Clinical Correlation: Dentistry and Diabetes

Question 1

healthy gingiva

Answer 1

pink

Question 2

gingivitis

Answer 2

inflammation confined in the gingival unit

no supporting bone loss and attachment loss

Question 3

periodontitis

Answer 3

inflammation not only affects the tissue, but also the surrounding bone
supporting bone loss and attachment loss

Question 4

peri-implant mucositis

Answer 4

plaque and calculous build up

Question 5

per-implantitis

Answer 5

supporting bone around the implant is affected

Question 6

how many Americans suffer from gum disease?

Answer 6

47. 2% have periodontitis

64. 7 million adults 30 years and older

Question 7

70% of adult took loss is contributed to

Answer 7

periodontal disease

Question 8

periodontal disease can effect systemic health, such as (4)

Answer 8

diabetes
adverse pregnancy outcomes
respiratory diseases
cardiovascular disease and stroke

Question 9

how many new cases of diabetes are there per year?

Answer 9

1.4 million

Question 10

diabetes increases with

Answer 10

age

90% over 45 y/o

Question 11

prevalence of type 1 diabetes vs type 2

Answer 11

5-10%

90-95%

Question 12

tendency toward ketosis and coma in type 1 vs type 2

Answer 12

type 1: marked tendency toward ketosis and coma

type 2: development of ketosis and coma is uncommon

Question 13

random blood sugar test

diabetes:

Answer 13

200 mg/dl or above

Question 14

glucose tolerance test
diabetes:
prediabetes:
normal:

Answer 14

diabetes: 200+ mg/dl
prediabetes: 140-199 mg/dl
normal: <140 mg/dl

Question 15

fasting blood sugar test
diabetes:
prediabetes:
normal:

Answer 15

diabetes: 126+ mg/dl
prediabetes: 100-125 mg/dl
normal: <99 mg/dl

Question 16

what complication can hyperglycemia lead to? (3)

Answer 16

macro/micro antipathy
neuropathy
increased risk of infections

Question 17

what are the oral impacts of uncontrolled diabetes? (2)

Answer 17

recession and tooth loss

papilla is swollen/enlarged

Question 18

diabetes is a risk factor for

Answer 18

periodontal disease

Question 19

diabetes is a risk factor for periodontal disease which can lead to… (3)

Answer 19

increased prevalence and severity of attachment loss
multiple periodontal abscess
impaired wound healing

Question 20

type 1 diabetes was associated with a 5 fold increased prevalence of — in teenagers

Answer 20

periodontitis

Question 21

type 2 diabetes patients are three times more likely to develop

Answer 21

periodontal diseases

Question 22

how many diabetics have severe periodontitis?

Answer 22

1 in 3

Question 23

oral microbial flora
type 1:
type 2:

Answer 23

type 1: capnoctyophaga sp

type 2: porphyromonas gingivitis (similar to non-diabetic patients)

Question 24

how does diabetes-periodontal disease alter host defense mechanisms? (2)

Answer 24

decreased PMN function (decreased chemotaxis and phagocytosis)
increased glucose in GCF promotes increased AGE

Question 25

what are the vascular changes in diabetes-periodontal disease? (2)

Answer 25

increased thickness of basement membrane and vessel walls (due to AGEs accumulation) leading to decreased O2 diffusion and elimination of wastes

Question 26

collagen breakdown in diabetes-periodontal disease patients (3)

Answer 26

altered collagen metabolism (stimulation of collagenase activity) limited production of growth factors impaired wound healing and increased severity of periodontitis

Question 27

how does diabetes lead to periodontal disease?

Answer 27

those with diabetes have increased cytokine production and altered apoptosis, along with AGE/RAGE interaction and decreased PMN function. the factors lead to dysregulated inflammatory response with increased pro inflammatory cytokines and collagenases. this leads to altered oral microbiota and eventual periodontal disease

Question 28

are diabetes and periodontal disease a two way relationship?

Answer 28

yes

Question 29

poor glycemic control and insulin resistance in patients with diabetes may be a result of cytokines secreted due to

Answer 29

chronic inflammation

Question 30

patients with type 2 diabetes who had severe periodontitis have -- times more risk of worsening glycemic control

Answer 30

6x

Question 31

how does periodontal disease affect diabetes?

Answer 31

moderate to severe periodontitis is associated with an increased risk for the development of diabetes

Question 32

severe periodontitis affects --- levels

Answer 32

HbA1c

Question 33

periodontitis also affects

Answer 33

glycemic control

Question 34

how does periodontitis affect glycemic control?

Answer 34

gram-infection insulin resistance poor glycemic control

Question 35

how does periodontal treatment affect glycemic control?

Answer 35

periodontal treatment improved insulin sensitivity improved glycemic control

Question 36

evidence showed significant improvement of --- control after treatment

Answer 36

glycemic

Question 37

after scaling and root planning, there was an average decrease in --- values about 0.4%

Answer 37

HbA1c

Question 38

does antibiotic therapy have any additional benefits?

Answer 38

no

Question 39

what is the protocol for treatment for patients with diabetes-periodontal disease? (8)

Answer 39

``` prescription has been taken morning appointments morning vitals may need t alter post-op insulin doses short appointments limited amount of epinephrine diet control frequent recall and reinforcement of OH ```

Question 40

how to achieve periodontal health, goals for treatment (4)

Answer 40

medication and diet instruction impact of periodontal infection educate diabetic patients about the importance of their personal oral hygiene as well as regular professional care actively treat periodontal disease

Question 41

can diabetic patients receive dental implants?

Answer 41

yes, if they have good metabolic glucose control

Question 42

hyperglycemia has a negative effect on

Answer 42

bone metabolism

Question 43

diabetic osteopathy (3)

Answer 43

reduce bone mineral density and bone mechanical properties increase risk fracture impair endochondral bone formation, intramembranous bone formation, microarchitectual quality

Question 44

what are the survival rates of dental implants in diabetic patients with good/fair metabolic control?

Answer 44

85-100%

Question 45

strict --- control before and after dental implant treatment is highly recommended

Answer 45

glycemic

Question 46

what if the patient has uncontrolled diabetes>

Answer 46

no dental implants until it is controlled (<7% is ideal, <8% is acceptable)

Question 47

what is a good alternative solution to those with uncontrolled diabetes? (2)

Answer 47

removable dentures | bridges as fixed prosthesis