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2nd yr - CSA- Tugnait > Systemic Risk factors 2 > Flashcards

Systemic Risk factors 2 Flashcards

1
Q

What is diabetes mellitus characterised by?

A

Chronic hyperglycaemia from insulin deficiency or impaired utilisation of insulin

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2
Q

How many people world wide are estimated to suffer from diabetes?

A

451 million

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3
Q

How many people in the uK are estimated to have diabetes?

A

3.7 million

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4
Q

What percentage of diabetics in the UK have type 1 diabetes?

A

10%

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5
Q

What percentage of diabetics in the UK have type 2 diabetes?

A

90%

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6
Q

Describe type 1 diabetes

A

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

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7
Q

Describe type 2 diabetes

A

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

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8
Q

What increases your risk of developing type 2 diabetes?

A
  1. If you’re obese
  2. If you have a sedentary lifestyle
  3. If you are of asian or afro Caribbean descent
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9
Q

How can you diagnose diabetes?

A
  1. By checking a patients venous plasma glucose concentrations
  2. We can use Haemoglobin A1c (HbA1C)
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10
Q

How high would a diabetic patients venous plasma glucose concentrations at a random time of the day and after fasting?

A

Random venous plasma glucose > 11.1 mmol/litre,

or fasting venous plasma glucose >7.0mmol/litre,

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11
Q

How high would a normal patients venous plasma glucose concentrations before and 2 hours after a meal

A

4–5.5 mmol/l before meals,

<8mmol/l two hours after meals

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12
Q

What symptoms are associated with diabetes?

A
  1. Unexplained weight loss
  2. Polyuria
  3. Polydipsia
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13
Q

Why can we use Haemoglobin A1c to diagnose diabetes?

A

As glucose binds to blood haemoglobin within circulating erythrocytes for lthe life span of a RBC

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14
Q

What is the life span of a red blood cell?

A

8-12 weeks

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15
Q

How can we use Haemoglobin A1c to diagnose diabetes?

A

We can measure how much of the haemoglobin is glycated

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16
Q

What is the cut of concentration when testing for Haemoglobin A1c?

A

4.8mmol/mol which is 6.5%

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17
Q

What should you ask a patient who has diabetes?

A

Which type of diabetes they have and how well is their diabetes controlled
Also ask for their HbA1c levels

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18
Q

How is type one diabetes mellitus treated/controlled?

A

Treated by insulin injections/insulin pump

Patients need to balance carbohydrate intake and insulin levels

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19
Q

How is type two diabetes mellitus treated/controlled?

A

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

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20
Q

When using a home blood glucose monitoring kit what concentration of blood glucose should a patient aim for?

A

4-7 mmol/ litre

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21
Q

What are some of the complication of diabetes?

A
  1. Cardiovascular diseases
  2. Peripheral vascular disease
  3. Cerebrovascular disease & stroke
  4. Retinopathy (blindness)
  5. Nephropathy (renal failure)
  6. Neuropathy (painful nerve damage)
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22
Q

What problems can poorly controlled diabetes lead to in dentistry?

A

Periodontal disease As patients have more attachment loss and more bone loss

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23
Q

What implications does diabetes have on the NHS?

A
  1. Diabetes cost estimated £23.7 billion in UK (80% on complications)
  2. 10% NHS budget & 19% hospital beds accounted for by patients with diabetes
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24
Q

What increases the severity of periodontal disease?

A

Increased age and increases with diabetes duration

25
Q

What links diabetes mellitus and periodontitis?

A

Inflammation is key to the pathogenesis of both diabetes and periodontitis

26
Q

What do periodontal infection induce?

A

Systemic inflammatory response

27
Q

What does an increased inflammatory response lead to?

A

Increases levels of acute phase proteins and pro pro-inflammatory cytokines

28
Q

An increase in which acute phase protein can lead to insulin resistance?

A

Increased IL-6 and TNF

29
Q

An increase in which acute phase protein can lead to pancreatic beta cell destruction?

A

Increased IL-18

30
Q

What does AGE stand for?

A

Advanced Glycation End products

31
Q

What leads to an AGE interaction?

