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
What can negative coping mechanisms to chronic stress lead to?
Prolonged stress which then leads to:
* Increased cortisol production
* Health impairing behaviors
What does increased cortisol production cause?
- Suppression of inflammatory response
- Increase in blood glucose levels
- Altered cytokine levels
What are some health impairing behaviors?
- Poor oral hygiene
- Cigarette and alcohol consumption
- Altered sleep patterns
- Poor nutritional intake
What can an increase in cortisol production and health impairing behaviors lead to?
Increased susceptibility to chronic systemic conditions
What affects can menopause have on the periodontium?
Menopausal gingivostomatitis- gingiva that bleads readily, pain, and a dry, shiny, erythematous appearance
What is medication related osteonecrosis of the jaw (ONJ)?
- Painful areas of exposed bone that fail to heal after extration or oral surgery
- Can be caused by bisphosphonates which are prescribed to inhibit the bone resorption of osteoporosis
What is metabolic syndrome?
Combination of closely related metabolic disturbances marked by an increase in:
Blood pressure
Glucose levels
Cholesterol and triglycerides
Tendency toward thrombosis
Proinflammatory state and excess fat around the waist
Together, what do all of the factors of metabolic syndrome do?
Act to increase the risk of diabetes, stroke and heart disease
What are the shared risk factors between metabolic disease and priodontitis?
- Obesity associated w/ perio pathogens
- An increased number of adipocytes means an increased production of adipokines which leads to an inflammatory state which leads to an increase in insulin resistance and an increased susceptibility to perio infection
Periodontal effects of HIV/AIDS
Linear Gingival Erythema:
* 2-3mm red band on the free gingiva
* Not associated w/ PD, reduced attachment or AB
* Non-biofilm induced gingival disease
* Form of candidiasis
* Not responsive to conventional therapy
What is cyclic neutropenia characterized by?
- Deficiency of neutrophils including PMNs
- More susceptible to perio diseases
- Higher plaque scores, gingival bleeding and inflammation, and AB loss
Down Syndrome affect on the periodontium
Abnormal PMN chemotaxis and phagocytosis
Impaired wound healing
Perio disease in 58-96% of down syndrome pts under 35 years
Colonization of pathogens in childhood
Characterized by biofilm formation, deep pockets, extensive inflammation
What type of medication in phenytoin (Dilantin) and what are its effects on the periodontium?
Anticonvulsant
Causes gingival overgrowth
What type of medication is alprazolam (Xanax) and what are its effects on the periodontium?
Antianxiety agent
Causes increased biofilm formation
What type of medication is enalapril (Vasotec) and what are its effects on the periodontium?
Antihypertensive
Causes increased gingival inflammation
What type of medication is nifedipine (Procardia) and what are its effects on the periodontium?
Calcium channel blocker
Causes gingival overgrowth
What type of medication is cyclosporine (Sandimmune) and what are its effects on the periodontium?
Immunosuppressive
Causes gingival overgrowth
What does association mean?
- Indicates a relationship or connection btw 2 or more variables but the relationship is unexplained
- Does not mean one variable causes the other
What does causation mean?
- Variable A is ceertain to cause/lead to variable B
- Determining causation of disease or condition is difficult
It is not possible to prove causality btw periodontitis and systemic disease
What is metatstatic infection?
Infectious disease mediated by microorganisms that originate from a distant body site (oral bacteria disseminate)
What are possible mechanisms linking periodontitis to systemic disease?
- Metatstatic infection- oral bacteria disseminate
- Inflammation- proinflmmatory mediators from tissue can initiate systemic inflammation
- Immune response- systemic inflammation associated w/ obesity, diabetes and perio proposed as a connection
What are some systemic conditions associated w/ periodontitis?
- Atherosclerotic Cardiovascular disease
- Diabetes mellitus
- Adverse pregnancy outcomes
- Other: pneumonia, COPD, chronic kidney disease, RA, obesity, metabolic syndrome, cancer, cognitive impairment
What are the fasting blood glucose levels for health, prediabetes and poor control?
Health= less than or equal to 100mg/dL
Prediabetes= 100-125mg/dL
Poor control= 126mg/dL
What are the HbA1c levels for poor control, “reasonable” for diabetics and normal or non-diabetics?
Poor control= Greater than 7%
Reasonable= Below 7%
Normal or non-diabetics= Below 5.6%
What is the relationship between perio disease and hospital/ventilator acquired pneumonia?
- Oral pathogens may be directly inhaled into the lungs
- Oral microorganisms may release enzymes that may damage oral mucosal surfaces and lead to an increase in colonization by pathogenic bacteria
- Oral bacterial enzymes may reduce the protection of the pellicle
- Salivary cytokines may alter the respiratory epithelium, promoting respiratory infection
Relationship btw obesity and perio disease
- Higher prevalence of periodontitis among obese adults
- Obese individuals more likely to suffer from perio
- Obesity associated w/ perio pathogens
- Contributes to perio through chronic low-grade inflammtion
How are adverse pregnancy outcomes and perio related?
- Shared risk factors: tobacco use, alcohol use, obesity, diabetes
- DIRECT: Fetal exposure to perio pathogens may mean their immune system not able to recognize them as foreign invaders
- INDIRECT: Proinflammatory mediators reaching placenta or systemic spread of cytokines may cause premature rupture of membrane causing preterm labor, low birthweight, pre eclampsia
