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Perio - Exam 2 > 1/2 of this is on Final only - Utah Systemic Perio Disease > Flashcards

1/2 of this is on Final only - Utah Systemic Perio Disease Flashcards

1
Q

Which pro-inflammatory signals are high in disease?

Which are high in health?

A 
IL-1beta
TNF-alpha
INF-gamma
PGE2
MMPs
IL-4
IL-10
IL-1ra
TGF-beta
TIMPs
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2
Q

Periodontitis may be related to the risk of what?

A

Cardiovascular disease

Preterm low-birth weight infants

Diabetes

Respiratory disease

Osteoporosis

Menopause

HIV

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3
Q

What is SBE?

A

Sub-acute Bacterial Endocarditis

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4
Q

Practice adjustments should be made for what populations?

A

Diabetes pts

Pregnancy

Cardiovascular disease pts

Elderly pts

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5
Q

Antibx prophylaxis is indicated when?

A

For pts with:

  • Prosthetic cardiac valve(s)
  • Previous endocarditis
  • Sometimes with congenital heart disease
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6
Q

What is the number one food that causes diabetes?

A

RICE

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7
Q

Diagnosis of diabetes?

A

Fasting blood glucose levels greater than or equal to 126 mg/dL

OR

2 hour blood sugar level greater than or equal to 200 mg/dL after oral glucose test

HbA1c level greater than or equal to 6.5%

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8
Q

Biggest dental problem in our office will be what?

A

Hypoglycemia

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9
Q

Type I diabetes is also called what?

A

IDDM (Insulin-dependent diabetes mellitus) 5-10%

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10
Q

Type II diabetes is also called what?

A

NIDDM (Non-insulin dependent diabetes mellitus) 90-95%

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11
Q

Gestational diabetes is how prevalent?

A

3-5% of all pregnancies

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12
Q

Who is at risk for secondary diabetes?

A

Weightlifters

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13
Q

What is diabetes?

A

Metabolic disorder where the body does not produce or use insulin properly

About 10% of US population

6th leading cause of death among Americans

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14
Q

When does diabetes express?

A

In childhood

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15
Q

Tell me about type I diabetes.

A

Insulin not created at all

5-10% of diabetes cases

Req’s daily insulin supplementation

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16
Q

Tell me about type II diabetes.

A

Insulin is produced, but not used effectively

90-95% of diabetes cases

Occurs most often in overweight people

May or may not req medication

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17
Q

Gestational diabetes is more frequent among what populations?

A

Black, Latino, American Indians

Obese women and women and family history during pregnancy

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18
Q

Tell me about gestational diabetes.

A

Req’s thx to normalize maternal blood glucose levels to avoid infant complications

After pregnancy

  • 5-10% of women get Type II
  • 20-50% chance of developing diabetes in the next 5-10 years
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19
Q

What are 6 classic complications of DM?

A

Retinopathy

Nephropathy

Neuropathy

Cardiovascular disease

Altered wound healing

Periodontal disease

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20
Q

What is insulin resistance?

A

Common symptom of type II DM

Insufficient insulin production OR improper insulin fx at cellular level

Sugar is locked out of cells and builds up in blood

Production of AGEs

Metabolic syndrome

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21
Q

What are the 4 types of pts with diabetes that we will see?

A

Diagnosed and controlled

Diagnosed and uncontrolled

Family history
-diagnosed/undiagnosed

Undiagnosed

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22
Q

How to detect diabetes?

A

Classic signs and symptoms:

Excessive thirst (polydipsia)
Excessive urination (polyuria)
Unexplained weight loss
Vision changes
Weakness, malaise
Irritability
Nausea
Dry mouth
Ketoacidosis
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23
Q

Two types of glucose monitoring.

A

Glucometer
-Widespread use

Glycosylated hemaglobin

  • HBA1 - less common
  • HBA1c - Home/office test
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24
Q

Dx of diabetes?

A

Test must be confirmed on subsequent day

Urinary test is no longer the standard of care

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25
Q

What are the normal values for HbA1 levels?

A

5.8-8.4%

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26
Q

What are the normal levels for HbA1c test?

A

4.5-6.7%

27
Q

What is HbA1c?

A

Glycosylated hemoglobin level

Reflect glucose levels in the blood over the preceding 30-90 days

28
Q

What are the normal clinical levels of HbA1c?

A

4.5 - 6.7%

29
Q

Epinephrine does what to the blood glucose level?

A

Drops glucose in the blood

30
Q

What are the other percentages for total hb for clinical interpretation?

A

< 7% - Good control

7-8% - Moderate control

> 8% - Time to improve control

31
Q

For 1 A1c% increase, what is the increase in average blood sugar (mg/dL)?

A

30

*5% HbA1c = 80 mg/dL
6% HbA1c = 120 mg/dL
…
12% HbA1c = 300 mg/dL

32
Q

What are AGEs?

A

Advanced glycation end products

33
Q

What do AGEs do to connective tissue?

