androgens
(testosterone &
hydrotestosterone)
Progesterone
Estradiol
Fibroblasts
Decrease proliferation
Decrease IL-6 production
Decrease proliferation
Decrease protein synthesis
Decrease cytokine production
Increase proliferation
Increase cytokine production
Increase growth factor

27. Factors influencing sex hormones on
periodontium
Gender
Age
Hormone supplements

28. Gender
Studies by Lau et al 2001 showed that gender plays an
important role in changes associated with bone density
throughout the entire skeleton.
It was showed that 80% of decreased bone density patients
were females.( 80% osteoporotic patients were females)

29. Regarding periodontal anatomic differences:
Residual ridge height was lower in women compared
to men + decreased amount of estrogen in post menopausal
women was associated with decreased crestal/subcrestal bone
density

30. Age
With regard to age, females undergo more biologic changes
(hormonal imbalances) compared to males such as during
puberty, menstrual cycle, pregnancy, menopause

31. Hormone supplements
These are common used drugs that stimulates a state of
pregnancy to prevent ovulation.
HRT has helped in overcoming bone loss in menopausal
women, it also has been associated with side effects like
thromboembolism, irregular bleeding, fear of cancer,.

32. Longitudinal studies have examined the transformation of
subgingival flora from pre puberty to puberty and have
demonstrated a significant increase in the frequency of
Eikenella corrodens,
Prevotella intermedia,
Bacteroides melaninogenicus ,
Prevotella nigrescens,

33. Etiology of gingival responses to elevated
estrogen & progesterone during pregnancy
Subgingival plaque composition
Maternal immuno-response.
Sex hormone concentration

34. Pancreatic hormones
Effect of pancreatic hormones on
periodontium
The metabolic disturbances and the resulting
disease sequallae of diabetes mellitus are ultimately
the result of a complete or partial reduction in insulin
secretion from the β cells

35. Oral manifestations
Oral changes described in diabetic patients including
Cheilosis
Mucosal drying
Cracking
Burning mouth and tongue
Diminished salivary flow
Altered oral cavity flora

36. Complications of diabetes mellitus

37. Mechanisms of diabetic influence on
periodontium
These are primarily related to changes in
GCF glucose level
Periodontal vasculature
Collagen metabolism.
The subgingival microbiota

38. CONCLUSION

39. References
Newmann, Takei, Klokkevold, Fermin A Carranza:
Carranza’s clinical Periodontology: 10th Ed: Saunders,
Elsevier
Britto IM et al , JCP 2011 :38:525-531
Partovi et al. Mitogenic effect of L dopa on human
periodontal ligament fibroblast cells: Jour of Endodontics.
Vol 28(3): 193-196
Eriksen. Cellular mechanism of bone remodelling: Rev
Endocr. Metab Disord 2010: 11: 219-227
Amy Romania et al: stress, depression, cortisol and
periodontal disease. J periodontol 2009: 80: 260-266
Depression: Psychiatric clinics of North America. March
2012: 35: 1

40. references…
Glassman et al: where there is depression there is inflammation. Biol
Psychiatry 2007: 62: 280
Kaufman et al: Analysis of saliva for periodontal diagnosis- A review:
JCP 2000: 27: 453-465
Johanssen et a: Dental plaque, gingival inflammation and elevated
levels of IL-6 and cortisol in GCF from women with stress related
depression and excusion: J Periodontol 2006:77: 1403
Balwanth Rai et al: salivary stress markers, stress and periodontitis: A
pilot study . J Periodontol 2011: 82: 287-292
Patricia R Cury et al: hydrocortisone affects the expression of MMP1,2,3,7,11 and tissue inhibitor of matrix metalloproteinases TIMP-1 in
human gingival fibroblasts: J Periodontol 2007: 78: 1309-1315
Peruzzo et al. Systemic review of stress and psychological factors as
possible risk factors for periodontal disease. J Periodontol 2007: 78:
1491-1504

41. references…
Persson RE, Hollender et al. assessment of periodontal conditions and
systemic disease in older subjects. Focus on osteoporosis: J Clin
Periodontol 2002: 29: 796-802
Frankenthal S et al: the effect of the secondary hyperthyroidism and
hemodialysis therapy on alveolar bone and periodontium: J Clin
Periodontol 2002: 29: 479-483
Barros et al: parathyroid hormone protects against periodontitis
associated bone loss: J Dent Res 2003: 83: 791
Marriotti A: Sex steroid hormones and cell dynamics in the
periodontium. Crit Rev Oral Biol Med 1994:5:27-53
Liang et al: effect of estrogen receptor β on osteoblasticdifferentiation
function of human periodontal ligament cells: Arch Oral Biol 2008:
53: 553-557
Tang et al: Up regulation of estrogen receptor β expression during
osteogenic differentiation of human periodontal ligament cells. J
Periodontol Res ;2008: 43: 311-321

42. references…
Lindhe et al : influence of sex hormones on gingival exudation in
dogs with chronic gingivitis: J Periodontol Res: 3 :279-283
Kumare et al: sex and the subgingival microbiome: do female sex
steroids effect periodontol bacteria Perio 2000: 2013: 103
Shiau, Reynolds: sex differences in destructive periodontal disease:
exploring the biologic basis. J Periodontol 2010: 81: 1505-1517
Mariotti. Sex steroid hormones and cell dynamics in the
periodontium: Crit Rev Oral Biol Med 1994: 5: 27-53
Mariotti AJ. Estrogen and extracellular matrix influence human
gingival fibroblast proliferation and protein production. J Periodontol
2005: 76: 1391-1397
Lapp CA, Thomas et al. Modulation by progesterone of Interleukin-6
production by gingival fibroblasts. J Periodontol 1995: 66: 279-284
Loe H: Periodontal disease: the sixth complication of diabetes
mellitus: Diabetes Care: 1993: 16: 329