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Dental Hygiene > Systemic Risk factor 2 > Flashcards

Systemic Risk factor 2 Flashcards

1
Q

define DIABETES MELLITUS (DM)

A

A common group of metabolic disorders characterised by chronic hyperglycaemia resulting from insulin deficiency or impaired utilisation of insulin (insulin resistance)

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2
Q

Diagnosis

A

Venous plasma glucose
Random venous plasma glucose >= 11.1 mmol/litre, ot fasting venous plasma glucose >= 7.0 mmol/l plus
Unexplained weight loss, polyuria, polydipsia
Normal blood glucose 4-5.5 mmol/l before meals. <8mmol/l two hours after meals

Haemoglobin A1c may be used for diagnosis
Cut off point 48mmol/mol (6.5%)

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3
Q

Types of diabetes

A 
○ Type 1 10%  
○ Type 2  90% 
○ Other 
	§ Maturity Onset Diabetes in the Young 1-2% (20-40k)
Gestational diabetes 3.5% of pregnancies
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4
Q

Type 1 dibetes

A

• Destruction of ß 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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5
Q

Type 2 diabetes

A

• Defect in ß cell and insulin resistance
• Usually manifests mid life
○ Small number of children affected
• Genetic influence
• á risk if obese, sedentary lifestyle, close relative with DM, Asian/Afro-Caribbean
Complications possible before diagnosis

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6
Q

Control/diagnosis of diabetes is important,

A

…implications of poor control or undiagnosed DM include: diabetes complication/ risk factor for periodontal disease

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7
Q

Control of Type 2 diabetes

A

Type 2
Treat by diet or diet and oral - hypoglycaemic drugs plus exercise
25% may go on to need insulin injections
Balancing act

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8
Q

Control of Type 1 diabetes

A

Type 1
Treat by insulin injections/insulin pump
Balance carbohydrate intake and insulin
New technology includes transplantation of pancreatic islets of langerhans cells

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9
Q

Home blood glucose monitoring

A

Simple finger prick
Drop of blood on strip
Direct reading in secs
Aim for 4-7mmol/ litre

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10
Q

Complications of diabetes commonly cited
Macrovascular

Micro vascular

A

Macrovascular: cardiovascular disease-
the major cause of death
peripheral vasular disease- amputation,
cerebrovascular disease and stroke

Microvascular:
retinopathy- blindness,
Nephropathy- renal failure,
Neuropathy- painful nerve damage

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11
Q

Systemic inflammation,Strong evidence periodontal infections induce systemic inflammatory response
Evidence of increase levels of…..

A

acute phase proteins (eg C-reactive protein) and pro-inflammatory cytokines

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12
Q

What may play a role in the devlopment of type 1 DM?

A

Increased IL-1Beta may result in pancreatic Beta cell destruction (i.e role in type 1 DM)

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13
Q

how does obesity play a role in development of type 2 DM? (interlukein)

A

In obesity IL-6 stimulates TNF-alpha

Increse IL-6 and increase TNF-alpha may result in insulin resistance (i.e role in type 2 DM)

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14
Q

BMI linked to……

Obesity significant predictor of…….

A

……severity of attachment loss in NHANES III

……… periodontal disease; insulin resistance may mediate link

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15
Q

Adipocyte production of proinflammatory cytokines (adipokines) may link……….

A

obesity to diabetes and periodontitis

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16
Q

Hyperglycaemia may result in collagen to undergo non-enzymatic glycation to Advanced End Products (AGEs) leading to…..

linked to……

A

Increased collagen cross-linking, increased cytokine production,
linked to- microvascular complications, atherosclerosis, decreased production bone matrix

17
Q

AGES activate Receptor for AGES=RAGES

Interaction of RAGEs and AGES perturb vascular and inflammatory cell function

A

Microvascular and macrovascular diabetes complications

Accelerated periodontal tissue destruction

18
Q

Polymorphonuclear leukocyte (PMN’s) is first line of defence, but in DM…

A

Decreased PMN function, increased periodontitis
Enhanced respiratory burst
Delayed apoptosis, increased tissue desruction

19
Q

Effect of periodontal diseases on diabetes control (HbA1c)

