Risk Factors in Periodontal Disease - Diabetes Flashcards
Give 6 complications of diabetes.
- Retiniopathy
- Neuropathy
- Nephropathy
- Macrovascular and microvascular disease
- Altered wound healing
What does type 1 diabetes result in and how?
- Insulin deficiency
- Due to an autoimmune loss of beta cells in the pancreas.
What does type 2 diabetes result in and what is it associated with?
- Impaired insulin secretion and increased insulin resistance.
- Associated with diet and obesity.
What percenatage of diabetic patients are type 1 and what percentage are type 2?
- Type 1 - 10%
- Type 2 - 90%
What are 5 risk factors for type 2 diabetes?
- Age
- Obesity
- Lack of exercise
- Genetic - family history
- Genetic - racial background - esp. Indian Subcontinent, Black Carribean
What is the most commonly used method of diagnosing diabetes?
Measuring non-fasting glycated haemoglobin (HbA1C) levels. measure in mmol/mol
What are the glycated haemoglobin levels for health, the diabetes threshold, and diabetes that is well controlled?
- Health = 37mmol/mol.
- Diabetes threshold = 48mmol/mol.
- Good control = <53mmol/mol.
By how much does having diabetes increase the risk of developing periodontitis and what else can it affect in the oral cavity?
2-3 times that of non-diabetics.
- Also increases the extent and severity of periodontitis
- Increases the risk of gum abscesses
Give 3 mechanisms of damage of diabetes.
- Advanced glycation end products (AGE)
- Lipids and inflammatory dysfunction
- Systemic inflammation leads to reduced beta cell function, apoptosis and insulin resistance
What is the mechanism of action of advanced glycation endproducts (AGE)?
- They form glucose-derived molecules that once formed are irreversible.
- They accumulate in plasma and tissues, damaging cell walls and cross-linked matrix structures.
- They bind to receptors in the endothelium and macrophages activating inflammtory responses:
- Increased secretion of cytokines such as IL-1beta, TNF-alpha, IL6.
- Increased oxidative stress.
- Disruption of RANKL/OPG axis favouring bone resorption.
How can diabetes cause the release of cytokines from adipose tissue?
When blood glucose is high, cytokines are released from adipose tissue such as lectin and resistin.
What is the effect of an increase in cytokines in the blood as a result of diabetes?
Increase number of lipids causing:
- Altered cell membrane function
- Further increase in cytokine output resulting in more inflammation
- Inflammatory cells become hyperresponsive.
Give 2 excaberbated features diabetes adds to periodontitis.
Diabetes-associated periodontitis:
- Increased pocketing
- Sometimes periodontal abscesses.
How does periodontitis affect glycaemic control and what link does this suggest between diabetes and periodontitis?
- Severe periodontitis worsens glycaemic control in both diabetes and non diabetes patients:
- The bacteria and inflammatory molecules leave periodontal tissues, enter the circulation, and contribrute to upregulated systemic inflammation.
- This leads to impaired insulin signalling and resistance. - This suggests a bidirectional link.
How much can periodontal treatment help improve diabetic control?
- Reduction of 3-4mmol/mol (HbA1C) in short term- similar effect of a drug.
- Also reduced bacterial challenge thought to reduce systemic inflammation and improve insulin resistance and insulin signalling
When would you consider a referral for testing diabetes?
- Recurrent periodontal abscesses.
- Rapidly progressing periodontitis
- Severe periodontitis
Esp if over 45
Have risk factors e.g. BMI>25, hypertension, family history.
What precautions would you take for a diabetic patient?
- Hypoglycaemia
- So raise chair slowly, make sure appointment is in morning or straight after lunch.
What may diabetic patients present with orally?
- Xerostomia
- Oral mucosal diseases
- Gingival overgrowth as a result of taking calcium channel blocking hypertensives,
