ICS Autumn midterm: Diabetes w/perio + perio/systemic rlxn Flashcards
(37 cards)
what are the signs of diabetes
thirst urination weight loss poor wound healing excessive hunger blurred vision tingling or numbness of hands/feet
what are oral manifestations of poorly controlled diabetes
- oral candidiasis
- xerostomia
- dental caries
- burning mouth syndrome
- gingivitis and periodontitis
how can perio therapy help diabetes control
- decrease chronic oral gum infections
- can lower Hba1c
- removes pathogens that can react w glucose in uncontrolled diabetes
- improves glycemic control
- improved glucose metabolism
(biofilm with gram neg bacteria initiates immune response- can have adverse impact on insulin)
what is normal/pre diabetes and diabetes for hba1c
normal; less than 5.7%
prediabetes: 5.7-6.4%
diabetes: more than 6.5%
what are the types of insulin? what other oral medications do diabetes patients take
insulin:
- rapid acting; novolog, humalog, apidra, intermediate actin
- long acting-lantus (up to 24 hours), tresiba (up to 42 hours)
metformin and glipizide (sulfonylureas)
what are 2 names of continuous glucose monitors
dexcom 6 and libre
what are the instructions for a diabetic patient before treatment
- eat normal meal before appointment and take medicine
- bring medication and some glucose (juice, candy etc) with them
- have early morning appointments
what should you ask a diabetic patient
- confirm testing of glucose that day- what it was and when was it taken
- confirm they had breakfast, what did they eat
- have a source of glucose in the office JUST IN CASE
- quickest source is orange juice 4 oz
suggest a smoothie after treatment
whats the most common complication of diabetes in dental offices
HYPOGLYCEMIA
what are the diabetes risk factors to share w/patients
- overweight
- over 45
- patient/sib w type 2
- activity less than 3x a week
- gestation diabetes or having a baby over 9 pounds
- african american, hispanic, american indian, alaska native, pacific islanders and asian american
whats the health belief model
- perceived susceptibility (what if. i dont)
- perceived severity (whats the consequence)
- perceived barriers
- cues to action (reminders)
- self efficacy (habits to enhance)
what is a dental health coordinator
CDHC
- bring better oral health to underserved communities. role:
- provide care coordination
- provide community based prevention
- patient navigation, connect to a dentist
- oral health education
what are CHCs trained to do
- work in clinics, schools, private practice and public health settings
- collect info to assist dentists in triaging patients
- address social environmental and health literacy issues
- provide dental health education, help people enhance oral health
- provide limited clinical services: screenings, fluoride treatments, placement of sealants, x rays
what is the national diabetes education program
nDEP
- provides free evidence based and culturally appropriate resources to help community based organizations address diabetes in communities.
- resources can be used by community health workers, diabetes educatiors and health care providers
what health issues are related to perio health
- respiratory infections
- severe osteopenia (bone mass loss)
- preterm/low birthweight babies
- stroke
- heart disease
- uncontrolled diabetes
what is the connection between periodo and overall health
-perio inflammation- increases level of inflammatory mediators in systemic corculation. periodontal pathogens enter bloodstream and travel to distant parts of body
describe what release is from microbials in perio disease, host immuno inflammatory response, and results
microbial (gram neg mostly) release antigens, lipopolysaccharides (endotoxin produced by g-ve bacteria)and other virulence factors (protease released by p gingivalis)
host immune response releases antibodies back at antigens. it also releases cytokines and prostanoids, and matrix metalloproteinases (MMP) which result in connective tissue and bone metabolism. (MMP - proteolytic enzymes that destroy matrix molecules like collagen , gelatin and elastin) also osteoclast activation
BTW host immune response and connective tissue/bone metabolism are impacted by environment and genetic risk factors!!!!!!
what are systemic effects of periodontitis
- cardiovascular disease
- preterm birth
- diabetes mellitus
- respiratory disease
- alzheimers
what is artherosclerosis
progressive disease-> loss of elasticity of medium and large arteries. studies support that infections/inflammation are associated with artherogenesis and thromboembolic events
-primary risk factors for artherosclerosis: BP, high cholesterol, smoking obesity
how does perio disease associate with cardiovascular
periodontitis-> bacteremia (inblood) and systemic inflammatory response. -> c reative protein/acute phase response, fibrinogen -> these proteins trigger artherogenesis, plaque in arteries
the bacteremia/bacteria themselves are also responsible for artherogenesis!!
how do antibody titers prove the perio/cardiovasc relationship
-elevated antibody titers to certain perio pathogens linked to increased prevalence of cardiovascular disease, artherosclerosis in carotid and increased risk for cardiac events in 10 year followup
what systemic/inflammatory markers have they found related to periodontal disease?
-creative protein levels have strong linear relationship with incidecne of CV events.
patients with periodontitis had greater serum elevations in systemic markers of inflammation (CRP, IL6, fibrinogen) than healthy ppl
how does treating periodontal disease impact systemic
decreased systemic nflammation (CRP and TNF alpha), improvement of endothelial function
how common is pregnancy gingivitis
30-75% of pregnant women!!!!
-resolves after preg