A

Forms cross-links in tissue fibers

  • Delayed wound healing
  • Smoking exacerbates this

Rxns with RAGEs (receptors of advanced glycation end products)

Inflammatory products

34
Q

What time frame does HbA1c measure?

A

30-90 days

-2-3 months

35
Q

What do AGEs result in?

A

Collagen accumulation in periodontal capillary membranes (membrane thickening)

Stim of smooth muscle increases thickness of vessels

Binding of LDL to AGE-modified collagens
-Narrows the vessel lumen

36
Q

What effects do AGEs have on collagen turnover?

A

Increased MMP production
-Degrades newly formed collagen

Decreased solubility

Leads to narrow vessels, increased damage, and less wound healing

37
Q

What are AGEs?

A

Nonenzymatic addition of hexoses to proteins

Interfere w/ proper fx of proteins they are attached to

HbA1c measure 2-3 months preceding the test

38
Q

What are AGEs?

A

Nonenzymatic addition of hexoses to proteins

Interfere w/ proper fx of proteins they are attached to

HbA1c measure 2-3 months preceding the test

39
Q

What AGE effects are on the PMNs?

A

Leukocyte adherence

Chemotaxis

Phagocytosis

*Defect in the first line of defense

40
Q

What AGE effects happen on the macrophages?

A

HYPERresponse

  • Increase IL-1beta secretion
  • IL-6
  • TNF-alpha
  • PGE2
41
Q

What are the AGE effects on endothelial cells?

A

HYPERpermeability

HYPERexpression of adhesion molecules

Procoagulatory changes
-Blood clots and vasoconstriction

42
Q

Macrophage interacts with LPS via what receptor?

A

Toll-like receptor

-Including CD14

43
Q

T/F - Diabetics have an increased risk for periodontal disease.

A

TRUE

*For both types

44
Q

T/F - If we can control blood glucose levels, we can decrease the diabetic’s risk for periodontal disease.

A

TRUE

*And vice versa

45
Q

For uncontrolled diabetics, what two things need to be used to improve glycemic control, in terms of the oral cavity?

A

Mechanical (scaling) AND systemic antibiotics
-Doxycycline is commonly used
—Binds the divalent cations and decreases collagenase levels

*NOT JUST MECHANICAL ALONE

46
Q

T/F - Evidence supports a relationship b/t diabetes and periodontal disease.

T/F - The relationship is most likely bi-directional.

T/F - Add’l studies are needed to establish this relationship.

A

TRUE

TRUE

TRUE

  • Tx of periodontal disease contributes to glycemic control
  • Reduces complications of diabetes
47
Q

T/F - Obesity affects up to 30% of the US population.

A

TRUE

  • Linked to other health concerns
  • Diabetes
  • Periodontal disease
48
Q

T/F - Fat is an inflammatory tissue that releases TNF-alpha, CRP, and other cytokines.

A

TRUE

49
Q

T/F - Cytokines can lead to insulin resistance and type II diabetes.

A

TRUE

50
Q

________ is a risk factor for both type 2 diabetes and periodontal infection.

A

Obesity

51
Q

T/F - Diabetes heightens risk for periodontal disease.

A

TRUE

52
Q

Does obesity affect wound healing?

A

Yes

-Decreases wound healing

53
Q

What is the 3 way street?

A

Obesity Diabetes Periodontal disease

54
Q

What two inflammatory molecules are in the middle of the 3 way street triangle?

A

IL-6

TNF-alpha

55
Q

T/F - There is a higher prevalence of tooth loss in diabetics.

A

TRUE

  • Increased inflammation
  • Decreased ability to fight infection
56
Q

T/F - Tx of periodontal disease reduces need for insulin.

A

TRUE

57
Q

What major cytokine interferes with the action of insulin and glycemic control?

A

TNF-alpha

*Associated with glycated hemoglobin

58
Q

What are warning signs of diabetes?

A 
Frequent urination
Extreme hunger
Extreme there’s
Fatigue
Impaired wound healing
Frequent infection
BLURRED VISION
Unusual weight loss
Fruity breath
59
Q

What are the oral signs of diabetes?

A

Foamy saliva

Dry and irritated tissue

Severe periodontal inflammation

60
Q

What is the target glucose levels in type 2 diabetes?

A

90-126 mg/dL

After a meal
-<170 mg/dL

61
Q

How to treat diabetics?

A

Manage soft tissue inflammation

More recalls

Enforce home care
-Brush, floss, rinse

Monitor blood glucose levels

62
Q

T/F - About 1/2 of people with diabetes have severe periodontal disease.

A

TRUE

63
Q

RAGEs are found on what cells?

A

Monocytes

Macrophages

Endothelial cells

NOT FIBROBLASTS

64
Q

AGEs do what?

A

INCREASE the amount of cross-linking in the triple helix making the collagen fiber stronger (and less easy to participate in turnover, resulting in wound healing issues)

Perio - Exam 2 (8 decks)

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