1/2 of this is on Final only - Utah Systemic Perio Disease Flashcards by Brennan Stringam

Which pro-inflammatory signals are high in disease?

Which are high in health?

IL-1beta
TNF-alpha
INF-gamma
PGE2
MMPs

IL-4
IL-10
IL-1ra
TGF-beta
TIMPs

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Periodontitis may be related to the risk of what?

Cardiovascular disease

Preterm low-birth weight infants

Diabetes

Respiratory disease

Osteoporosis

Menopause

HIV

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What is SBE?

Sub-acute Bacterial Endocarditis

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Practice adjustments should be made for what populations?

Diabetes pts

Pregnancy

Cardiovascular disease pts

Elderly pts

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Antibx prophylaxis is indicated when?

For pts with:

Prosthetic cardiac valve(s)
Previous endocarditis
Sometimes with congenital heart disease

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What is the number one food that causes diabetes?

RICE

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Diagnosis of diabetes?

Fasting blood glucose levels greater than or equal to 126 mg/dL

2 hour blood sugar level greater than or equal to 200 mg/dL after oral glucose test

HbA1c level greater than or equal to 6.5%

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Biggest dental problem in our office will be what?

Hypoglycemia

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Type I diabetes is also called what?

IDDM (Insulin-dependent diabetes mellitus) 5-10%

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Type II diabetes is also called what?

NIDDM (Non-insulin dependent diabetes mellitus) 90-95%

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Gestational diabetes is how prevalent?

3-5% of all pregnancies

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Who is at risk for secondary diabetes?

Weightlifters

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What is diabetes?

Metabolic disorder where the body does not produce or use insulin properly

About 10% of US population

6th leading cause of death among Americans

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When does diabetes express?

In childhood

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Tell me about type I diabetes.

Insulin not created at all

5-10% of diabetes cases

Req’s daily insulin supplementation

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Tell me about type II diabetes.

Insulin is produced, but not used effectively

90-95% of diabetes cases

Occurs most often in overweight people

May or may not req medication

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Gestational diabetes is more frequent among what populations?

Black, Latino, American Indians

Obese women and women and family history during pregnancy

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Tell me about gestational diabetes.

Req’s thx to normalize maternal blood glucose levels to avoid infant complications

After pregnancy

5-10% of women get Type II
20-50% chance of developing diabetes in the next 5-10 years

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What are 6 classic complications of DM?

Retinopathy

Nephropathy

Neuropathy

Cardiovascular disease

Altered wound healing

Periodontal disease

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What is insulin resistance?

Common symptom of type II DM

Insufficient insulin production OR improper insulin fx at cellular level

Sugar is locked out of cells and builds up in blood

Production of AGEs

Metabolic syndrome

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What are the 4 types of pts with diabetes that we will see?

Diagnosed and controlled

Diagnosed and uncontrolled

Family history
-diagnosed/undiagnosed

Undiagnosed

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How to detect diabetes?

Classic signs and symptoms:

Excessive thirst (polydipsia)
Excessive urination (polyuria)
Unexplained weight loss
Vision changes
Weakness, malaise
Irritability
Nausea
Dry mouth
Ketoacidosis

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Two types of glucose monitoring.

Glucometer
-Widespread use

Glycosylated hemaglobin

HBA1 - less common
HBA1c - Home/office test

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Dx of diabetes?

Test must be confirmed on subsequent day

Urinary test is no longer the standard of care

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What are the normal values for HbA1 levels?

5.8-8.4%

What are the normal levels for HbA1c test?

4.5-6.7%

What is HbA1c?

Glycosylated hemoglobin level *Reflect glucose levels in the blood over the preceding 30-90 days*

What are the normal clinical levels of HbA1c?

4.5 - 6.7%

Epinephrine does what to the blood glucose level?

Drops glucose in the blood

What are the other percentages for total hb for clinical interpretation?

< 7% - Good control 7-8% - Moderate control >8% - Time to improve control

For 1 A1c% increase, what is the increase in average blood sugar (mg/dL)?

30 *5% HbA1c = 80 mg/dL 6% HbA1c = 120 mg/dL ... 12% HbA1c = 300 mg/dL

What are AGEs?

Advanced glycation end products

What do AGEs do to connective tissue?

