Hormonal Imbalance

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Puberty is from ?-? yoa ovulation begins

9-16

Menses cycle: ave. ? days cycle

28

Pregnancy, oral contraceptives, and menopause (peri & post) all cause hormonal ?

imbalance

What female hormone is responsible for the cyclical changes, ? epithelium, endometrium of ?

-estrogen
-vaginal
-uterus

Estrogen levels peak at ?

ovulation

Estrogen decreases during the ? half of cycle

2nd

What female hormone is responsible for changes in endometrium of the uterus

progesterone

Progesterone is responsible for changes in ? if the uterus, ? of ? egg, and development of ? & ? glands

-endometrium
-implantation, fertilized
-placenta, mammary

Progesterone remains ? until ovulation occurs

stable

Hormonal effects on oral flora cause changes in the ? of gingival ?

-microflora
-sulcus

Hormonal effects on oral flora alter ? growing in ?

-bacteria
-plaque

Hormonal effects on oral flora can cause increased ? & ?:
-? capillaries
-regulated cellular ?
-decreased ?
-increased vascular ?
-increased production of gingival ? ?
-occurs even in the absence of what

-bleeding
-gingivitis
-dilated
-proliferation
-keratinization
-permeability
-crevicular fluid
-bacterial plaque

In hormonal effects on the oral flora you get an increase in periodontal pathogens, name the 2

-Porphyromonas gingivalis
-Actinobacillus actinomycetemcomitans

In hormonal effects on the oral flora you also see an increased on prostaglandin ?, which serves as a mediator for ?

-E
-inflammation

Hormonal effects on the oral flora also influence the ? system by ? of
-? chemotaxis
-P
-A
-?-cell response

-immune
-depression
-neutrophil
-phagocytosis
-antibodies
-T

Progesterone alters ? & ? of ? production in ?

-rate
-pattern
-collagen
-gingiva

Since progesterone alters rate & pattern of collagen production in gingiva, this results in ? ability to ? & ? structure of gingiva

-reduced
-repair
-maintain

Hormonal effects on the oral flora also cause an ? in microbes:
-Gram ? ?
-Name the 2, and say what they each do

-increase
-negative anaerobes
-Prevotella intermedia- affects blood clotting
-Capnocytophagia & P. intermedia- causes increased bleeding

In hormonal effects on the oral flora Prevotella intermedia cause what 2 things, and what is its classification

-affects bld clotting
-increases bleeding
-gram negative anaerobe

In hormonal effects on the oral flora Capnocytophagia cause what and what is its classification

-increased bleeding
-gram negative anaerobe

The male hormone testosterone is a ? hormone from the ? group

-steroid
-androgen

What is the principle male sex hormone, and where is it secreted

-testosterone
-male testes

Testosterone plays a key role in ? & ?
-20 times greater in ? than ?
-enhanced ?
-E
-? function
-protection against ?

-male & female
-male, female
-libido
-energy
-immune
-osteoporosis

What male testosterone hormones promote protein synthesis and growth of tissues with their receptors

androgens

Androgens are male testosterone hormones that promote ? ? & growth of ? with androgen ?

-protein synthesis
-tissues
-receptors

What is maturation of sex organ called

virilizing

Male testosterone hormones (androgens) have a ? effect:
-growth of ? mass & ?
-increased ? density & ?
-stimulation of ? growth & ?
-increased ? performance

-anabolic
-muscle, strength
-bone, strength
-linear, maturation
-athletic

Male testosterone hormones
*Prenatal androgen effects (7-12 weeks)
-? virilization & development of ?

-genital
-prostate

Male testosterone hormones
*Prenatal androgen effects occur when, and what 2 things happen

7-12 weeks
-genital virilization & development of prostate

Male testosterone hormones
*In early infancy (1st wks of life), ? masculinization occurs

-brain

Male testosterone hormones
*Early infancy occurs when and what occurs

1st wks of life
-brain masculinization

Male testosterone hormones
*Early postnatal effects (childhood)
-adult type body ?
-? ? of skin & hair
-appearance of ? hair
-? hair
-? spurt accelerated by ? maturation
-? upper ?, and ? hair

-odor
-increased oiliness
-pubic
-axillary
-growth, bone
-fine, lip, sideburn

In male testosterone hormones, what are these effects called, and when do they occur...
-adult type body odor
-increased oiliness of skin and hair
-appearance of pubic hair
-axillary hair
-growth spurt accelerated by bone maturation
-fine upper lip, and sideburn hair

early postnatal effects (childhood)

