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CSA > SYSTEMIC ANTIMICROBIALS PART 2- SYSTEMIC ANTIBIOTICS AND PERIODONTAL DISEASES > Flashcards

SYSTEMIC ANTIMICROBIALS PART 2- SYSTEMIC ANTIBIOTICS AND PERIODONTAL DISEASES Flashcards

1
Q

name the 3 most common systemic risk factors after smoking and stress

A
  • diabetes
  • genetic factors
  • Osteoporosis
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2
Q

Define Diabetes mellitus

A
  • common group of metabolic disorders characterised by chronic hyperglycaemia resulting form insulin deficiency or impaired utilisation of insulin
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3
Q

How many people in the world have diabetes in 2017

A

451 million
increase by 2045
WHO estimated direct consequence of diabetes will be 7th leading cause of death by 2030

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4
Q

How many people will have diabetes in the UK by 2025

A

more than 5 million
almost 3.7 million have diabetes now

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5
Q

how much % of people have diabetes and which types

A

> 6% of UK have diabetes
type 1 - 10%
Type 2- 90%
estimated 1 million undiagnosed, mainly type 2

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6
Q

Describe type 1 Diabetes mellitus

A
  • Destruction of beta cells in pancreas
  • autoimmune process
  • Islet cell antibodies at time of diagnosis
  • genetic predisposition
    -Abrupt onset, most often in children/teens
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6
Q

Describe Type 2 DM

A
  • defect In beta cell and insulin resistance
  • usually manifests mid life
  • small number of children affected
  • Genetic influence
  • Increase risk if obses
  • sedentary lifestyle
  • close relative with DM
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  • complications possible before diagnosis
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7
Q

Describe diagnosis of venous plasma glucose

A
  • random venom plasma glucose > 11.1mmol/lire or fasting venous plasma glucose > 7.0 mmol/I,
  • unexplained weight loss
  • Polyuria
    -Polydipsia
    Normal blood glucose is 4-5.5 mol/I before meals <8mmol/I 2 hours after meals
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8
Q

Describe diagnosis of diabetes using HbA1C

A

Heamoglbin A1c may be used for diagnosis
- Glucose binds to blood haemoglobin within the circulation erthyocrites for life of red blood cell,8-12 weeks
- Measure how much haemoglobin is glycated
- Cut off point 48mmol/mol (6.5%)

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9
Q

what are implications of poor control or undiagnosed DM

A
  • Diabetes complications
  • Risk factor for periodontal disease
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10
Q

how is type 1 DM treated?

A
  • treat by insulin injections/insulin pump
  • Balance carbohydrate intake and insulin
  • New technology includes transplantation of pancreatic islets of Langerhans cells
  • patients need to monitor glucose regularly
  • appropriate levels of carbohydrates needed
  • careful examination of diet to identify amount of sugar consumption
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11
Q

How is glucose monitored at home

A
  • SImple finger prick
  • Drop of blood on strip
  • Direct reading in secs
  • Aim for 4-7mmol/litre
  • Under renal threshold of 10mmol
  • Above level of hypoglycaemia when blood glucose <4mmol/I
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11
Q

How is Type 2 DM treated

A
  • treat by diet or diet and oral hypoglycaemic frugs plus exercise
  • 25 may go on to need insulin injections
  • Balancing act
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12
Q

List some complications of diabetes

A
  • Macrovascualr
    cardiovascular disease - major cause of death and peripheral vascular disease- amputations
  • Cerebrovascualr disease and stroke
    -Microvascualr
    Retinopathy- blindness
    Nephropathy- renal failure
    Neuropathy- painful nerve damage
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13
Q

what is the NICE target of HbA1c

A

<58mmol/mol

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14
Q

what are the implication of diabetes on NHS

A
  • Diabetes cost estimated £23.7 billion in UK
  • 10% NHS budget and 19% hospital beds accounted for by patients with diabetes
    -Projected cost increase £39.8 billion 2035/6
15
Q

what is the epidemiiolyg study on Pima Indians

A
  • high prevalence Type 2 DM
  • worse periodontal problems with poor control
  • Increased frequent and increase advanced periodontal destruction with increased duration of diabetes
  • Pima indians with severe period disease x3.2 RISK MORTALITY DUE TO ISCHAMEIC HEART DISEASE AND DIABETIC NEPHROPATHY
16
Q

