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CSA periodontology > CSA diabetes and perio disease > Flashcards

CSA diabetes and perio disease Flashcards

1
Q

What is diabetes?

A

• metabolic disorders shown by chronic hyperglycaemia (high blood sugar levels) due to insulin deficiency or impaired use of insulin (insulin resistance).

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2
Q

How to diagnose diabetes ?

A
  • venous plasma glucose greater than or equal to 11.1 mmol/litre, or:
  • fasting venous plasma glucose concentration greater than/ equal to 7.0 mmol/litre
  • Unexplained weight loss
  • Polyuria> excessive urine
  • Polydipsia> excessive drinking (of fluids)
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3
Q

What is used for diabetes diagnosis?

A
  • Haemoglobin A1c
  • Glc. binds to (Hb) during life of RBC, 8-12 weeks
  • Measure how much hb glycated
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4
Q

What is type 1 diabetes?

A

• Associated w/ destruction of Beta cells in pancreas
o autoimmune disease
• Genetic predisposition
• Abrupt onset, most often in children & teens

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5
Q

How is diabetes a autoimmune disease?

A

o Islet cell antibodies antibodies attach to & cause destruction of own body cells

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6
Q

What is type 2 diabetes ?

A
  • Defect in beta cell & insulin resistance
  • Insulin produced, but not used very well
  • mid life
  • Genetic influences
  • Inc. risk of Typ.2 if obese, inactive lifestyle, close
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7
Q

What are risk factors of type 2 diabetes?

A

obese, inactive lifestyle, close relatives with DM, Asian/afro Caribbean

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8
Q

How do we manage type 1 ?

A
  • insulin injections/insulin pump

* Balance carb intake & insulin

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9
Q

How do insulin injections react in body?

A
  • quickly break down carbs ingested

- can act over long time to keep constant level of insulin

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10
Q

How do we manage type 2?

A
  • Diet control
  • Oral hypoglycaemic drugs
  • exercise
  • 25% of patient may require insulin injections
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11
Q

What is maturity onset diabetes in the young?

A

usually <25 but age range of 10-45
• by mutation in single gene, has different forms
o Difficult to distinguish from type 1 & 2

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12
Q

What is gestational diabetes? (3,5% of pregnancies)

A

• 2nd or 3rd trimester due to maternal insulin insufficiency and resistance due to pancreatic beta-cell dysfunction

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13
Q

What is home blood monitoring ?

A

• simple finger prick >blood dropped onto strip >direct reading in seconds

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14
Q

What is ideal blood glucose level?

A
  • 4-7mmol/litre
  • Under 4mmol/l > risk of hypoglycaemia
  • Over 10mmol/l > Renal threshold surpassed & blood spills into urine
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15
Q

What is NICE HbA1c threshold is ?

A

o <58mmol/mol (7.5%)

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16
Q

What are microvascular implications?

A

o Cardiovascular disease
o Peripheral vascular disease >Amputations needed amputations/week)
o Cerebrovascular diseases & stroke occurs

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17
Q

What are microvascular diseases?

A

o Retinopathy >blindness (blood vessels at back of eye)
o Nephropathy >renal failure
o Neuropathy >Nerve damage, very painful

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18
Q

What are perio findings with type 1 ?

A

poorly controlled type 1lost more attachment and bone:
o Incr. risk of perio disease with older patients
o Incr. in severity dependent on diabetes duration

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19
Q

What is a feature in children with POORLY CONTROLLED type 1 DM?

A
  • associated gingivitis

* Inflammatory response of gingiva to plaque was worsened

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20
Q

What do patients with poorly controlled DM?

A

increased inflammation and CAL

o First stages of incipient chronic periodontitis (CAL is irreversible)

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21
Q

Why do perio infections occur ?

A

periodontal host response
o Bacteraemia
o Inflammatory mediators (TNF-Alpha & IL-6)
o Immune responses

22
Q

What do inflammatory mediators affect?

A

liver & cause production of C reactive protein

• C reactive protein has direct effect on CHD & CVD

23
Q

What are risk factors of perio disease?

A
  • Smoking/Stress
  • Genetics
  • Diet & exercise
  • Markers/ mediators are involved
  • Lipids  Adiponectin (links in with obesity)
  • All show an increased risk in CHD & CHV
24
Q

What are inflammatory markerss?

A

CRP
IL6
TNF
Microalbuminuria

25
Q

What is systemic inflammation ?

A

• high levels of acute phase proteins ( C reactive protein) & pro-inflammatory cytokines

26
Q

What happens with systemic inflammation and markers?

A

o In obesity IL-6 stimulates TNF-Alpha >May result in insulin resistance
o Increase in IL-1Beta may lead to pancreatic Beta cell production

27
Q

What are associated with perio ?

