1/2 of this is on Final only - Utah Systemic Perio Disease Flashcards
Which pro-inflammatory signals are high in disease?
Which are high in health?
IL-1beta TNF-alpha INF-gamma PGE2 MMPs
IL-4 IL-10 IL-1ra TGF-beta TIMPs
Periodontitis may be related to the risk of what?
Cardiovascular disease
Preterm low-birth weight infants
Diabetes
Respiratory disease
Osteoporosis
Menopause
HIV
What is SBE?
Sub-acute Bacterial Endocarditis
Practice adjustments should be made for what populations?
Diabetes pts
Pregnancy
Cardiovascular disease pts
Elderly pts
Antibx prophylaxis is indicated when?
For pts with:
- Prosthetic cardiac valve(s)
- Previous endocarditis
- Sometimes with congenital heart disease
What is the number one food that causes diabetes?
RICE
Diagnosis of diabetes?
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%
Biggest dental problem in our office will be what?
Hypoglycemia
Type I diabetes is also called what?
IDDM (Insulin-dependent diabetes mellitus) 5-10%
Type II diabetes is also called what?
NIDDM (Non-insulin dependent diabetes mellitus) 90-95%
Gestational diabetes is how prevalent?
3-5% of all pregnancies
Who is at risk for secondary diabetes?
Weightlifters
What is diabetes?
Metabolic disorder where the body does not produce or use insulin properly
About 10% of US population
6th leading cause of death among Americans
When does diabetes express?
In childhood
Tell me about type I diabetes.
Insulin not created at all
5-10% of diabetes cases
Req’s daily insulin supplementation
Tell me about type II diabetes.
Insulin is produced, but not used effectively
90-95% of diabetes cases
Occurs most often in overweight people
May or may not req medication
Gestational diabetes is more frequent among what populations?
Black, Latino, American Indians
Obese women and women and family history during pregnancy
Tell me about gestational diabetes.
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
What are 6 classic complications of DM?
Retinopathy
Nephropathy
Neuropathy
Cardiovascular disease
Altered wound healing
Periodontal disease
What is insulin resistance?
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
What are the 4 types of pts with diabetes that we will see?
Diagnosed and controlled
Diagnosed and uncontrolled
Family history
-diagnosed/undiagnosed
Undiagnosed
How to detect diabetes?
Classic signs and symptoms:
Excessive thirst (polydipsia) Excessive urination (polyuria) Unexplained weight loss Vision changes Weakness, malaise Irritability Nausea Dry mouth Ketoacidosis
Two types of glucose monitoring.
Glucometer
-Widespread use
Glycosylated hemaglobin
- HBA1 - less common
- HBA1c - Home/office test
Dx of diabetes?
Test must be confirmed on subsequent day
Urinary test is no longer the standard of care
What are the normal values for HbA1 levels?
5.8-8.4%
What are the normal levels for HbA1c test?
4.5-6.7%
What is HbA1c?
Glycosylated hemoglobin level
Reflect glucose levels in the blood over the preceding 30-90 days
What are the normal clinical levels of HbA1c?
4.5 - 6.7%
Epinephrine does what to the blood glucose level?
Drops glucose in the blood
What are the other percentages for total hb for clinical interpretation?
< 7% - Good control
7-8% - Moderate control
> 8% - Time to improve control
For 1 A1c% increase, what is the increase in average blood sugar (mg/dL)?
30
*5% HbA1c = 80 mg/dL
6% HbA1c = 120 mg/dL
…
12% HbA1c = 300 mg/dL
What are AGEs?
Advanced glycation end products
What do AGEs do to connective tissue?
Forms cross-links in tissue fibers
- Delayed wound healing
- Smoking exacerbates this
Rxns with RAGEs (receptors of advanced glycation end products)
Inflammatory products
What time frame does HbA1c measure?
30-90 days
-2-3 months
What do AGEs result in?
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
What effects do AGEs have on collagen turnover?
Increased MMP production
-Degrades newly formed collagen
Decreased solubility
Leads to narrow vessels, increased damage, and less wound healing
What are AGEs?
Nonenzymatic addition of hexoses to proteins
Interfere w/ proper fx of proteins they are attached to
HbA1c measure 2-3 months preceding the test
What are AGEs?
Nonenzymatic addition of hexoses to proteins
Interfere w/ proper fx of proteins they are attached to
HbA1c measure 2-3 months preceding the test
What AGE effects are on the PMNs?
Leukocyte adherence
Chemotaxis
Phagocytosis
*Defect in the first line of defense
What AGE effects happen on the macrophages?
HYPERresponse
- Increase IL-1beta secretion
- IL-6
- TNF-alpha
- PGE2
What are the AGE effects on endothelial cells?
HYPERpermeability
HYPERexpression of adhesion molecules
Procoagulatory changes
-Blood clots and vasoconstriction
Macrophage interacts with LPS via what receptor?
Toll-like receptor
-Including CD14
T/F - Diabetics have an increased risk for periodontal disease.
TRUE
*For both types
T/F - If we can control blood glucose levels, we can decrease the diabetic’s risk for periodontal disease.
TRUE
*And vice versa
For uncontrolled diabetics, what two things need to be used to improve glycemic control, in terms of the oral cavity?
Mechanical (scaling) AND systemic antibiotics
-Doxycycline is commonly used
—Binds the divalent cations and decreases collagenase levels
*NOT JUST MECHANICAL ALONE
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.
TRUE
TRUE
TRUE
- Tx of periodontal disease contributes to glycemic control
- Reduces complications of diabetes
T/F - Obesity affects up to 30% of the US population.
TRUE
- Linked to other health concerns
- Diabetes
- Periodontal disease
T/F - Fat is an inflammatory tissue that releases TNF-alpha, CRP, and other cytokines.
TRUE
T/F - Cytokines can lead to insulin resistance and type II diabetes.
TRUE
________ is a risk factor for both type 2 diabetes and periodontal infection.
Obesity
T/F - Diabetes heightens risk for periodontal disease.
TRUE
Does obesity affect wound healing?
Yes
-Decreases wound healing
What is the 3 way street?
Obesity Diabetes Periodontal disease
What two inflammatory molecules are in the middle of the 3 way street triangle?
IL-6
TNF-alpha
T/F - There is a higher prevalence of tooth loss in diabetics.
TRUE
- Increased inflammation
- Decreased ability to fight infection
T/F - Tx of periodontal disease reduces need for insulin.
TRUE
What major cytokine interferes with the action of insulin and glycemic control?
TNF-alpha
*Associated with glycated hemoglobin
What are warning signs of diabetes?
Frequent urination Extreme hunger Extreme there’s Fatigue Impaired wound healing Frequent infection BLURRED VISION Unusual weight loss Fruity breath
What are the oral signs of diabetes?
Foamy saliva
Dry and irritated tissue
Severe periodontal inflammation
What is the target glucose levels in type 2 diabetes?
90-126 mg/dL
After a meal
-<170 mg/dL
How to treat diabetics?
Manage soft tissue inflammation
More recalls
Enforce home care
-Brush, floss, rinse
Monitor blood glucose levels
T/F - About 1/2 of people with diabetes have severe periodontal disease.
TRUE
RAGEs are found on what cells?
Monocytes
Macrophages
Endothelial cells
NOT FIBROBLASTS
AGEs do what?
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)
