2d - RFOP Diabetes Flashcards
Common complications of diabetes?
- Periodontitis – “sixth complication of diabetes”
• Retinopathy
• Neuropathy
• Nephropathy
• Macrovascular and microvascular disease
• Altered wound healing
1
Types of diabetes?
2
What are they?
3
Caused by / associated with?
Prevalence of type 2 diabetes?
- world wide epidemic
- continues to increase
- Prevalence increases in proportion with age
Risk factors for Type II Diabetes
• Age
• Obesity
• Lack of Exercise
• Genetic - family history
• Genetic - Racial Background- esp Indian Subcontinent, Black Carribean
Type 2 diabetes
What are the 4 tests we can do to diagnose ?
What is plasma glucose measured in?
Plasma glucose units in diabetes?
1
What is HbA1c?
2
Why is it useful
3
What does it tell us and what are the levels?
Why are HbA1c test important?
Effects of Diabetes on Periodontal Disease
Effect of Blood Glucose on risk of Periodontitis
How does diabetes cause this damage
What are AGE?
• Glucose-derived molecules
• once formed they’re Irreversible
What do AGE do? Why bad? ↳
.
Diabetes, lipids and periodontitis
Adiposity = high levels of fat / fat person
what does adiposity contribute to?
What do raised lipids cause ? (3)
.
what does diabetes-associated periodontitis look like clinically
- No particular characteristic appearance
- sometimes increased pocketing disproportionate to amount of plaque present
- Sometimes periodontal abscesses
what is the evidence of a bidirectional link between diabetes and periodontitis?
- 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
1 - Can periodontal treatment help improve diabetic status / control?
2 - Why?
1 - yes
- Reduction of HbA1C following periodontal therapy
- Reduction of 3-4mmol/mol (≈ 0.3-0.4%) in short term
- Similar to effect of additional drug!
2 -
Reduced bacterial challenge thought to reduce systemic inflammation and improve insulin resistance and insulin signalling
what oral observations in patients may indicate that they have undiagnosed diabetes?
- 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
what to consider when treating patients with diabetes
- 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)