Male testosterone hormones
*Advanced postnatal effects (puberty)
-? enlargment, ?
-Name the 3 types of hair this person would have at this time
-What happens to their voice
-they have a growth ? (give some ex)
-What happens with their shoulders & rib cage

-phallic, libido
-pubic, face, & chest
-it deepens
-spurt (adam's apple, jaw, brow, chin, nose, etc)
-their shoulders widen, and their rib cage expands

What are the adult testosterone effects

maintence of bone density & strength

Male testosterone hormones
*Effects of testosterone on the brain
-Enlargening of what 3 body parts (there are more just give 3)
-Enzyme ? converts testosterone into ? & is responsible for ?
-? ? enzyme results in ? genders, but ? brain

-heart, lungs, liver, etc.
-aromatase, estrogen, masculinization
-reduced aromatase, male, female

In the effects of testosterone on the brain what causes male gender, but female brain

reduced aromatase enzyme

In the effects of testosterone on the brain what causes the conversion, what is converted, and it is responsible for what

-enzyme aromatase
-testosterone to estrogen
-masculinization

What else can testosterone effect regarding the brain, give details

-difference in the size of it
-males brains are typically on average larger

Since testosterone effects the difference in sizes of the brain and a male's brain is on average larger, this means, as the brain is greater in volume, it has ? ? ? ?

less interwoven brain halves

Since testosterone effects the difference in sizes of the brain and a male's brain is on average ?, this means, as the brain is ? in ?, it has ? interwoven brain ?

-larger
-greater, volume
-less, halves

In a normal brain the two sides of the brain operate together, but with the connection ?, the two halves cannot ?

-severed
-communicate

Clinical manifestations of puberty are...
-increased ?
-bacteria in the ? act to increase ?
-? response to ? irritants
-? in severity over time
-? with removal of local ?
-gingival tissue appear ?, ?-?, & ?

-gingivitis
-sulcus, bleeding
-exaggerated, minor
-decrease
-disappear, irritants
-enlarged, bluish-red, bulbous

Menstruation clinical manifestations are...
-? ? gingival tissues
-herpes ?
-? ulcers
-prolonged ? after oral ?
-swollen ? glands
-pts are generally unaware of this correlation

-erythematous swollen
-labialis
-aphthous
-bleeding, surgery
-salivary

In pregnancy there are clinical manifestations such as...
-increase ? & ? = increased ?.? bacteria
-pregnancy ?
-most evident in what months
*gingival tissue:
-bright red edema at ? & ?
-? bleeding, but decreases after what

-estrogen & progesterone = P. intermedia
-gingivitis
-2nd & 8th
-margins & papilla
-increased, after birth

If a pt is pregnant they are likely to have pregnancy gingivitis, and bc of the the increase in estrogen and progesterone they have a increase in P. intermedia bacteria. In what months is this most evident, and describe what their gingival tissues may look like, also discuss bleeding rates, and how they are affected after birth regarding bleeding

-2nd & 8th
-bright red edema at margins and papilla
-their bleeding increases, but decreases after delivery

Why may a pregnant pt have a increase in P. intermedia

b/c of the increase in estrogen & progesterone

What could a pt be affected by if their gingiva appears erythematous and swollen, they have herpes labialis, aphthous ulcers, prolonged bleeding after oral surgery, swollen salivary glands

menstruation

If a pts gingival tissues appear enlarged, bluish-red, and bulbous, what could be causing this

them going through puberty

If a pt has an exaggerated response to minor irritants, they have bacteria in their sulcus that is increasing bleeding, this will decrease in severity over time, and will disappear with removal of local irritants, what could they be going through that is causing this

puberty

A pyogenic granuloma is a clinical manifestation of what

pregnancy

A pyogenic granuloma is a clinical manifestation of pregnancy and it is a ? lesion, and sometimes called what, and how can this be treated

-benign
-pregnancy tumor
-after surgical removal the tissue returns to health

If a pt is getting aphthous ulcers and herpes labialis what could be causing this

menstruation

Menstruation can cause what glands to become swollen

salivary

In what trimester of pregnancy could you experience these physiology & complications..
-fatigue, syncope, postural hypotension

1st trimester

In what trimester of pregnancy could you experience these physiology & complications..
-BP drops (100/70 mm Hg or lower)
-90% develop benign heart murmur- ends after delivery

2nd trimester

In what trimester of pregnancy could you experience these physiology & complications..
-supine hypotension syndrome

3rd trimester

In what trimester could a pt who is prego experience postural hypotensiom

1st

In the 2nd trimester the ?? drops (give ex)

bp (100/70 or lower)

What percent of prego pt will develop a heart murmur, gives 2 significant details about it. What trimester does this occur in

-90%
-that is the Benign and that it ends after delivery
-2nd

In the 3rd trimester what syndrome might they experience

supine hypotension syndrome

In 90% of prego pt there are ? alterations, and increased ? ?

