SYSTEMIC ANTIMICROBIALS PART 2- SYSTEMIC ANTIBIOTICS AND PERIODONTAL DISEASES Flashcards
name the 3 most common systemic risk factors after smoking and stress
- diabetes
- genetic factors
- Osteoporosis
Define Diabetes mellitus
- common group of metabolic disorders characterised by chronic hyperglycaemia resulting form insulin deficiency or impaired utilisation of insulin
How many people in the world have diabetes in 2017
451 million
increase by 2045
WHO estimated direct consequence of diabetes will be 7th leading cause of death by 2030
How many people will have diabetes in the UK by 2025
more than 5 million
almost 3.7 million have diabetes now
how much % of people have diabetes and which types
> 6% of UK have diabetes
type 1 - 10%
Type 2- 90%
estimated 1 million undiagnosed, mainly type 2
Describe type 1 Diabetes mellitus
- Destruction of beta cells in pancreas
- autoimmune process
- Islet cell antibodies at time of diagnosis
- genetic predisposition
-Abrupt onset, most often in children/teens
Describe Type 2 DM
- 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
asianafro-carribeann - complications possible before diagnosis
Describe diagnosis of venous plasma glucose
- 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
Describe diagnosis of diabetes using HbA1C
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%)
what are implications of poor control or undiagnosed DM
- Diabetes complications
- Risk factor for periodontal disease
how is type 1 DM treated?
- 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
How is glucose monitored at home
- 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
How is Type 2 DM treated
- treat by diet or diet and oral hypoglycaemic frugs plus exercise
- 25 may go on to need insulin injections
- Balancing act
List some complications of diabetes
- 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
what is the NICE target of HbA1c
<58mmol/mol
what are the implication of diabetes on NHS
- 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
what is the epidemiiolyg study on Pima Indians
- 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
What are the links between diabetes and periodontal disease
Inflammation is central feature of pathogenesis of DM and periodontitis
describe systemic inflammation in diabetes
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
What are AGEs
- 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
what are RAGEs
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
What is the PMNs firs line of defence
- Decrease PMN function increases periodontist
- Enhanced respiratory burst
- Delayed apoptosis increases tissue destruction
what does the Cochrane review say about periodontal treatment - diabetes control
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
what does the D’aiuto suggest about periodontal treatment
- Intensive periodontal therapy reduced HbA1c in patients with type 2 diabetes and moderate to severe periodotnisit after 12 months
how is periodontal care managed for patients with diabetes
- 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
what is hypoglycaemia and how is it managed
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
How is severe Hypoglycaemia managed?
- 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
Describe link between periodontitis and genetics studies
- 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
what can be other risk factors of periodontitis?
- osteoporosis
- Dietary calcium
- Vitamin D
-Obesity
Describe osteoporosis
- 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
