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Applied Biochemistry > Clinical Correlation: Dentistry and Diabetes > Flashcards

Clinical Correlation: Dentistry and Diabetes Flashcards

1
Q

healthy gingiva

A

pink

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2
Q

gingivitis

A

inflammation confined in the gingival unit

no supporting bone loss and attachment loss

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3
Q

periodontitis

A

inflammation not only affects the tissue, but also the surrounding bone
supporting bone loss and attachment loss

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4
Q

peri-implant mucositis

A

plaque and calculous build up

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5
Q

per-implantitis

A

supporting bone around the implant is affected

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6
Q

how many Americans suffer from gum disease?

A
  1. 2% have periodontitis

64. 7 million adults 30 years and older

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7
Q

70% of adult took loss is contributed to

A

periodontal disease

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8
Q

periodontal disease can effect systemic health, such as (4)

A

diabetes
adverse pregnancy outcomes
respiratory diseases
cardiovascular disease and stroke

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9
Q

how many new cases of diabetes are there per year?

A

1.4 million

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10
Q

diabetes increases with

A

age

90% over 45 y/o

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11
Q

prevalence of type 1 diabetes vs type 2

A

5-10%

90-95%

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12
Q

tendency toward ketosis and coma in type 1 vs type 2

A

type 1: marked tendency toward ketosis and coma

type 2: development of ketosis and coma is uncommon

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13
Q

random blood sugar test

diabetes:

A

200 mg/dl or above

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14
Q

glucose tolerance test
diabetes:
prediabetes:
normal:

A

diabetes: 200+ mg/dl
prediabetes: 140-199 mg/dl
normal: <140 mg/dl

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15
Q

fasting blood sugar test
diabetes:
prediabetes:
normal:

A

diabetes: 126+ mg/dl
prediabetes: 100-125 mg/dl
normal: <99 mg/dl

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16
Q

what complication can hyperglycemia lead to? (3)

A

macro/micro antipathy
neuropathy
increased risk of infections

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17
Q

what are the oral impacts of uncontrolled diabetes? (2)

A

recession and tooth loss

papilla is swollen/enlarged

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18
Q

diabetes is a risk factor for

A

periodontal disease

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19
Q

diabetes is a risk factor for periodontal disease which can lead to… (3)

A

increased prevalence and severity of attachment loss
multiple periodontal abscess
impaired wound healing

20
Q

type 1 diabetes was associated with a 5 fold increased prevalence of — in teenagers

A

periodontitis

21
Q

type 2 diabetes patients are three times more likely to develop

A

periodontal diseases

22
Q

how many diabetics have severe periodontitis?

A

1 in 3

23
Q

oral microbial flora
type 1:
type 2:

A

type 1: capnoctyophaga sp

type 2: porphyromonas gingivitis (similar to non-diabetic patients)

24
Q

how does diabetes-periodontal disease alter host defense mechanisms? (2)

A

decreased PMN function (decreased chemotaxis and phagocytosis)
increased glucose in GCF promotes increased AGE

25
Q

what are the vascular changes in diabetes-periodontal disease? (2)

A

increased thickness of basement membrane and vessel walls (due to AGEs accumulation)
leading to decreased O2 diffusion and elimination of wastes

26
Q

collagen breakdown in diabetes-periodontal disease patients (3)

A

altered collagen metabolism (stimulation of collagenase activity)
limited production of growth factors
impaired wound healing and increased severity of periodontitis

27
Q

how does diabetes lead to periodontal disease?

A

those with diabetes have increased cytokine production and altered apoptosis, along with AGE/RAGE interaction and decreased PMN function. the factors lead to dysregulated inflammatory response with increased pro inflammatory cytokines and collagenases. this leads to altered oral microbiota and eventual periodontal disease

28
Q

are diabetes and periodontal disease a two way relationship?

A

yes

29
Q

poor glycemic control and insulin resistance in patients with diabetes may be a result of cytokines secreted due to

A

chronic inflammation

30
Q

patients with type 2 diabetes who had severe periodontitis have – times more risk of worsening glycemic control

A

6x

31
Q

how does periodontal disease affect diabetes?

A

moderate to severe periodontitis is associated with an increased risk for the development of diabetes

32
Q

severe periodontitis affects — levels

A

HbA1c

33
Q

periodontitis also affects

A

glycemic control

34
Q

how does periodontitis affect glycemic control?

A

gram-infection
insulin resistance
poor glycemic control

35
Q

how does periodontal treatment affect glycemic control?

A

periodontal treatment
improved insulin sensitivity
improved glycemic control

36
Q

evidence showed significant improvement of — control after treatment

A

glycemic

37
Q

after scaling and root planning, there was an average decrease in — values about 0.4%

A

HbA1c

38
Q

does antibiotic therapy have any additional benefits?

A

no

39
Q

what is the protocol for treatment for patients with diabetes-periodontal disease? (8)

A 
prescription has been taken
morning appointments 
morning vitals
may need t alter post-op insulin doses 
short appointments 
limited amount of epinephrine 
diet control
frequent recall and reinforcement of OH
40
Q

how to achieve periodontal health, goals for treatment (4)

A

medication and diet instruction
impact of periodontal infection
educate diabetic patients about the importance of their personal oral hygiene as well as regular professional care
actively treat periodontal disease

41
Q

can diabetic patients receive dental implants?

A

yes, if they have good metabolic glucose control

42
Q

hyperglycemia has a negative effect on

A

bone metabolism

43
Q

diabetic osteopathy (3)

A

reduce bone mineral density and bone mechanical properties
increase risk fracture
impair endochondral bone formation, intramembranous bone formation, microarchitectual quality

44
Q

what are the survival rates of dental implants in diabetic patients with good/fair metabolic control?

A

85-100%

45
Q

strict — control before and after dental implant treatment is highly recommended

A

glycemic

46
Q

what if the patient has uncontrolled diabetes>

A

no dental implants until it is controlled (<7% is ideal, <8% is acceptable)

47
Q

what is a good alternative solution to those with uncontrolled diabetes? (2)

A

removable dentures

bridges as fixed prosthesis

Applied Biochemistry (52 decks)

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