Chapters 16 & 34 Flashcards
What is diabetes mellitus?
A chronic, life-long metabolic disorder in which the body does not produce or properly use insulin
What is true about patients with well-controlled diabetes in terms of periodontal disease?
- Less susceptible to perio disease than uncontrolled
- NOT more susceptible than nondiabetic patients
- Response to nonsurgical therapies similar to nondiabetic pts w/ reduction in PD and attachment level gain
What is true about undiagnosed or poorly controlled diabetic patients in terms of periodontal disease?
- These pts are 3x more likely to develop periodontitis
- Blood glucose levels directly correlated to severity of perio
- Diabetes+smoking+over 45= 20x more likely to have severe perio
- Does not favor specific pathogens
- Poor wound healing
- Poor response to therapy, rapid recurrence, less long-term stability
Other oral complications for pts w/ poorly controlled diabetes
- Rediced salivary flow means an increased risk of caries and oral candidiasis
- Abscess formation from poor wound healing
- Cheilosis
- Burning tongue/mouth
What causes an altered inflammatory response to infection in pts w/ poorly controlled diabetes?
- Defective neutrophil function impairs the immune response
- Hyper responsive monocytes and ,acrophages cause an increase in proinflammatory cytokines
- This may also contribute to worsening of other chronic inflammatory conditions like cardiovascular disease
How does diabetes cause imbalanced bone metabolism?
Can contribute to net loss of alveolar bone in periodontitis due to:
* Prolonged osteoclastic activity
* Increased programmed cell death of osteoblasts which causes impairment of bone formation following bone resorption
What does AGE stand for?
Advanced Glycation End products
What does RAGE stand for?
Receptor for Advanced Glycation End products
What is glycation?
Metabolic process in which glucose irreversibly binds to proteins and lipids forming AGE which are harmful byroducts
What does an increase in AGE lead to?
- Neuropathy
- Retinal disease
- Kidney failure in diabetics
Where is RAGE found?
Cell membrane surface of endothelial cells, neurons, monocytes/macrophages and periodontium
What does the interaction of AGE and RAGE do?
Stimulates the release of proinflammatory cytokines TNF-a and IL-1-B
Major factor for exaggerated perio and systemic inflammation, insulin resistance and impaired tissue repair in diabetic pts w/ perio
What does bacterial challenge+AGE-RAGE+diabetes equal?
Accelerated/severe periodontitis
How does chronic stress affect the immune response?
Impairs the regulation of the immune response
Positive correlation between stress and periodontal disease
How does acute stress affect the immune response?
It is immunoenhancing
What are some stress-induced behavioral changes that can affect oral health?
Decreased homecare
Smoking
Drinking
Increased carbohydrate consumption
What can lead to chronic stress?
- Environmental influences
- Psychological factors
- Major life events
- Daily hassles