2d - RFOP Diabetes

Question 1

Common complications of diabetes?

Answer 1

• Periodontitis – “sixth complication of diabetes”

• Retinopathy

• Neuropathy

• Nephropathy

• Macrovascular and microvascular disease

• Altered wound healing

Question 2

1
Types of diabetes?

2
What are they?

3
Caused by / associated with?

Answer 2

Question 3

Prevalence of type 2 diabetes?

Answer 3

• world wide epidemic
• continues to increase
• Prevalence increases in proportion with age

Question 4

Risk factors for Type II Diabetes

Answer 4

• Age
• Obesity
• Lack of Exercise
• Genetic - family history
• Genetic - Racial Background- esp Indian Subcontinent, Black Carribean

Question 5

Type 2 diabetes
What are the 4 tests we can do to diagnose ?
What is plasma glucose measured in?

Plasma glucose units in diabetes?

Answer 5

Question 6

1
What is HbA1c?

2
Why is it useful

3
What does it tell us and what are the levels?

Answer 6

Question 7

Why are HbA1c test important?

Answer 7

Question 8

Effects of Diabetes on Periodontal Disease

Answer 8

Question 9

Effect of Blood Glucose on risk of Periodontitis

Answer 9

Question 10

How does diabetes cause this damage

Answer 10

Question 11

What are AGE?

Answer 11

• Glucose-derived molecules
• once formed they’re Irreversible

Question 12

What do AGE do? Why bad? ↳

Answer 12

.

Question 13

Diabetes, lipids and periodontitis

Adiposity = high levels of fat / fat person

what does adiposity contribute to?
What do raised lipids cause ? (3)

Answer 13

.

Question 14

what does diabetes-associated periodontitis look like clinically

Answer 14

• No particular characteristic appearance
• sometimes increased pocketing disproportionate to amount of plaque present
• Sometimes periodontal abscesses

Question 15

what is the evidence of a bidirectional link between diabetes and periodontitis?

Answer 15

• Severe periodontitis worsens glycaemic control in DM and non-DM pts
  ↳ * Bacteria and inflammatory molecules leave periodontal tissues, enter the circulation
  and contribute to upregulated systemic inflammation
  ↳ * Leads to impaired insulin signalling and resistance
• In Diabetic pts, relationship between periodontitis severity and diabetes complications
• Evidence for diabetes onset in severe periodontitis patients

Question 16

1 - Can periodontal treatment help improve diabetic status / control?
2 - Why?

Answer 16

1 - yes

• Reduction of HbA1C following periodontal therapy
• Reduction of 3-4mmol/mol (≈ 0.3-0.4%) in short term
  
  • Similar to effect of additional drug!

2 -

Reduced bacterial challenge thought to reduce systemic inflammation and improve insulin resistance and insulin signalling

Question 17

what oral observations in patients may indicate that they have undiagnosed diabetes?

Answer 17

• Recurrent periodontal abscesses
• Rapidly progressing periodontitis
• Severe periodontitis
  - Particularly : those over the age of 45 years
  - Concomitant risk factors ( BMI > 25, hypertension, family history)

consider referral for testing

Question 18

what to consider when treating patients with diabetes

Answer 18

• Regularly updated medical history – medications and level of glycaemic control
• Precautions for insulin-using diabetics – risk of hypoglycaemia
• Diabetics may also present with xerostomia and oral mucosal diseases
• May also be multi-medicated eg calcium channel blocking antihypertensives - have direct relevance to periodontium - may aggravate problems
• Part of diagnostic statement in periodontal diagnosis (diabetes = formal risk factor)