What are the links between diabetes and periodontal disease

A

Inflammation is central feature of pathogenesis of DM and periodontitis

17
Q

describe systemic inflammation in diabetes

A

strong evidence periodontal infections induce systemic inflammatory response
- evidence of increase levels f acuter phase proteins and pro inflammatory cytokines
- In Obesity IL- stimulated TNF-a
- Increase in IL-6 and TNF-a may bring insulin resistance
- Increase in I-1Beta may - pancreatic B cell destruction

18
Q

What are AGEs

A
  • Advanced glycation end product
  • hyperglycaemia - collagen undergoes non enzymatic glycation to advanced glycation end products
  • increases collagen cross linking
  • increases cytokine production
  • Linked to micorvascualr complication
  • atherosclerosis
  • decrease production of bone matrix
19
Q

what are RAGEs

A

AGES activates receptor for AGEs- RAGEs
- interaction of RAGEs and AGEs perturb vascular and inflammatory cell function
- microvascular and macrovascualr diabetes complications
- Accelerated periodontal. tissue destruction

20
Q

What is the PMNs firs line of defence

A
  • Decrease PMN function increases periodontist
  • Enhanced respiratory burst
  • Delayed apoptosis increases tissue destruction
21
Q

what does the Cochrane review say about periodontal treatment - diabetes control

A

Low quality evidence that the treatment of periodontal disease by SRP does improve glycemic control in people with diabetes, with a mean percentage reduction in HbA1c of 0.29% at 3-4 months; however, there is insuffiencet evidence to demonstrate that this is maintained after 4 months

22
Q

what does the D’aiuto suggest about periodontal treatment

A
  • Intensive periodontal therapy reduced HbA1c in patients with type 2 diabetes and moderate to severe periodotnisit after 12 months
23
Q

how is periodontal care managed for patients with diabetes

A
  • Check HbA1c with diabetes care team
  • Follow principles of 3 stage of therapy
  • Initial therapy; if poor response consider specialist referral
  • Corrective therapy; consider adjunctive systemic antibiotics
  • Supportive therapy; GDP can undertake
24
Q

what is hypoglycaemia and how is it managed

A

Hypoglycaemia; pale. shaky, clammy, may be aggressive/ confused; blood glucose `<4mmol/l
- give 3-6 glucose tablets (3g each) ie 10-20g
- give glucose drink eg lucozade 150-200ml

25
Q

How is severe Hypoglycaemia managed?

A
  • Give glucagon IM, SC or IV injection (1mg if adult or child over 8 yrs); 0.5mg if under 8 yrs
  • plus further carbohydrate on recovery
    Advice; get doctor/ dial 999 if no recovery in 10 minutes
  • iF STILL UNCOSIOUS, WILL NEED GLUCOSE IV
26
Q

Describe link between periodontitis and genetics studies

A
  • Twin studies showed some element of periodontitis could be ascribed to genetics
  • more recent study suggests that role of genetics in slow progression moderate type periodontitis may have been exaggerated
  • Studies to investigate polymorphism in inflammatory mediators ( such as interleukins,surface receptors, matrix metalloproteinase)
    -Meta analysis of 13 studies showed polymorphisms in IL-1A, IL-1B, IL-6,IL-10 and MMP-3 and MMP-9 genes were significantly associated with risk of development of periodontitis
26
Q

what can be other risk factors of periodontitis?

A
  • osteoporosis
  • Dietary calcium
  • Vitamin D
    -Obesity
27
Q

Describe osteoporosis

A
  • reduced bone mineral density
  • Most common in post- menopausal women but does occur in men
  • Leads to increase risk of fracture; typically hip fractures after a fail
  • Reduced oestrogen production after menopause results in increased bone resorption
  • Systemic bone resorption associated with amdnibular bone reposition
  • Soem saudeis show correlation between systemic bone loss and periodontal disease
28
Q
A

CSA (32 decks)

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