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Fast Facts: Perio Edition - Periodontitis as a Manifestation of Systemic Disease - Histiocytosis Syndromes

Fast Facts

Fast Facts: Perio Edition Episode 63

[Andrew Johnston, RDH]
Welcome back everyone! You are listening to another episode of Fast Facts- Perio Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Katrina Sanders.
[Katrina Sanders, RDH]
Hello, and welcome to Fast Facts: Perio Edition. This week's episode we are continuing the conversation around patients who may present in our chairs with Periodontitis as a Manifestation of Systemic Disease. This week, we are talking all things histiocytosis syndromes. How fancy does that sound? And in order to talk about histiocytosis syndromes, we need to first understand what the heck a histiocyte is. So let's go back to dental and dental hygiene school. A histiocyte is a component of our immune system. It is derived from our bone marrow, and then it matures within our stem cells and this histiocyte is an important component of our immune system because it does two major things. Histiocytes perform phagocytosis, and we all remember macrophages, right? They're the hungry guys in the immune system, so they help to consume or eat any foreign bodies that may be left behind within the immune system. The second thing they do is they function within antigen presentation. So their main property of dendritic cells or the main component of what they do is they recognize or aid in the presentation of antigens on our cells.
Well, why is this important? Because you see when a patient presents with any type of histiocytosis syndrome, and there are many different types of histiocytosis syndromes most commonly referred to as Langer hands cell histiocytosis. That's a mouthful, pun intended. These are patients that if they have any type of a syndrome of histiocytosis, they, for whatever reason, experience an abnormal increase in the amount of histiocytes within their body. So these are monocytes, macrophages and dendritic cells. So when we start to see this hike up of these cells more often than not, we will start to see this in a patient experiencing maybe a rash on the scalp, or maybe just some localized, bizarre observations, things like pain in our bones or discharge from the ear, loss of appetite or fever. Even in some cases, particularly in our pediatric patient population, they may be passing large amounts of urine and be very thirsty. So we start to see these kind of interesting symptoms. But it's important to know when a patient experiences histiocytosis oftentimes it begins with a localized component, one part of the body, and then as it continues to move and damage other tissues, this is where we will start to see some systemic observations. The problem is when we see that systemic observation. This systemic observation often times spreads to the gum tissues and the surrounding bone. This is where we'll start to see tumors that have a punched out appearance on X-rays within our patients bones. And so, of course, this is where we could see the exacerbation of advanced periodontal diseases. Essentially, if a patient presents with any one of these various types of histiocytosis syndromes, these are patients that will likely experience advanced periodontal disease because of the overabundance within the immune system and because of these punched out tumors, as you will likely see them within the alveolar bone. The patient can also experience things like weight loss, jaundice, vomiting, limping, delayed puberty, headaches, dizziness, seizures, a protrusion of their eyeballs, or a generalized rash.
When patients experience systemic involvement, they may even experience lung problems, generalized lymphatic swelling, hormonal issues, or even enlargement of the spleen and liver or subsequent anemia. So it's important to know gosh, how many times do patients check some of these things off in their health history and yet we have an unanswered reason for why these patients are experiencing advanced signs, stages or symptoms of periodontitis? So these are patients who may need a biopsy of the skin or bone under a microscope or specialized X-rays or scans of the bones or blood work in order to identify if they do in fact, present with a histiocytosis syndrome. Thank you for joining me this week. Stay tuned as we continue the conversation around Periodontitis as a Manifestation of Systemic Disease next time!
This has been another episode of Fast Facts - Perio Edition with Katrina Sanders, RDH. Please feel free to reach me on Instagram @thedentalwinegenist or on my website Cheers.
[Andrew Johnston, RDH]
Thank you for listening to another episode of Fast Facts - Perio Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at We'll see you next week for another Fast Fact!

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