Jackson Lectures 7 Flashcards
All the cards!!!!!!!
GAHHHHHHHHH
The role and importance of GH changes with age. GH is considered to have beneficial effects on cells and tissues early in life that then
diminish or even become detrimental later in life.
Anti-insulin effect of Gh
can block effects of insulin
Gh Affects aging, increases
cell replication in tumor cells
Decrease in GH over lifespan is adaptive because later in life it can be
detrimental
Excess production of GH results in
acromegaly and gigantism. This is typically caused by a pituitary tumor.
• Gigantism results from a
prepubertal onset of excess GH
• Acromegaly results from a
postpubertal onset of excess GH bones thicken, tongue will thicken, increase in glucose and fatty acids; decrease in insulin sensitivity
• Excess GH can produce a
diabetic-like condition and have oral consequences that include macroglossia, increased teeth spacing and tilting, enlarged salivary glands, and excess cementum.
• GH deficiency is relatively common, and often treated prepubertally with
exogenous GH.
• GH insensitivity or dwarfism is due to the absence of a
functional GH receptor. These individuals do not suffer from diabetes or cancer, but are often obese. The condition can be treated with exogenous IGF-1.
GH insensitivity or dwarfism can be treated with
exogenous IGF-1.
• Achondroplasia is reduced growth due to
constitutive activation of the fibroblast growth factor receptor.
FGF (fibroblast growth factor) normally inhibits or regulates
bone growth, and continued activation of its receptor results in abnormally impaired development of cartilage.
• Considerations for dental patients with GH insufficiency –
o delayed tooth shedding and replacement; decreased salivary function leading to increased incidence of periodontal disease and caries.
An adult taking GH will not get taller, but will
build muscle and bone beyond what is normal.
GH abuse can produce symptoms that resemble
acromegaly. This will also stimulate insulin insensitivity, at higher risk for cardiovascular disease as well
Diabetes results from a disruption in the normal function of
insulin.
Insulin is a peptide hormone produced in the
pancreas that normally regulates glucose transport into cells, particularly muscle, fat, and liver.
Insulin is an anabolic hormone that acts to store
nutrients.
Loss of insulin function has consequences, and can be fatal when it leads to
ketoacidosis
Insulin is released in response to an increase in
blood glucose or amino acids, and signals from the parasympathetic nervous system.
Insulin secretion is inhibited by the
sympathetic nervous system.
• Upregulation of glucose transporters,
increased glucose into cell
•
Not putting glucose into cells = leads to increase in
fluid in plasma and BP
• This means that kidney tries to get rid of fluid
• Glucose present in urine
Ghrelin regulates
hunger, regulates growth hormone, more of a connection of digestive system and brain to regulate digestive function
Type I diabetes is an autoimmune disorder in which
pancreatic beta cells are destroyed resulting in reduced production of insulin. Onset is usually early in life, and it can be managed with insulin supplementation, dietary control, and glucose monitoring. (5% of people w/diab).
(glycemic index is how quickly a certain food causes a spike in blood glucose)
Type II diabetes is a combination of
insulin resistance and insulin deficiency. The onset is usually later in life, and it can be managed with dietary and lifestyle controls. Treatment can also include insulin sensitizers and insulin supplements.
Type II descriptors:
- Due to loss of insulin or loss of receptor
- Or combo of the two
- More and more supplementation, or increase in expression of insulin receptors
- ~2 million new cases/year influenced by lifestyle
Common symptoms of diabetes relate to increases in
circulating glucose elevated fasting glucose concentrations polyuria fatigue blurred vision
Chronic hyperglycemia leads to several common complications of diabetes, primarily due to the
vascular effects related to increased plasma glucose
- kidney failure
- vascular disease
- blindness
- skin & mucosal infections
- periodontal disease
Dental patient considerations
vascular disease affects teeth
dehydration can reduce salivary flow
increased risk of periodontal disease with a diminished immune response and ability to repair tissue
For Type I diabetics
be familiar with history
snacks and/or insulin during prolonged procedures might be necessary
For Type II diabetics
Emphasize importance of maintaining glycemic control to avoid a cycle of
tooth pain → eating foods with high glycemic index (because they don’t hurt as bad)→ aggravation of diabetic condition → tooth pain due to complications involving oral health
frequently have cardiovascular & renal disease complications as well
Crunchy fruits and vegetables are not as appealing because mouth hurts