Forms cross-links in tissue fibers * Delayed wound healing * Smoking exacerbates this Rxns with RAGEs (receptors of advanced glycation end products) Inflammatory products

What time frame does HbA1c measure?

30-90 days | -2-3 months

What do AGEs result in?

Collagen accumulation in periodontal capillary membranes (membrane thickening) Stim of smooth muscle increases thickness of vessels Binding of LDL to AGE-modified collagens -Narrows the vessel lumen

What effects do AGEs have on collagen turnover?

Increased MMP production -Degrades newly formed collagen Decreased solubility Leads to narrow vessels, increased damage, and less wound healing

What are AGEs?

Nonenzymatic addition of hexoses to proteins Interfere w/ proper fx of proteins they are attached to HbA1c measure 2-3 months preceding the test

What are AGEs?

Nonenzymatic addition of hexoses to proteins Interfere w/ proper fx of proteins they are attached to HbA1c measure 2-3 months preceding the test

What AGE effects are on the PMNs?

Leukocyte adherence Chemotaxis Phagocytosis *Defect in the first line of defense

What AGE effects happen on the macrophages?

HYPERresponse - Increase IL-1beta secretion - IL-6 - TNF-alpha - PGE2

What are the AGE effects on endothelial cells?

HYPERpermeability HYPERexpression of adhesion molecules Procoagulatory changes -Blood clots and vasoconstriction

Macrophage interacts with LPS via what receptor?

Toll-like receptor | -Including CD14

T/F - Diabetics have an increased risk for periodontal disease.

TRUE *For both types

T/F - If we can control blood glucose levels, we can decrease the diabetic’s risk for periodontal disease.

TRUE *And vice versa

For uncontrolled diabetics, what two things need to be used to improve glycemic control, in terms of the oral cavity?

Mechanical (scaling) AND systemic antibiotics -Doxycycline is commonly used —Binds the divalent cations and decreases collagenase levels *NOT JUST MECHANICAL ALONE

T/F - Evidence supports a relationship b/t diabetes and periodontal disease. T/F - The relationship is most likely bi-directional. T/F - Add’l studies are needed to establish this relationship.

TRUE TRUE TRUE - Tx of periodontal disease contributes to glycemic control - Reduces complications of diabetes

T/F - Obesity affects up to 30% of the US population.

TRUE * Linked to other health concerns - Diabetes - Periodontal disease

T/F - Fat is an inflammatory tissue that releases TNF-alpha, CRP, and other cytokines.

TRUE

T/F - Cytokines can lead to insulin resistance and type II diabetes.

TRUE

________ is a risk factor for both type 2 diabetes and periodontal infection.

Obesity

T/F - Diabetes heightens risk for periodontal disease.

TRUE

Does obesity affect wound healing?

Yes | -Decreases wound healing

What is the 3 way street?

Obesity Diabetes Periodontal disease

What two inflammatory molecules are in the middle of the 3 way street triangle?

IL-6 TNF-alpha

T/F - There is a higher prevalence of tooth loss in diabetics.

TRUE - Increased inflammation - Decreased ability to fight infection

T/F - Tx of periodontal disease reduces need for insulin.

TRUE

What major cytokine interferes with the action of insulin and glycemic control?

TNF-alpha *Associated with glycated hemoglobin

What are warning signs of diabetes?

``` Frequent urination Extreme hunger Extreme there’s Fatigue Impaired wound healing Frequent infection BLURRED VISION Unusual weight loss Fruity breath ```

What are the oral signs of diabetes?

Foamy saliva Dry and irritated tissue Severe periodontal inflammation

What is the target glucose levels in type 2 diabetes?

90-126 mg/dL After a meal -<170 mg/dL

How to treat diabetics?

Manage soft tissue inflammation More recalls Enforce home care -Brush, floss, rinse Monitor blood glucose levels

T/F - About 1/2 of people with diabetes have severe periodontal disease.

TRUE

RAGEs are found on what cells?

Monocytes Macrophages Endothelial cells *NOT FIBROBLASTS*

AGEs do what?

INCREASE the amount of cross-linking in the triple helix making the collagen fiber stronger (and less easy to participate in turnover, resulting in wound healing issues)