Power Point not covered in lecture & other misc.

Question 1

Diabetes Mellitus?

Answer 1

• refers to a group of disorders exhibiting a defective/deficient insulin secretory resonse, glucose underutilization, and hyperglycemia
• net effect is a chronic disorder of carbohydrate, fat, and protein metabolism w/ long-term complications

Question 2

Diabetes Alert?

Answer 2

• family history
• age > 40 yrs
• classic symptoms (3 P’s)
• periodontal abscesses (multiple recurrent)
• rapid alveolar bone loss
• poor response to treatment

Question 3

Type 1 Diabetes?

Answer 3

• Beta-cell destruction
• Defective beta-cells
• result= insulin deficiency
• fatty acids (energy source) = ketones, ketoacidosis
• diabetic ketoacidosis (DKA)

Question 4

Type 2 Diabetes?

Answer 4

• beta cells release insulin but cell receptors are insulin resistant
• glucose transport variable and ineffective
• less risk for DKA
• HHNS = hyperglycemic hyperosmolar nonketotic syndrome

Question 5

Oral S/S?

Answer 5

• xerostomia
• burning mouth
• periodontal abscesses
• dental caries candidiasis

Question 6

Periodontal Considerations?

Answer 6

• impaired wound healing
• increased plaque activity (xerostomia)
• periodontal abscesses
• altered PMN chemotaxis
• increased bone resorption

Question 7

How does patient monitor condition? - Glycosylated Hb Assay?

Answer 7

• self-monitoring by patient
• “point-in-time” fasting, 2 hour PP
• over a period of time (10-12) weeks
• glycosylated Hb
• good long-term monitor
• Glycosylated Hb Assay
• 5-6% = normal
• 6-7% = moderate control
• > 8% = need to improve control
• • each 1% change in HbA1C = 25-35 mg/dl glucose

Question 8

Periodontal Treatment?

Answer 8

• determine the “control” status
• consultation if necessary
• schedule short appointments
• maximize stress reduction
• plan to treat before or shortly after peak insulin activity
• use antibiotics only as necessary

Question 9

Periodontal Disease - Diabetes Mellitus ?

Answer 9

• periodontitis associated w/ poor glycemic control in Type 2 patients
• increased insulin resistance
• treatment improves glycemic control

Question 10

PREGNANCY?

Answer 10

●	low-birth-weight < 2500g
●	multiple factors
●	bacterial vaginosis
●	gram (-) MO
●	cytokines, PGE2
●	preterm labor

Question 11

when we treat diabetics there are two values we ask?

Answer 11

• what is your blood glucose level (am glucose)
• What does this tell us? (doesn’t say anything about long term control
• We want Hemoglobin A1C measurements (most crucial information)

Question 12

Who is on anticoagulants?

Answer 12

• Angina, heart patients, transplant patients etc.
• NEED to know INR (valid of 24 hours) to assess bleeding risk
• Less than 2.5 is safe for bleeding/ procedures
• Even for an injection
• INR of 4 means blood is very thin, no coagulation, at risk for bleeding even if they cut themselves shaving, danger range. Refer case to Skip and Joe our resident OMSs
• Coumadin is vitamin K dependent (therefore extremely diet sensitive)

Question 13

Questions to never miss again?

Answer 13

1. Proper diagnosis is the most important factor in treating PD.
2. Primary bacteria associated with gingivitis is NOT anaerobic rods
   - There is an equal balance of G+ and G-
3. Tetracycline (apparently the same as doxycycline) is given in low does systemically to treat/regulate MMP.
4. Biological width= 2-3mm
5. MGJ is the demarcation between attached gingiva and alveolar mucosa

Question 14

How does Gram (-) periodontal infection affect glycemic control?

Answer 14

Gram (-) periodontal infection—> Increased insulin resistance–>Worsened glycemic control

Question 15

What can improve glycemic control ?

Answer 15

Periodontal treatment—>Improved insulin sensitivity–>Improved glycemic control

Question 16

How can a bacterial infection affect pre-term labor?

Answer 16

Bacterial infection—> Bacteria and products in amnion–>inflammatory response w/ cytokine production in amnion—> Increased amnionic prostaglandin production–>Preterm labor