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ADH - Shared Teaching Dental Surgery > Systemic Risk Factors - Part 2 > Flashcards

Systemic Risk Factors - Part 2 Flashcards

1
Q

Systemic risk factors

A
  • Smoking
  • Stress
  • diabetes
  • genetic factors
  • osteoporosis

Perio and nutrition
- dietary calcium
- vitamin D
- alcohol
- obesity

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2
Q

Diabetes mellitus

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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3
Q

Diabetes uk - Facts and figures

A

• International Diabetes Federation estimated that in 2017 there are 451 million (age 18-99 years) people with diabetes worldwide.

• These figures are expected to increase to 693 million) by 2045

• WHO estimated direct consequences of diabetes will be 7th leading cause of death by 2030

3.7 million (> 6% of UK) have diabetes
• Type 1 10%
• Type 2 90%
• Other
• Maturity Onset Diabetes in the Young 1-2% (20-40k)
• Gestational diabetes 3.5% of pregnancies
• Estimated 1 million undiagnosed, mainly Type 2

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4
Q

Difference between Type 1 and type 2 diabetes mellitus

A
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5
Q

Difference between diagnosis of type 1 and 2 diabetes

A
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6
Q

Which is the better measure for glucose levels?

A

Haemoglobin A1c test

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7
Q

Appendix: new system HbA1C

A
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8
Q

Why is Control/diagnosis of diabetes important

A

Implications of poor control or undiagnosed diabetes include:

  • diabetic complications
  • risk factor for periodontal disease
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9
Q

Type 1 diabetes mellitus treatment?

A
  • treat by insulin injections/insulin pump
  • balance carbohydrate intake and insulin
  • new technology included transplantation of pancreatic islets of langerhans
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10
Q

Type 2 diabetes treatment?

A
  • 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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11
Q

Home glucose monitoring

A
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12
Q

Complication of diabetes

A

Macrovascular
• Cardiovascular disease - majorcause of death & peripheralvascular disease - amputations
• Cerebrovascular disease & stroke

Microvascular
• Retinopathy – blindness
• Nephropathy – renal failure
• Neuropathy – painful nerve damage

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13
Q

Periodontal disease a complication of diabetes?

A
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14
Q

Glycated haemoglobin HbA1c 2018

A

Guide to diabetes control

Target is less than 7.5%

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15
Q

Implications on the nhs

A

Diabetes cost estimated £23.7 billion in UK (80% on complications)

• 10% NHS budget & 19% hospital beds accounted for by patients withdiabetes

• Projected cost  £39.8 billion 2035/6

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16
Q

Periodontology epidemiology type 1 diabetes mellitus adults

A

• With similar levels of plaque, poorlycontrolled Type 1 diabetics lost moreattachment and bone

• increased Risk of perio disease with increased age
• increased Severity with increased diabetes duration

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17
Q

Periodontal epidemiology in children age 6-18yrs

A

350 children 6-18 years with diabetes compared to 350 non-diabetes controls
• Mostly Type 1 DM (93%); 7%Type 2 DM
• 29% HbA1c < 7.5%

• Subjects with diabetes had increased inflammation and clinical attachment loss

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18
Q

Periodontal epidemiology type 2 diabetes mellitus adults

A

Many studies on Pima Indians
• High prevalence Type 2 DM
• x2.8 risk LOA, x3.4 risk bone loss than non-DM

• Worse periodontal problems with poor control
• increased frequent & increased advanced periodontal destruction with increased duration of diabetes

• Pima Indians with severe perio disease x3.2risk mortality due to ischaemic heart disease & diabetic nephropathy

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19
Q

US NHANESIII StudyType 2 DM

A

National Health and Nutrition Examination Study III

• Subset, n = 4343 aged 45-90years
• Poorly controlled T2 DM (HbA1c >9%)had higher prevalence severe periodontitis than if no DM, OR = 2.9

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20
Q

Links between diabetes and periodontal disease

A

Inflammation - central feature of pathogenesis of DM and periodontitis

It’s the likely shared pathway that causes these disease to interact with each other

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21
Q

Strong evidence periodontal infections induce systemic inflammatory response how?

A

• Evidence of increased levels of acute phase proteins (eg C-reactive protein) and pro-inflammatory cytokines
- In obesity IL-6 stimulates TNF-alpha
- Increased IL-6 and increased TNF-alpha may = insulin resistance (causes Type 2 DM)
- Increased IL-1ß may = pancreatic ß cell destruction (ie role in Type 1 DM)

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22
Q

What are the systemic risk factors and how are the connected / playing a part in periodontal disease?

A
23
Q

Potential connections between diabetes and periodontitis?

A
24
Q

Potential connections between diabetes and periodontitis?

AGE’s - how are they linked to perio

A

AGE
Advanced glycation end products

25
Q

Potential connections between diabetes and periodontitis?

RAGE’s - how are they linked to perio

A
26
Q

Relationship between periodontitis and obesity

A

Systematic review and Metaanalysis revealed significantassociation betweenperiodontitis and obesity, OR 1.35

27
Q

Obesity, periodontitis and insulin resistance connected how?

A

• BMI linked to severity of attachment loss in NHANESIII
• Obesity significant predictor of periodontal disease; insulin resistance may mediate link

Adipocyte production of proinflammatory cytokines (adipokines) may link obesity to diabetes and periodontitis

28
Q

In diabetes, what is impaired?

