2d RFOP - Diabetes

Question 1

Common complications of diabetes?

Answer 1

• Periodontitis – “sixth complication of diabetes”

• Retinopathy

• Neuropathy

• Nephropathy

• Macrovascular and microvascular disease

• Altered wound healing

Question 2

1
Types of diabetes?

2
What are they?

3
Caused by / associated with?

Answer 2

Question 3

Prevalence of type 2 diabetes?

Answer 3

• world wide epidemic
• continues to increase
• Prevalence increases in proportion with age

Question 4

Risk factors for Type II Diabetes

Answer 4

• Age
• Obesity
• Lack of Exercise
• Genetic - family history
• Genetic - Racial Background- esp Indian Subcontinent, Black Carribean
↳ Amy not be so obvious in people from diff racial backgrounds as they may not have much subcutaneous fat but have more visceral fat

Question 5

Type 2 diabetes diagnosis

Answer 5

Question 6

1
What is HbA1c?

2
Why is it useful

3
What does it tell us and what are the levels?

Answer 6

Question 7

Why are HbA1c test important?

Answer 7

Question 8

Effects of Diabetes on Periodontal Disease

Answer 8

Question 9

Effect of Blood Glucose on risk of Periodontitis

Answer 9

Question 10

How does diabetes cause this damage

Answer 10

Question 11

What are AGE?

Answer 11

• Glucose-derived molecules
• once formed they’re Irreversible

Question 12

What do AGE do? Why bad? ↳

Answer 12

• ACCUMALATE IN PLASMA AND TISSUES
  
  • Damages vessel walls (by impairing collagen
    molecules)
  • Cross-linked matrix structures, impaired
    Normal function of vasculature

Also have receptors that Bind to micro vascular cells and inflammatory cells - which lead to
* Activation of local immune and inflammatory responses
↳ * Increased secretion of pro inflamm cytokines such as IL-1beta, TNF-alpha, IL6,
↳ * Increased oxidative stress
↳ * Disruption of RANKL/OPG axis favouring bone resorption

Question 13

Diabetes, lipids and periodontitis

• elevated blood glucose also results in release of cytokines from adipose tissue called adipokines

what does this cause?

Answer 13

• Adiposity and adipokines further contribute to pro-inflammatory environment and tissue breakdown
• Infection induced elevations in cytokine levels:
  ↳ * may influence circulating lipid levels
  ↳ * may be induced by small elevations in bacterial toxin, to raise LDL and free fatty acids
• Raised lipids:
  ↳ * altered cell membrane function
  ↳ * increase cytokine output
  ↳ * make inflammatory cells hyperresponsive

(re watch 15 minutes onwards if unclear)

Question 14

what does diabetes-associated periodontitis look like clinically

Answer 14

• No particular characteristic appearance
• sometimes increased pocketing disproportionate to amount of plaque present
• Sometimes periodontal abscesses

Question 15

what is the evidence of a bidirectional link between diabetes and periodontitis?

Answer 15

• Severe periodontitis worsens glycaemic control in DM and non-DM pts
  ↳ * Bacteria and inflammatory molecules leave periodontal tissues, enter the circulation
  and contribute to upregulated systemic inflammation
  ↳ * Leads to impaired insulin signalling and resistance
• In Diabetic pts, relationship between periodontitis severity and diabetes complications
• Evidence for diabetes onset in severe periodontitis patients

Question 16

Can periodontal treatment help improve diabetic status / control?

Answer 16

yes evidence in studies

• Many studies show reduction of HbA1C following periodontal therapy
• Reduction of 3-4mmol/mol (≈ 0.3-0.4%) in short term
  ↳ * Similar to effect of additional drug!
• Reduced bacterial challenge thought to reduce systemic inflammation and improve insulin resistance and insulin signalling

Question 17

what oral observations in patients may indicate that they have undiagnosed diabetes?

Answer 17

• Recurrent periodontal abscesses
• Rapidly progressing periodontitis
• Severe periodontitis
  - Particularly : those over the age
  of 45 years
  - Concomitant risk factors ( BMI >
  25, hypertension, family history)

consider referral for testing

Question 18

what to consider when treating patients with diabetes

Answer 18

• Regularly updated medical history – medications and level of glycaemic control
• Precautions for insulin-using diabetics – risk of hypoglycaemia
• Diabetics may also present with xerostomia and oral mucosal diseases
• May also be multi-medicated eg calcium channel blocking antihypertensives - have direct relevance to periodontium - may aggravate problems
• Part of diagnostic statement in periodontal diagnosis (diabetes = formal risk factor)