Systemic Risk Factors 1 - Obesity and Nutrition Flashcards
What happens when we have over-nutrition?
What are the two drives?
- higher circulating glucose
- more adipose tissue
- greater inflammatory drive
- treatment becomes more complicated due to higher circulating glucose causing greater inflammatory drive
Two drives:
- inflammatory response increased - more oxidative stress
- change in oral and gut microbiomes
How can obesity and periodontitis be linked?
What should you suggest to your patients with regards to diet?
- obesity means greater risk of dysbiosis, less diverse microbiomes (greater effect on females)
Adipose tissue produces:
- cytokines, TNFa, IL6
- pro inflammatory mediators, leptin etc
- bacteria ise cytokines as energy source, increasing proteolytic activity and increase in anaerobes
- dysbiosis results as aerobic pathways become fermentation
Reducing refined and processed fods reduces inflammation !
Why and how should you induce dietary changes in an obese patient?
- approach sensitively, take care with patients taking warfarin/vegetables can alter INR
- weight loss can reset oral microbiome
- reduce refined carbohydrates and AGE products
- prebiotic diet
- if unaddressed, diabetes is likely in the future
What is the recommended target HbA1c level for diabetics and periodontitis?
- recommended target level of control = HbA1c of less than 48mmol/mol (6.5%)
- the higher above this score, the greater the risk of developing long term complications of diabetes
- ask patients about their control at each visit - be prepared for a hypoglycaemic emergency
What are some key signs of undiagnosed diabetes in a patient?
What is a pre-diabetic?
- recurrent periodontal abscesses/exaggerated periodontal inflammation, especially if OHI and RSD appears to have been adequate
- PD in DM is associated with an exaggerated and prolonged inflammatory response to the periodontal microflora
Pre-diabetes: abnormally high blood sugar levels but below threshold for diagnosis of diabetes
- can remain in this state for many years, but increased risk of periodontal destruction during this time
List some problems associated with uncontrolled DM:
- increased formation of advanced glycation end-products (AGE)
- altered immune cell function
- altered fibroblast function
- poor wound healing
Why is alcohol relevant to dentistry?
- excessive amounts cause a variety of medical problems, most notably liver disease –> affect safe dental treatment and prescribing
- alcohol is a risk factor for periodontal disease
- high intake compromises treatment outcome
- dental trauma, facial injury, oral cancer, periodontal disease, non-carious tooth surface loss
List some adverse effects of alcohol:
What effect does alcohol have on clinical attachment loss?
What should dental professionals do?
- defective neutrophil function
- altered clotting mechanism - defective prothrombin and Vit K activity
- increased bone resorption and decreased bone formation
- reduced healing (Vit B deficient)
- direct toxic effect on periodontal tissues
Alcohol is thought to have a similar influence on CAL as moderate smoking
We should ask patients about alcohol consumption and provide brief interventions to encourage patients to reduce risk
Which nutrient is essential for healing?
Vitamin C - healing
- essential for collagen
- important immune functions
- defends against oxidative stress and free radicals, promotes chemotaxis
- also essential for iron absorption
What is the role of vitamin D?
- essential for skeletal development
- modulation of immune system
- deficiency of vitamin D associated with reduced immunity and increased autoimmunity
What should we tell our patients about undernutrition?
Which foods may help improve periodontal disease?
- unless proven deficiencies supplements most likely not helpful
- taking supplements does not necessarily translate into the nutrient being available
- most likely benefits to eating the whole fruit or vegetable rather than taking supplements, iron deficiency would be the exception
- eat a balanced diet
Omega 3, cruciferous vegetables, pre and probiotics and some micronutrients may improve periodontal disease
