Systemic Risk factors 2 Flashcards
What is diabetes mellitus characterised by?
Chronic hyperglycaemia from insulin deficiency or impaired utilisation of insulin
How many people world wide are estimated to suffer from diabetes?
451 million
How many people in the uK are estimated to have diabetes?
3.7 million
What percentage of diabetics in the UK have type 1 diabetes?
10%
What percentage of diabetics in the UK have type 2 diabetes?
90%
Describe type 1 diabetes
It is the destruction of beta cells in the pancreas
It is a genetic autoimmune disease that affects the islet cell antibodies
It has an abrupt early onset
Describe type 2 diabetes
It is a defect in beta cells and insulin resistance
It usually manifests mid life
it does have a genetic influence but is affected by your lifestyle
What increases your risk of developing type 2 diabetes?
- If you’re obese
- If you have a sedentary lifestyle
- If you are of asian or afro Caribbean descent
How can you diagnose diabetes?
- By checking a patients venous plasma glucose concentrations
- We can use Haemoglobin A1c (HbA1C)
How high would a diabetic patients venous plasma glucose concentrations at a random time of the day and after fasting?
Random venous plasma glucose > 11.1 mmol/litre,
or fasting venous plasma glucose >7.0mmol/litre,
How high would a normal patients venous plasma glucose concentrations before and 2 hours after a meal
4–5.5 mmol/l before meals,
<8mmol/l two hours after meals
What symptoms are associated with diabetes?
- Unexplained weight loss
- Polyuria
- Polydipsia
Why can we use Haemoglobin A1c to diagnose diabetes?
As glucose binds to blood haemoglobin within circulating erythrocytes for lthe life span of a RBC
What is the life span of a red blood cell?
8-12 weeks
How can we use Haemoglobin A1c to diagnose diabetes?
We can measure how much of the haemoglobin is glycated
What is the cut of concentration when testing for Haemoglobin A1c?
4.8mmol/mol which is 6.5%
What should you ask a patient who has diabetes?
Which type of diabetes they have and how well is their diabetes controlled
Also ask for their HbA1c levels
How is type one diabetes mellitus treated/controlled?
Treated by insulin injections/insulin pump
Patients need to balance carbohydrate intake and insulin levels
How is type two diabetes mellitus treated/controlled?
Treated by diet control and exercise (in some cases oral hypoglycaemic drugs may be prescribed)
25% of patients may go o to need insulin injections
When using a home blood glucose monitoring kit what concentration of blood glucose should a patient aim for?
4-7 mmol/ litre
What are some of the complication of diabetes?
- Cardiovascular diseases
- Peripheral vascular disease
- Cerebrovascular disease & stroke
- Retinopathy (blindness)
- Nephropathy (renal failure)
- Neuropathy (painful nerve damage)
What problems can poorly controlled diabetes lead to in dentistry?
Periodontal disease As patients have more attachment loss and more bone loss
What implications does diabetes have on the NHS?
- Diabetes cost estimated £23.7 billion in UK (80% on complications)
- 10% NHS budget & 19% hospital beds accounted for by patients with diabetes
What increases the severity of periodontal disease?
Increased age and increases with diabetes duration
What links diabetes mellitus and periodontitis?
Inflammation is key to the pathogenesis of both diabetes and periodontitis
What do periodontal infection induce?
Systemic inflammatory response
What does an increased inflammatory response lead to?
Increases levels of acute phase proteins and pro pro-inflammatory cytokines
An increase in which acute phase protein can lead to insulin resistance?
Increased IL-6 and TNF
An increase in which acute phase protein can lead to pancreatic beta cell destruction?
Increased IL-18
What does AGE stand for?
Advanced Glycation End products
What leads to an AGE interaction?
Hyperglycaemia cashless collagen to undergo non enzymatic glycation to Advanced Glycation End products (AGES)
What change occurs in collagen during hyperglycaemia?
- Increased cross linking (but not in a +way)
- Increased cytokine production (microvascular complications)
- Atherosclerosis
- Decreased production of collagen in bone matrix
What do AGEs activate?
Receptors for AGEs also known as RAGEs
What do interactions between RAGEs and AGEs impact?
Impacts vascular and inflammatory cell function which lead to accelerated periodontal tissue breakdown
What can obesity lead to?
Insulin resistance and therefore type 2 diabetes
What is BMI linked to?
Severity of attachment loss in NHANES studies
What is obesity a significant predictor of?
Periodontal disease
An increase in IL6 and TNF can lead to what?
Insulin resistance
An increase in IL-18 can lead to what?
Pancreatic beta cell destruction
What causes an increase in acute phase proteins?
Inflammation
What does PMN stand for?
Polymorphonuclear leukocytes
What effect does diabetes have on PMNs?
- Decreases PMN function leading to increased periodontitis
- Enhances respiratory burst
- Delays apoptosis thus increasing tissue destruction
What do PMNs do?
They are our first line fo defence
What is there a bi directional relationship between?
Between the effect of periodontal diseases and treatment and diabetes control
What does it mean when we say theres a bi directional relationship between the effect of periodontal diseases and treatment and diabetes control
It means that not only does diabetes lead to periodontal destruction but periodontal disease and its treatment can impact on the diabetes
What has research suggested periodontal disease can have an effect on in regards to diabetes?
Diabetes:
control
complications
Incidences
What is a decrease in HbA1c by 1% associated with?
Decreased risk of:
- Deaths related to diabetes
- Myocardial infarction
- Microvascular complications
How would you manage hypoglycaemia?
Give 3-6 glucose tablets (10-20G glucose)
Or give a glucose drink like lucozade
What is hypoglycaemia characterised by?
Patient will be: Pale Shaky Clammy May be aggressive/confused Will have a blood glucose of les than 4mmol/l
How would you mange SEVERE hypoglycaemia?
- Give glucagon IM, SC or IV injection (1mg if adult or 0.5mg fro patients under 8)
- Get a doctor or call 999 if theres no recovery in 10 mins
- If they remain unconscious they’ll need a glucose IV
Name some other systemic diseases that affect periodontal disease
- Cardiovascular disease
- Ischaemc heart disease
- Cerebrovascular disease
- Chronic Obstructive Pulmonary Disease (COPD)
Is periodontitis genetic?
Theres is some sort of genetic factor
Cases of periodontitis in younger patients family aggregation has been seen so some aspects of periodontitis could be ascribed to genetics
How may genetics play a role in periodontal disease
Genetic factors may increase the suthe susceptibility to other associated chronic conditions like cancer, heart disease and diabetes
These condition scan increase a persons risk of developing periodontal disease
Give some other risk factors of periodontal disease
Osteoporosis Dietary Calcium Vitamin D Obesity See lecture on nutrition and periodontal disease IBMS
What is Osteoporosis?
It is a conditions where bone mineral density is reduced
this leads to increase risk of fractures
In which population is Osteoporosis most common
post-menopausal women
Why are post-menopausal women more lily to have Osteoporosis?
Reduced oestrogen production after menopause results in increased bone resorption
How does Osteoporosis affect the mouth?
Theres Systemic bone resorption associated with mandibular bone resorption
Some studies suggest theres a correlation between systemic bone loss and periodontal disease
What should you tell patients that have diabetes?
- They are at grater risk of periodontitis
- Glycaemic control may be more difficult
- At higher risk of other complications eg cardiovascular disease