A

• Smoking & Subgingival biofilm :
o Dysregulated inflammatory responses
o Increased proinflammatory cytokines & MMP’s

28
Q

Link between obesity and perio ?

A

• Adipocyte production of proinflammatory cytokines (adipokines) may link them

29
Q

What is AGES ( Advanced glycation end products)

A

• high lev. of glucose, collagen in perio. tissues undergoes non-enzymatic glycation & forms AGEs

30
Q

What do AGEs do ?

A 
o Incr. collagen cross linking
o Incr. cytokine production
o These ^ Linked to
 Microvascular complications
 Atherosclerosis
 Decreased production of bone matrix
31
Q

What are RAGEs

A

receptors for AGEs )

32
Q

What does interaction between RAGE and AGE lead to ?

A

disturb vascular & inflammatory cell function, leads to:
o Microvascular & macrovascular diabetes complications
o Accelerated perio destruction

33
Q

What is Impaired polymorphonuclear leukocyte function in poor controlled DM:

A

o red. in PMN function > Leads to Inc. in periodontitis
o Enhanced respiratory burst (release of reactive oxidative species to kill bacteria)
o Delayed apoptosis

34
Q

Why can wound healing be poor in DM patients?

A

o Decr. in collagen present due to increased activity of collagenases
o Inhib. of attach. & spreading of fibroblasts in wound
o Altered late infl.response

35
Q

What is microbiology in DM?

A
  • P. Gingivalis & P. Intermedia may be affected in DM patients
  • Capnocytophaga spp. total mean count higher in DM patients with periodontitis
36
Q

Can having perio disease affect DM patients?

A

o control of diabetes
o Induce complications associated with diabetes
o incidence of diabetes

37
Q

What do systematic reviews show about perio disease?

A

o control of diabetes
o Induce complications associated with diabetes
o incidence of diabetes

38
Q

What is the Effect of non-surgical periodontal treatment on diabetes control

A
  • P. Gingivalis can invade tissues & activate macrophages & monocytes, leads to:
  • RSD on its own may not be enough to eliminate P. Gingivalis (as it invades the periodontal tissues)  Mechanical treatment may/may not be enough to affect periodontal hygiene in diabetic patients
39
Q

What does combining RSD with an antibiotic do ?

A

o P. Gingivalis reduced to non-detectable levels

o Reduction of glycated Hb by 1%

40
Q

What does P. Gingivalis invading tissues & activating macrophages & monocytes, lead to:

A

o Complications of diabetes control

o Increase micro/macrovascular complications

41
Q

What is the effect of perio treatment on diabetes control do ?

A

• After non-surgical , was improvement in HbA1c

42
Q

What happens if we are successful in reducing HbA1c ?

A

o Deaths related to diabetes reduce
o Myocardial infarction risk reduced
o Microvascular complications reduced

43
Q

What is perio management of patients with diabetes?

A

o Initial therapy >GDP liaise with doctor/diabetes care team
o Corrective therapy >Adjunctive systemic antibiotics if poor to initial therapy
o Supportive therapy  GDP recall patient more if diabetes not controlled

44
Q

What is management of hypoglycaemia

A 
•hypo attack may be:
o Pale/Shaky/Clammy/
o Blood glc level less than 4mmol/L
• 3-6 glucose tablets 
•	OR a glucose drink given (Lucozade 50-100ml)
45
Q

What is management of severe hypo ?

A

• Injection of glucagon
o further carbs given to them when gain consciousness
• If don’t come around 999 (no recovery within 10 mins)
• If remain unconscious glucose administered IV

46
Q

What is hypergylcaemia ?

A

• Transient hyperglycaemia >10mmol/l after large meals

47
Q

What can prolonged hyperglycaemia lead to ?

A

can develop ketoacidosis:
o Caused by relative or absolute insulin deficiency
 Lack of glucose present in cells
 Ketones produced to act as fuel

48
Q

What can poorly controlled DM lead to ?

A
  • Decreased salivary flow
  • Burning mouth
  • Enlargement of the parotid
  • Glucose found in GCF
  • Snacking on food leads to caries
49
Q

What is supportive therapy >

A

• After treatment , patient has 3 monthly visits ,maintains:
o Improved periodontal status & oral hygiene
o Compliance/motivation
o Smoking cessation
o Improved diabetes control & decreased HbA1c

50
Q

If you have periodontitis?

A

they need therapy (IT, CT, SPT)
o Infections managed
o Dental rehab to take place in areas of tooth loss
o Oral complications managed

51
Q

If you don’t have periodontitis?

A

make it known they are at risk
o Prevent & monitor from periodontitis
o Do HbA1c either chairside to refer to GDP

CSA periodontology (5 decks)

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