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ICS1 > ICS Autumn midterm: Diabetes w/perio + perio/systemic rlxn > Flashcards

ICS Autumn midterm: Diabetes w/perio + perio/systemic rlxn Flashcards

1
Q

what are the signs of diabetes

A 
thirst
urination
weight loss
poor wound healing
excessive hunger
blurred vision
tingling or numbness of hands/feet
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2
Q

what are oral manifestations of poorly controlled diabetes

A
  • oral candidiasis
  • xerostomia
  • dental caries
  • burning mouth syndrome
  • gingivitis and periodontitis
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3
Q

how can perio therapy help diabetes control

A
  • decrease chronic oral gum infections
  • can lower Hba1c
  • removes pathogens that can react w glucose in uncontrolled diabetes
  • improves glycemic control
  • improved glucose metabolism

(biofilm with gram neg bacteria initiates immune response- can have adverse impact on insulin)

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4
Q

what is normal/pre diabetes and diabetes for hba1c

A

normal; less than 5.7%

prediabetes: 5.7-6.4%
diabetes: more than 6.5%

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5
Q

what are the types of insulin? what other oral medications do diabetes patients take

A

insulin:
- rapid acting; novolog, humalog, apidra, intermediate actin
- long acting-lantus (up to 24 hours), tresiba (up to 42 hours)

metformin and glipizide (sulfonylureas)

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6
Q

what are 2 names of continuous glucose monitors

A

dexcom 6 and libre

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7
Q

what are the instructions for a diabetic patient before treatment

A
  • eat normal meal before appointment and take medicine
  • bring medication and some glucose (juice, candy etc) with them
  • have early morning appointments
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8
Q

what should you ask a diabetic patient

A
  • confirm testing of glucose that day- what it was and when was it taken
  • confirm they had breakfast, what did they eat
  • have a source of glucose in the office JUST IN CASE
  • quickest source is orange juice 4 oz

suggest a smoothie after treatment

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9
Q

whats the most common complication of diabetes in dental offices

A

HYPOGLYCEMIA

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10
Q

what are the diabetes risk factors to share w/patients

A
  • overweight
  • over 45
  • patient/sib w type 2
  • activity less than 3x a week
  • gestation diabetes or having a baby over 9 pounds
  • african american, hispanic, american indian, alaska native, pacific islanders and asian american
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11
Q

whats the health belief model

A
  • perceived susceptibility (what if. i dont)
  • perceived severity (whats the consequence)
  • perceived barriers
  • cues to action (reminders)
  • self efficacy (habits to enhance)
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12
Q

what is a dental health coordinator

A

CDHC

  • bring better oral health to underserved communities. role:
  • provide care coordination
  • provide community based prevention
  • patient navigation, connect to a dentist
  • oral health education
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13
Q

what are CHCs trained to do

A
  • work in clinics, schools, private practice and public health settings
  • collect info to assist dentists in triaging patients
  • address social environmental and health literacy issues
  • provide dental health education, help people enhance oral health
  • provide limited clinical services: screenings, fluoride treatments, placement of sealants, x rays
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14
Q

what is the national diabetes education program

A

nDEP

  • provides free evidence based and culturally appropriate resources to help community based organizations address diabetes in communities.
  • resources can be used by community health workers, diabetes educatiors and health care providers
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15
Q

what health issues are related to perio health

A
  • respiratory infections
  • severe osteopenia (bone mass loss)
  • preterm/low birthweight babies
  • stroke
  • heart disease
  • uncontrolled diabetes
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16
Q

what is the connection between periodo and overall health

A

-perio inflammation- increases level of inflammatory mediators in systemic corculation. periodontal pathogens enter bloodstream and travel to distant parts of body

17
Q

describe what release is from microbials in perio disease, host immuno inflammatory response, and results

A

microbial (gram neg mostly) release antigens, lipopolysaccharides (endotoxin produced by g-ve bacteria)and other virulence factors (protease released by p gingivalis)

host immune response releases antibodies back at antigens. it also releases cytokines and prostanoids, and matrix metalloproteinases (MMP) which result in connective tissue and bone metabolism. (MMP - proteolytic enzymes that destroy matrix molecules like collagen , gelatin and elastin) also osteoclast activation

BTW host immune response and connective tissue/bone metabolism are impacted by environment and genetic risk factors!!!!!!

18
Q

what are systemic effects of periodontitis

A
  • cardiovascular disease
  • preterm birth
  • diabetes mellitus
  • respiratory disease
  • alzheimers
19
Q

what is artherosclerosis

A

progressive disease-> loss of elasticity of medium and large arteries. studies support that infections/inflammation are associated with artherogenesis and thromboembolic events
-primary risk factors for artherosclerosis: BP, high cholesterol, smoking obesity

20
Q

how does perio disease associate with cardiovascular

A

periodontitis-> bacteremia (inblood) and systemic inflammatory response. -> c reative protein/acute phase response, fibrinogen -> these proteins trigger artherogenesis, plaque in arteries

the bacteremia/bacteria themselves are also responsible for artherogenesis!!