A

Systematic review of current evidence suggests that periodontal diseases adversely affect diabetes outcome:

  • Control
  • Complications
  • Incidence
20
Q

Decreased HbA1c of 1% associated with decreased risk of:

A

Deaths related to diabetes
Myocardial infarction
Microvascular complications

21
Q

Recent systematic reviews/ meta analyse on the effect of periodotnal treatment on Diabetes control

A

Improvement in HbA1c significant 0.4% after non-surgical treatment but after non-surgical therapy and antibiotic not significant
In type 2 DM, equivalent to single extra drug effect
Need more studies with larger samples

22
Q

Periodontal care for patients with diabetes

A

Check HbA1c with diabetes care team
Follow 3 principles of 3 stages of therapy
Initial therapy: GDP can undertake; if poor response, consider specialist referral
Corrective therapy: consider adjunctive systemic antibiotics (but more research needed)
Supportive therapy: GDP can undertake

23
Q

Managment of ‘hypo’

A

Hypoglycemia: pale, shaky, clammy, may be aggreessive/confused; blood glucos <4mmol/l
Give 3-6 glucose tablets (3g each) i.e 10-20g
Or give glucose drink e.g Lucozade 150-200ml

24
Q

Managemnet of severe ‘hypo’

A

Give glucogon IM, SC or IV injections (1mg if adult or child over 8yrs; 0.5mg if under8 yrs)
Plus further carbohydrate on recovery
Advice: get doctor/ dial 999 if no recovery in 10 minutes
If still unconscious, will need glucose IV

25
Q

Diabetes:
Loe in 1993 proposed

Lamster & Lalla after reviewing the evidence concluded

What is most important

A

periodontal disease as the sixth complication of diabetes
Loe 1993

periodontal disease is a clinical complication of diabetes

Diabetes control is critical

26
Q

Genetic factors may increase the susceptibility to other associated chronic conditions: cancer/ heart disease/ diabetes.
A study of shred genetics risk factors between cancer and periodontal disease in monozygotic twins found

A

associataion between periodontal disease and several cancers
Hypothesis that inflammation underlines the association and IL-1 gene polymorphisms associated with increased levels of periodontal disease may be associated with icnreased cance

27
Q

How is progresion of periodontits linked to genetics

A

Periodontitis that occur early in age and progresses fast has shown familial aggregation
In the more common form of periodontal disease seen in older patients with slower progression the picture is less clear

28
Q

Conclusion

A

Several systemic risk factors where some evidence of a link to periodontitis
Potentially bi-directional relationship
Evidence for diabetes as risk factor is insignificant
Patients should be informed about the relationship of diabetes and periodontitis for optimum management of both conditions
Some other potential risk factors require further research to establish the relationship and its extent

29
Q

Periodontitis

A

Initial therapy: GDP can undertake; if poor response, consider specialist referral
Corrective therapy: consider adjunctive systemic antibiotics (but more research needed)
Supportive therapy: GDP can undertaker

30
Q

Guidelines for dental practice- EFP/AAP workshop & manifesto (part one)

A

If periodontitis, need:
Therapy (IT, CT, SPT) ; OHE
-manage acute, infections, oral complications; dental rehabilitation if tooth loss

31
Q

Guidelines for dental practice- EFP/AAP workshop & manifesto (part 2)

A

If no periodontitis and no DM (yet!) need
Prevention, monitor
If risk for type 2 DM, inform patient, do chairside HbA1c or refer to GP

32
Q

Guidelines for dental practice- EFP/AAP workshop and manifesto
Patients with DM should be told:

A

At higher risk of periodontitis
Gylycamic control may be difficult
At higher risk of other complications
At higher risk of other complication e.g cardiovascular disease
And should:
Receive a thorough oral/perio exam (adults and children)

33
Q

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 fall
Reduced oestrogen production after menopause results in increased bone resorption
Systemic bone resorption associated with mandibular bone resorption
Some studies show a correlation between systemic bone loss and periodontal disease

34
Q

Other risk factors

A

Dietary calcium
Vitamin D
obesity

Dental Hygiene (9 decks)

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