-taste
-gag reflex

In what % of prego pts is there an increased gag reflex and taste alterations

90%

When a pt is prego what is the contributing factor form GDM

insulin resistance

GDM ? risk for ? and babies that are what size

-increase
-infection
>9 lbs

In prego pt's hypertension increases their risk for ?

preclampsia

Spontaneous abortions of pregnancies account for what percent due to fetal abnormalities

15%

Spontaneous abortions of pregnancies account for 15% due to ? ?

fetal abnormalities

For dental mgmt of a prego pt we need to evaulate and determine ? and ? status, also confirm medical ? care provision or ? entry

-trimester
-health
-prenatal
-facilitate

For dental mgmt of a prego pt we would want to monitor what, and provide what type of therapy, and give them instructions on what. The key word here is ? ? ?

-VS
-periodontal therapy
-OHI
-EDUCATE, EDUCATE, EDUCATE

For dental mgmt with a prego pt we would want to minimize ? use, and ? exposure, what would b a good thing to avoid, and what is the safest trimester for appts

-drug
-radiographic
-avoid prolonged appts
-2nd

Oral contraceptives contain ? & ?, and some clinical manifestations are...
-? gingival ?, and there is more ? destruction if taken over ? years
*? localized ? after mandibular ? ? extractions
-effects of ? on blood ?
-time extraction to day ?-? of cycle

-increased, inflammation, perio, 1.5 yrs
-increased, Osteitis, 3rd molar
-estrogen, clotting
-23-28

If a pt is taking oral contraceptives what day would you want to time the extraction and why

23-28 days of cycle
-b/c estrogen effects on blood clotting

When a pt is going through menopause some clinical manifestations may include...
-? ? syndrome
-? mouth
-menopausal ?
-? ? sensation (give 3 ex's)
-bone ?
-tissue ?
-sensitivity to ? & ?
-alleviation of symptoms with ???

-burning mouth
-dry
-gingivostomatitis
-altered taste (salty, peppery, sour)
-loss
-atrophy
-hot, cold
-HRT (hormone replacmt therapy)

With hormone replacmt therapy, postmenopausal pt have an increased risk for what 2 things

-osteoporosis
-CVD

There are 2 forms of HRT, one is ??? for women ? uterus, and estrogen alone can cause ? of uterine lining; leads to ? cancer

-ERT (estrogen replacmt therapy)
-without
-hyperplasia
-endometrial

The other form of HRT is ? HRT, it contains ? & ? to mimic ? ? of hormones

-combined
-estrogen
-progesterone
-normal release

-Osteoporosis is ? in bone ? associated with ?, ?, and ?
-Affects ?-? ? Americans (what % are women)
-Osteoporotic effects on ? & ? bone -Correlation with systemic osteoporosis & ??? leads to ? loss
-??? protects against osteoporosis & maintains bone ?

-reduction , mass, deformity, fractures, pain
-25-28 million, 80%
-max & mand
-LOA, tooth
-ERT (estrogen replacmt therapy), density

DHPC for hormonal imbalance is that you would develop an effective plan to meet special needs of pts, assess exaggerated responses to local irritants, and would do a thorough periodontal examination consisting of what 3 exams

-gingival assessment
-bleeding index
-periodontal probing

What is the best time to schedule surgeries for pt with hormonal imbalance

on non-estrogen days of cycle (23-28 days of cycle would be best)

DHPC for pt with hormonal imbalance we would have to institute tx modification to address oral manifestations during ?, such as...
-? substitutes
-? supplements
-? deficiencies
-Dentures: promote proper ? & prevent ? spots

-menopause
-saliva
-zinc
-vitamin
-fit, sore

We as clinicians must recognize the association b/t ? ?, ? ?, & ?, and educate the pt about ? effects, b/c most pts are NOT aware of this

-hormonal imbalance
-periodontal dz
-osteoporosis
-oral

What hormone alter rate and pattern of collagen production in gingiva, which results in reduced ability to repair and maintain structure of gingiva

progesterone

What gram negative anaerobic bacteria affect blood clotting, and cause increased bleeding as a hormonal effect

P. intermedia

What gram negative anerobic bacteria cause increased bleeding as a hormonal effect

Capnocytophagia

Porphyromonas gingivalis & Actinobacillus actinomycetemcomitans are 2 bacteria that are ? pathogens that are seen in hormonal effects on oral flora

periodontal

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