Diabetes and periodontitis Flashcards
How many Americans had diabetes in
2021?
38.4 million Americans (11.6% of the population).
Of the 38.4 million adults with diabetes, how many were diagnosed vs. undiagnosed?
29.7 million were diagnosed, and 8.7 million were undiagnosed.
How many Americans are diagnosed with diabetes each year?
1.2 million.
What is diabetes mellitus?
A metabolic disorder characterized by chronic hyperglycemia and altered lipid and protein metabolism.
What causes diabetes mellitus?
Diminished insulin production, impaired insulin action, or a combination of both.
Why does blood glucose remain high in diabetes?
The inability of glucose to be transported from the bloodstream into tissues.
Why is sugar found in the urine of diabetic patients?
Excess blood glucose spills into the urine due to high blood sugar levels.
What are some other types of Diabetes?
Gestational Diabetes, Pancreatic disease, Immune-related, Drug-induced, etc.
What is the diagnostic criteria for diabetes using Fasting Plasma Glucose?
≥126 mg/dL after an 8-hour fast.
What FPG level is considered prediabetes?
100-125 mg/dL.
What does the HbA1c test measure?
Average blood glucose level over the past 3 months.
What HbA1c level indicates diabetes?
≥6.5%.
What HbA1c range indicates prediabetes?
5.7% - 6.4%.
What HbA1c level indicates uncontrolled diabetes?
> 7%.
What is the cause of type 1 diabetes?
Autoimmune destruction of beta cells.
What is the main cause of type 2 diabetes?
Insulin resistance or low insulin response to glucose.
What blood glucose level defines hypoglycemia and what are the symptoms?
<70 mg/dL.
Dizziness, fatigue, and cognitive impairment.
Symptoms of diabetes?
Always hungry, thirsty
Weakness, numbness in hands/feet
Weight loss, nausea
Frequent urination
Blurry vision
How many Americans over 50 have at least one chronic disease?
71 million, with numbers expected to double by 2050.
What two diseases are highly prevalent and often coexist?
Diabetes and periodontitis.
What was considered sever periodontitis in the Genco 2013 (Perio 2000) study?
Radiographic bone loss >50%
Attachment loss >6mm for at least one of six index teeth
What were the key findings in the Genco 2013 (Perio 2000) study?
Severe periodontitis at baseline increased the risk of poor glycemic control (HbA1c = 9%)
2.81 times more (attachment loss)
3.43 times more(alveolar bone loss)
What was the conclusion of the Genco 2013 (Perio 2000) study?
Type 2 diabetes increases the risk of destructive periodontal disease by ~3-fold, independent of age, sex, and oral hygiene.
T or F: Periodontitis should be considered a complication of diabetes.
True
Why is periodontitis and diabetes considered a bidirectional relationship?
Diabetes increases the risk of periodontitis by threefold.
Periodontitis worsens glycemic control which further complicates diabetic management
How does diabetes affect the oral microbiome?
It increases the pathogenicity of the oral microbiome.
Which periodontal pathogen is found in higher levels in type 2 diabetics with periodontitis?
Porphyromonas gingivalis (P. gingivalis).
How does diabetes contribute to increased susceptibility to periodontal disease?
Through changes in salivary flow (flux) and concentration, including alterations in gingival crevicular fluid (GCF).
What happens when elevated glucose reacts with plasma proteins?
It forms Advanced Glycation End Products (AGEs).
How do AGEs contribute to diabetic complications?
Through pro-inflammatory and pro-oxidant effects.
What are the effects of the AGE-RAGE axis on vascular integrity?
Alters the inflammatory response and decreases vascular stability.
How does diabetes affect vascular pathology?
It leads to apoptosis (cell death), decreased capillary growth, and reduced vessel proliferation.
How does a hyperglycemic state affect wound healing?
It impairs fibroblast function, slowing tissue repair.
How do Advanced Glycation End Products (AGEs) affect collagen?
They reduce collagen stability, increasing the risk of infection.
How does impaired collagen metabolism impact wound healing?
It leads to inflammatory-induced tissue destruction.
How does hyperglycemia affect polymorphonuclear leukocyte (PMN) function?
It impairs PMN function, reducing the body’s ability to fight infections.
How does diabetes affect monocyte cytokine production?
It increases production of IL-1β and TNF-α, leading to heightened inflammation.
How does an altered host response contribute to complications in diabetes?
It leads to inflammatory-induced tissue destruction and increased infection risk.
What is the common link between periodontal disease and diabetes mellitus?
Inflammation.
How does TNF-α affect insulin sensitivity?
It impairs insulin receptor signaling and directly induces insulin resistance.
How does IL-6 contribute to insulin resistance?
It promotes TNF-α production and stimulates hepatic C-reactive protein (CRP) production.
How do these cytokine interactions affect glycemic control in diabetic patients?
They further impair glycemic control by increasing inflammation and insulin resistance.
T or F: Periodontal treatment will cause a reduction in HbA1c levels and improve diabetes controls
True
How does obesity contribute to systemic inflammation?
It creates a chronic inflammatory state, increasing insulin resistance (IR) and disease risk.
What chronic condition is associated with both type 2 diabetes (T2D) and periodontitis?
Metabolic syndrome.
What are the key conditions of metabolic syndrome?
High blood pressure
High blood sugar
High triglycerides
Low HDL cholesterol
Excess body fat
What proinflammatory substances are released by adipose tissue?
Adipokines (e.g., leptin, resistin, adiponectin) and cytokines (IL-6, TNF-α).
How does a higher BMI affect periodontal disease risk?
Increased BMI → More inflammatory mediators → Greater periodontal disease risk.
How does obesity lead to insulin resistance?
Obesity → Increased TNF-α → Insulin Resistance (IR)
TNF-α inhibits insulin signaling.
Free fatty acids trigger β-cell apoptosis, worsening Insulin resistance.
How does insulin resistance progress to diabetes and periodontal disease?
Insulin resistance → Diabetes Mellitus (hyperinflammatory state).
Diabetes → Periodontal Infections (exaggerated immune response).
According to the International Diabetes Federation & European Federation of Periodontology, how much does periodontal therapy reduce HbA1c?
By 0.27-0.48% after 3 months.
What is the effect of periodontal therapy on glycemic control?
Clinical studies show improved glycemic control after therapy.
How does periodontal therapy affect insulin sensitivity?
It may help restore insulin sensitivity.
How does poorly controlled type 2 diabetes (HbA1c >8.1%) affect implant therapy?
It decreases implant stability and requires a longer healing time.
What are the implant survival rates in diabetic patients?
98.6% at 1 year
96.6% at 2 years
Increased Inflammatory Responses
causes:
Advanced glycation end-products (AGEs)
Increased AGE receptor expression
Activation of protein kinase C isoforms
Increased reactive oxygen species
Decreased Wound Healing causes:
Ischemia (reduced blood flow)
Neuropathy
Trauma
Poor cellular chemotaxis (impaired immune cell movement)
Decreased Osseointegration causes:
Impaired osteoblast function (bone-forming cells)
Poor matrix production
Increased Peri-implant Disease Progression causes:
Increased AGEs
Exacerbated and persistent inflammation
