periodontal disease- diabetes and pregnancy Flashcards
explain the relationship between periodontal disease and diabetes?
bi-directional relationship meaning those with poorly controlled periodontal disease will find it more difficult to control blood glucose levels and vice versa
what is the difference between type 1 and type 2 diabetes
type 1- insulin dependent- body doesn’t produce insulin
type 2- insulin independent- body doesn’t make enough and becomes insulin resistant
what does diabetes cause?
chronic hyperglycaemia
what would indicate a patient has undiagnosed diabetes in dentistry?
- recurrent abscesses
- exaggerated periodontal disease
- poor tx outcome
what does uncontrolled diabetes do to periodontium?
increase in advanced glycation end products causing:
hyper responsive monocyte phenotype- release damaging amounts of pro-inflammatory cytokines IL1 and TNF
- increased vasculature, vasodilation and leakiness
- oxidative stress and periodontal tissue damage
what does periodontal disease do to diabetes?
- increase in inflammatory response= vasodilation, increase vascularity and leakiness of blood vessels
- meaning bacteria and inflammatory cytokines leak into blood vessels causing systemic inflammation- worsening systemic conditions and increasing insulin resistance.
what else does diabetes cause?
- reduced neutrophil function, adherance, chemotaxis- failure to phagocytose microbes
- increase collagenases and breakdown of collagen
- reduction in fibroblasts needed for healing and formation of gingival collagen
- poor wound healing
how can periodontal disease affect CVD?
- hyper responsive monocytes- release excessive cytokines into blood stream due to increase vascularity and leakiness- causing systemic inflammation and worsening of systemic diseases
- periopathogens such as p gingivalis have surface proteins that trigger thrombosis of platelets which can lead to MI/stroke if bacteria enters blood stream
- periopathogens such as p.gingivalis can invade endothelial cells in vessel lining triggering immune response causing damage to tissue and contribute to plaque formation in vessels- atherosclerosis
what is pregnancy gingivitis?
increased progesterone levels during pregnancy leads to increase sensitivity to plaque
why is their an increase sensitivity to plaque?
- increases vascularity and vasodilation
- reduces keratinisation of gingivae- reduced barrier to bacteria
if patient has good OH will pregnancy gingivitis returns to normal ?
yes after birth
if more sever pregnancy gingivitis what should you do?
- OHI
- Debridement
what can periodontal disease during pregnancy increase the chances of?
- low birth weight and early labour due to stimulated prostaglandins due to increased inflammatory response
- miscarriage
- high blood pressure
what anaesthetic should be avoided and why?
prilocaine with felypressin- induce early labour
articaine not licensed for pregnancy
how should a patient lie on the chair?
with right hip elevated- avoid compression of inferior vena cava and aorta
how can pregnancy affect dentistry?
- morning sickness/acid reflux- erosion
- teratogenic effects of certain drugs especially during first trimester
- uncomfortable lying in dental chair
- drug contraindications
- higher caries risk due to poor tb (nausea), sugary snacks
what can lying supine do in later pregnancy?
hypotension/ acid reflux
are radiographs safe during pregnancy?
yes
what should be given if acid reflux/erosion/morning sickness?
- OHI- don’t brush straight after
- fluoride mouthwash
why may pregnant pt be taking fragmin and aspirin?amo
- previous miscarriages
- p gingivalis has surface proteins which trigger thrombosis so periodontal disease should be treated before progression
what antibiotics are safe during pregnancy?
amoxycillin
clindamycin
what may a pregnant patient present with on gum?
epulis- bleeding but no pain caused by changes in hormones
how are epulis treated?
OHI as will resolve after birth- if not surgery
why should periodontal disease treatment in pregnant patients be done and why in small sections and why not in first trimester?
- prevent progression
- increases bacteria in blood and systemic inflammation
- increases foetal stress due to increased inflammatory response
amalgams should be avoided during pregnancy- when is the exception? can u do it if breast feeding?
- remove amalgam if in pain
- no mercury can be passed through breast milk
what antibiotics should be avoided in pregnancy?
- zoles
- tetracycline
if periodontal disease left untreated what may this cause?
- increased inflammatory response- stimulate prostaglandins causing low birth weight and premature birth
how should amalgam be removed?
- rubber dam and good suction
