Risk Factors: Diabetes

Question 1

What are the risk factors for type 2 diabetes?

Answer 1

• Age
• Obesity
• Lack of exercise
• Genetics

Question 2

What are the main ways of diagnosing diabetes?

Answer 2

• Random blood glucose test
• Fasting plasma glucose
• 2h glucose tolerance test following 75g oral glucose
• HbA1C

Question 3

What % of hbA1C decrease leads to:
21% reduction in diabetes related death
14% reduction of heart attacks
37% reduction of microvascular complications

Answer 3

1%

Question 4

What increase in risk does someone with diabetes have for getting periodontal disease?

Answer 4

2-3 times

Question 5

What does diabetes do to periodontal disease?

Answer 5

Increases the extent (number of teeth affected) and the severity of the disease (amount of attachment loss)
More suppuration due to increase in gum abscesses

Question 6

What are the three main mechanisms for diabetes causing damage to the periodontium?

Answer 6

1) Formation of advanced glycation products
2) Increased lipids and inflammatory dysfunction
3) Systemic inflammation leading to reduced beta cell function, apoptosis and insulin resistance

Question 7

How do glycation end products cause damage?

Answer 7

They accumulate in plasma and tissues anc can then impair collagen molecules which damages the vessel walls.
They cross link with each other which impairs the vasculature.

AGEs have receptors which bind to endothelial cells and macrophages. This leads to increased cytokine secretion and disruption of tissue turnover to favour bone resorption due to RANKL/OPG axis.

Question 8

When AGE binds to endothelial cells and macrophages and cytokines are released, how does this affect periodontitis?

Answer 8

Alteration in cell membrane function, increase in cytokine output and make inflammatory cells hyperresponsive.

Question 9

Does diabetes - associated periodontitis have a particular look?

Answer 9

No particular appearance.
Increased pocketing can occur that does not correlate with the amount of plaque present.
May get some periodontal abscesses.

Question 10

Does periodontal treatment improve diabetes?

Answer 10

Reduction in HbA1c in patients who have had periodontal therapy.
Works due to a reduction in systemic inflammation due to less bacterial load. This improves insulin resistance and insulin signalling.

Question 11

When should we consider referring a patient to investigate suspected diabetes?

Answer 11

Recurrent periodontal disease
Rapidly progressing periodontitis
Severe periodontitis

Question 12

Name some of the practical considerations that we need to take into account as dentists treating diabetic patients

Answer 12

Update medical history regularly for changes in glycaemic control.
Diabetic patients are better treated after they have eaten.
Diabetic patients tend to have drier mouths and lack of saliva leads to increased risk of caries
Explain the bidirectional correlation between diabetes and periodontal disease.