Periodontal Disease in Immunodeficient Patients: Clinical Guidelines for Diagnosis and Management

Primary immunodeficiency diseases are rare hereditary conditions that usually occur at a young age; however, secondary immunodeficiency is acquired due to disease, drug treatment and is increasing in frequency among the population. Although periodontal diseases related to these conditions are secondary to other life threatening manifestations, they are very common and easily detectable by the patient, patient guardians and periodontists. Periodontists have a major role in both helping to detect undiagnosed diseases, as well as improving the oral care of diagnosed patients, thus a thorough knowledge of these conditions, causes, local and systemic involvement, diagnostic tools and proper management is very important. This article summarizes selected primary and secondary immunodeficiency conditions such as neutropenia, leukocyte adhesion deficiency (LAD) and ChediakHegashi syndrome, and places schematic, diagnostic, and management steps that may help periodontists manage unexplained severe periodontal diseases related to immunodeficiency. Introduction Immunodeficiency diseases are defects in the immune system in which the host defense mechanism cannot function properly. Primary immunodeficiency is inherited and therefore is caused by a gene defect. However, secondary immunodeficiency conditions are acquired and usually happen due a defect of lymphocyte function as a result of the usage of drugs, irradiation or invasion of pathogens such as HIV virus and measles.[1] There are many types of diseases caused by primary immunodeficiency , which is a result of a defect in Tcell or B-cell function, antibody deficiency, or loss of phagocyte function and/or number[2] ,which for the latter these can be included as any deficiency in the adhesion process of neutrophil [3], NADPH oxidase or chemotaxis.[4] The epidemiology of the diseases differ based on race, gender, ethnic factors and geographic region[4]. It has been estimated that one in 1200 people are affected by primary Immunodeficiency. Due to cancer therapies, usage of immunosuppressant’s and other biological therapies, the occurrence of secondary immunodeficiency is growing. Organ damage is preventable if there is minimal delay in the diagnosis of immunodeficiency[5]. Periodontal disease is an inflammatory state of the gingiva which affects the supporting structure of the teeth.[6, 7]. Periodontal disease is caused by plaque accumulation , and poor dental hygiene[8] leading to inflammation of surrounding tissue[4].It has been observed that individuals suffering from any types of immunodeficiency diseases may manifest some oral, dental and facial problems[4]which include periodontal diseases, oral lesions and developmental abnormalities. These can be a sign of immunity defect. Therefore, it is crucial for physicians and dentist to be able to recognize these systematic disorders by the oral manifestation, carry out an accurate diagnosis and perform the corresponding treatment[9].