A

Hyperglycaemia cashless collagen to undergo non enzymatic glycation to Advanced Glycation End products (AGES)

32
Q

What change occurs in collagen during hyperglycaemia?

A
  1. Increased cross linking (but not in a +way)
  2. Increased cytokine production (microvascular complications)
  3. Atherosclerosis
  4. Decreased production of collagen in bone matrix
33
Q

What do AGEs activate?

A

Receptors for AGEs also known as RAGEs

34
Q

What do interactions between RAGEs and AGEs impact?

A

Impacts vascular and inflammatory cell function which lead to accelerated periodontal tissue breakdown

35
Q

What can obesity lead to?

A

Insulin resistance and therefore type 2 diabetes

36
Q

What is BMI linked to?

A

Severity of attachment loss in NHANES studies

37
Q

What is obesity a significant predictor of?

A

Periodontal disease

38
Q

An increase in IL6 and TNF can lead to what?

A

Insulin resistance

39
Q

An increase in IL-18 can lead to what?

A

Pancreatic beta cell destruction

40
Q

What causes an increase in acute phase proteins?

A

Inflammation

41
Q

What does PMN stand for?

A

Polymorphonuclear leukocytes

42
Q

What effect does diabetes have on PMNs?

A
  1. Decreases PMN function leading to increased periodontitis
  2. Enhances respiratory burst
  3. Delays apoptosis thus increasing tissue destruction
43
Q

What do PMNs do?

A

They are our first line fo defence

44
Q

What is there a bi directional relationship between?

A

Between the effect of periodontal diseases and treatment and diabetes control

45
Q

What does it mean when we say theres a bi directional relationship between the effect of periodontal diseases and treatment and diabetes control

A

It means that not only does diabetes lead to periodontal destruction but periodontal disease and its treatment can impact on the diabetes

46
Q

What has research suggested periodontal disease can have an effect on in regards to diabetes?

A

Diabetes:
control
complications
Incidences

47
Q

What is a decrease in HbA1c by 1% associated with?

A

Decreased risk of:

  1. Deaths related to diabetes
  2. Myocardial infarction
  3. Microvascular complications
48
Q

How would you manage hypoglycaemia?

A

Give 3-6 glucose tablets (10-20G glucose)

Or give a glucose drink like lucozade

49
Q

What is hypoglycaemia characterised by?

A 
Patient will be:
Pale
Shaky 
Clammy
May be aggressive/confused 
Will have a blood glucose of les than 4mmol/l
50
Q

How would you mange SEVERE hypoglycaemia?

A
  1. Give glucagon IM, SC or IV injection (1mg if adult or 0.5mg fro patients under 8)
  2. Get a doctor or call 999 if theres no recovery in 10 mins
  3. If they remain unconscious they’ll need a glucose IV
51
Q

Name some other systemic diseases that affect periodontal disease

A
  1. Cardiovascular disease
  2. Ischaemc heart disease
  3. Cerebrovascular disease
  4. Chronic Obstructive Pulmonary Disease (COPD)
52
Q

Is periodontitis genetic?

A

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

53
Q

How may genetics play a role in periodontal disease

A

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

54
Q

Give some other risk factors of periodontal disease

A 
Osteoporosis
Dietary Calcium
Vitamin D
Obesity
See lecture on nutrition and periodontal disease
IBMS
55
Q

What is Osteoporosis?

A

It is a conditions where bone mineral density is reduced

this leads to increase risk of fractures

56
Q

In which population is Osteoporosis most common

A

post-menopausal women

57
Q

Why are post-menopausal women more lily to have Osteoporosis?

A

Reduced oestrogen production after menopause results in increased bone resorption

58
Q

How does Osteoporosis affect the mouth?

A

Theres Systemic bone resorption associated with mandibular bone resorption
Some studies suggest theres a correlation between systemic bone loss and periodontal disease

59
Q

What should you tell patients that have diabetes?

A
  1. They are at grater risk of periodontitis
  2. Glycaemic control may be more difficult
  3. At higher risk of other complications eg cardiovascular disease

2nd yr - CSA- Tugnait (3 decks)

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