A

Impaired Polmorphonuclear Leucocyte (PMN) Function in DM

29
Q

Impaired Polmorphonuclear Leucocyte (PMN) Function in DM how?

A
30
Q

What type of relationship is periodontal disease and treatment and diabetes control?

A

Bi directional relationship

31
Q

Effect of periodontal diseases on diabetes control

Periodontal disease adversely affect diabetic control and outcomes - what?

A
  • control
  • complications
  • incidence
32
Q

Effect of periodontal treatment on diabetes control studies?

A

Review shows
• There is low quality evidence that the treatment of periodontal disease by SRP does improve glycaemic control in people with diabetes, with a mean percentage reduction in HbA1c of 0.29% at 3-4 months; however, there is insufficient evidence to demonstrate that this is maintained after 4 months.

recent study shows
• Intensive periodontal therapy reduced HbA1c in patients with type 2 diabetes and moderate-to-severe periodontitis after 12months

33
Q

Effect of periodontal treatment on diabetes control

A

Decreased HbA1c of 1% = decreased risk of

  • deaths related to diabetes 21%
  • myocardial infarction 14%
  • microvascular complications 37%

Reduction of relatively small levels of HbA1c may be equivalent to a drug therapy (pt can be taken off a drug) - perio therapy is better and has less side effects than being on meds

34
Q

Periodontal care for patients with diabetes

A

Check HbA1c with Diabetes Care Team

Follow principles of 3 stages of therapy

• Initial therapy: GDP canundertake; if poor response,consider specialist referral
• Corrective therapy: Consideradjunctive systemic antibiotics (but more research needed)
• Supportive therapy: GDP canundertak

35
Q

Management of hypo

A

• Hypoglycaemia: Pale, shaky, clammy, may beaggressive/confused; blood glucose <4 mmol/l

• Give 3-6 glucose tablets (3g each) ie 10 - 20g

• OR, give glucose drink eg Lucozade 150-200m

36
Q

Management Of Severe “Hypo

A

• Give glucagon IM, SC or IV injection (1 mg if adult or childover 8 yrs; 0.5mg if under 8yrs)

• Plus further carbohydrate on recovery

• Advice: get doctor/dial 999 if no recovery in 10 minutes

• If still unconscious, will need glucose IV

37
Q
A
38
Q

Case supportive Therapy

  • what is it
  • how freq
  • why
A

• Three monthly visits to General DentalPractitioner / Hygienist to maintain:

• Improved periodontal status andoral hygiene• Compliance/motivation
• Smoking cessation
• Improved diabetes control and decreased HbA1c

39
Q
A
40
Q

Pre tx chart shows what

A

PD > 5mm = pt unstable

41
Q

Following initial therapy what does the chart show

A

Improvement

42
Q

Other systemic disease / conditions

What are they and their relationship to periodontitis

(Base don studies no evidence)

A
43
Q

What is another systemic factor with evidence relating to periodontitis?

A

Genetics

44
Q

Relevance of genetics (young and old pt)

A

Periodontitis that occurs early in age and progresses fast has shown familial aggregation

In the more common form of periodontaldisease seen in older patients with slower progression the picture is less clear

45
Q

Periodontitis andGenetics Studies

A
46
Q

Genetic Factors and Periodontal Disease

  • what can genetic factors increase susceptibly to
A

Genetic factors may increase the susceptibility to other associated chronic conditions
• Cancer
• Heart disease
• Diabetes

• A study of shared genetic risk factors between cancer and periodontal disease inmonozygotic twins
• Found association between periodontal disease and several cancers
• Hypothesis that inflammation underlies the association and IL-1 gene polymorphisms associated with increased levels ofperiodontal disease may be associated withincreased cancer

47
Q

Other risk factors for periodontal disease

A

• Osteoporosis
• Dietary Calcium
• Vitamin D
• Obesity

48
Q

What is osteoporosis and how does it does it correlate to perio?

A

• Reduced bone mineral density
• Most common in post-menopausal womenbut does occur in men
• Leads to increase risk of fracture; typically hip fractures after a fall
• Reduced oestrogen production aftermenopause results in increased bone resorption
• Systemic bone resorption associated withmandibular bone resorption
• Some studies show a correlation between systemic bone loss and periodontal diseas

49
Q

What is EFP manifesto

A
50
Q

Guidelines for dental practice - EFP/AAP

For patients with diabetes mellitus

A

Patients with DM should be told:
• At increased risk of periodontitis
• Glycaemic control may be more difficult
• At higher risk of other complications eg cardiovascular disease

And should:
• Receive thorough oral/perio exam(adults and children)

51
Q

Guidelines For Dental Practice – EFP/AAP

For pt with periodontitis

A

If periodontitis, need:

•Therapy (IT,CT,SPT);OHE
•Manage acute infections, oral complications; dental rehabilitation if tooth loss

52
Q

Guidelines For Dental Practice – EFP/AAP

If no periodontitis & no DM(yet!) need:

A

If no periodontitis & no DM(yet!) need:
•Prevention, monitor
•If risk for Type 2 DM, informpatient, do chairside HbA1c or refer to GP

53
Q

Conclusion

A

ADH - Shared Teaching Dental Surgery (8 decks)

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