21
Q

how do antibody titers prove the perio/cardiovasc relationship

A

-elevated antibody titers to certain perio pathogens linked to increased prevalence of cardiovascular disease, artherosclerosis in carotid and increased risk for cardiac events in 10 year followup

22
Q

what systemic/inflammatory markers have they found related to periodontal disease?

A

-creative protein levels have strong linear relationship with incidecne of CV events.
patients with periodontitis had greater serum elevations in systemic markers of inflammation (CRP, IL6, fibrinogen) than healthy ppl

23
Q

how does treating periodontal disease impact systemic

A

decreased systemic nflammation (CRP and TNF alpha), improvement of endothelial function

24
Q

how common is pregnancy gingivitis

A

30-75% of pregnant women!!!!

-resolves after preg

25
Q

where do pregnancy tumors occur

A

interdental papillae of maxillary anteriors is the most common. grow fast and bleed easily! hyperplastic and nodular

-resolves after preg

26
Q

what etiology factors contribute to pregnancy tumors

A
  • subgingival plaque and calculus (mostly)
  • hyper immuno responseveness maternal
  • hormone concentrations and fluctuations
27
Q

how does periodontitis influence pregnancy outcomes

A
  • preterm birth (before 9 months)
  • low birth weight (less than 5 pounds)

(reasearch shows perio treatment decreased chances of preterm birth)

28
Q

what may be the pathway for why perio disease causes preterm brith

A

perio disease->inflammatory response-> mediators like PGE2, TNF -> uterine contraction and cervical dilation

-inflammatory mediators go into fetal/placental space too.. also may weaken placenta and cause low birth weight

29
Q

how should perio be treated with pregnancy for prevention

A

-preventative oral care should be given early in pregnancy. if exam indicates a need for periodontal therapy, should be scheduled early in second trimester. presence of acute infection, abscess, or other disseminating sources of sepsis may warrant prompt intervention irrespective of the stage of pregnancy

30
Q

how does hyperglycemia impact perio disease

A

glycation; protein/fat and sugar -> advanced glycation end product (AGE) (hyperglycemia increases AGE) –> accumulation of AGE influences perio destruction -> 1. alters collagen metabolism leading to unehalthy collagen breakdown and poor healing. 2. alters immuno inflammatory response; AGE+ RAGE (receptor) increases proinflammatory cytokines

btw obesity and diabetes are linked and adipokines is another inflamm from obestiy.

31
Q

how does perio disease impact diabetes?

A

-perio is chronic inflammation, increasing pro inflammatory cytokines causing a dysregulated inflammatory environemnt, increasing insulin resistance. chronic inflammation increases insulin resistance so its difficult for sugar to enter tissues, increases blood sugar.

32
Q

how much does diabetes increase perio disease risk? what hba1c level increases perio disease

A

3x

above9% a1c, higher prevalence of severe periodontitis

33
Q

how much can perio disease control impact hbaqc

A

reduction of .4% can occur after periodontal therapy

34
Q

how does periodontal disease influence alzheimers development

A
  • periodontal microorganisms and host response cause an increase in proinflammatory cytokines. these molecules compromise blood brain barrier entering cerebral regions, leading to activation of microglial cells (macrophages in CNS) leading to neuronal damage.
  • evidence suggests presence of inflammation in cns results in cognitive impairment as seen in alzheimers
35
Q

what pathogen related alzheimers and perio disease specficially

A

porphyromonas gingivalis - key pathogen in chronic periodontitis- identified in brain of alzheimers disease patients! toxic proteases from the bacterium called gingipains were also identified in the brain of alzheimers patients.

36
Q

what is MMP

A

host immune response releases and matrix metalloproteinases (MMP) (in addition to antibodies ,cytokines and prostanoids,) which result in connective tissue and bo`ne metabolism. (MMP - proteolytic enzymes that destroy matrix molecules like colalso osteoclast activation

btw this is in response to microbials releasing antigens, lipopolysaccharides (endotoxin produced by g-ve bacteria)and other virulence factors (protease released by p gingivalis)

37
Q

whats AGE and what does it do? what increases it?

A

glycation; protein/fat and sugar -> advanced glycation end product (AGE) (hyperglycemia increases AGE) –> accumulation of AGE influences perio destruction -> 1. alters collagen metabolism leading to unehalthy collagen breakdown and poor healing. 2. alters immuno inflammatory response; AGE+ RAGE (receptor) increases proinflammatory cytokines

ICS1 (23 decks)

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