medical history

Question 1

What is diabetes?

Answer 1

Systemic disease with increased blood glucose levels due to absence or decreased level of insulin

Question 2

How does diabetes contribute to the periodontal condition?

Answer 2

-periodontitis is the 6th complication of DM
-greater loss of attachment, greater bone loss, increased BOP, increased mobility

Question 3

incidence of perio in DM patients

Answer 3

Nelson 1990: Pima Indian study
-incidence of perio is 2.6 times higher in DM

Question 4

risk of perio in DM patients

Answer 4

Emrich 1991
-DM increases the risk of perio disease by 3 times, also had more calculus and tooth loss

Question 5

Hydrochlorothiazide MOA

Answer 5

directly inhibits the Na-Cl cotransporter in the distal convoluted tubules in the kidney, which prevents sodium from being reabsorbed, causing an increased excretion of sodium and water

Question 6

Quinapril MOA

Answer 6

ACE inhibitor; prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor

Question 7

Metformin MOA

Answer 7

decreases production of glucose in liver, decreases intestinal absorption of glucose and improves insulin sensitivity

Question 8

Gliclazide MOA

Answer 8

Stimulates insulin release from the pancreatic beta cells; reduces glucose output from the liver; increases insulin sensitivity

Question 9

Rosuvastatin MOA

Answer 9

HMG-CoA reductase inhibitor, the rate-limiting enzyme in cholesterol synthesis

Question 10

Amitriptyline MOA

Answer 10

TCA, Increases the synaptic concentration of serotonin and/or norepinephrine in the central nervous system by inhibition of their reuptake by the presynaptic neuronal membrane pump.

Question 11

Describe possible mechanisms for the effects of diabetes on periodontitis.

Answer 11

1. Impairment of neutrophil chemotaxis, recruitment, and function
2. Increased levels of inflammatory mediators and host-modulatory agents, leading to a proinflammatory state with increased vascular permeability
3. Increase in AGEs and activation of RAGE
   1) increase in adhesion molecules and cytokines
   2) thicker blood vessel walls (which reduces absorption of nutrients and oxygen)
   3) inhibits fibroblast viability (which decreases formation of type 1 and 3 collagen, and impairs wound healing.
4. Decreased collagen formation and increased collagenase activity

Question 12

What are the expected treatment outcomes for DM patients?

Answer 12

• Christgau: DM have equal response to perio tx
  -well controlled DM have similar response as non diabetics
  Kowall 2015:
  -prediabetes or well controlled DM is NOT at additional risk for perio
  Janket 2005
  -NSPT can reduce HbA1C (0.3-0.4%) but it may not be significant or stable overtime

Question 13

Do u need to rx antibioitcs for diabetes after NSPT

Answer 13

-systemic antibiotics after NSPT: (Souto 2018) 0.14mm reduction in PD, no change in CAL gain. Best results were amox with metro
-Wu: systemic antibiotics had a short term improvement in PD but not long term

Question 14

Do u need to rx antibioitcs for diabetes after exo

Answer 14

Gazal 2019:
-tooth extraction at a blood glucose level of 240 mg/dl (13.3 mmol/L) will lead to severe infection and delay socket healing

Question 15

normal BP range

Answer 15

<120 / <80

Question 16

elevated BP

Answer 16

120-129 / <80

Question 17

stage 1 hypertension

Answer 17

130-139 / 80-89

Question 18

stage 2 hypertension

Answer 18

140+ / 90+

Question 19

hypertensive crisis

Answer 19

180+ / 120+