periodontal disease- diabetes and pregnancy

Question 1

explain the relationship between periodontal disease and diabetes?

Answer 1

bi-directional relationship meaning those with poorly controlled periodontal disease will find it more difficult to control blood glucose levels and vice versa

Question 2

what is the difference between type 1 and type 2 diabetes

Answer 2

type 1- insulin dependent- body doesn’t produce insulin

type 2- insulin independent- body doesn’t make enough and becomes insulin resistant

Question 3

what does diabetes cause?

Answer 3

chronic hyperglycaemia

Question 4

what would indicate a patient has undiagnosed diabetes in dentistry?

Answer 4

• recurrent abscesses
• exaggerated periodontal disease
• poor tx outcome

Question 5

what does uncontrolled diabetes do to periodontium?

Answer 5

increase in advanced glycation end products causing:

hyper responsive monocyte phenotype- release damaging amounts of pro-inflammatory cytokines IL1 and TNF
- increased vasculature, vasodilation and leakiness
- oxidative stress and periodontal tissue damage

Question 6

what does periodontal disease do to diabetes?

Answer 6

• increase in inflammatory response= vasodilation, increase vascularity and leakiness of blood vessels
• meaning bacteria and inflammatory cytokines leak into blood vessels causing systemic inflammation- worsening systemic conditions and increasing insulin resistance.

Question 7

what else does diabetes cause?

Answer 7

• reduced neutrophil function, adherance, chemotaxis- failure to phagocytose microbes
• increase collagenases and breakdown of collagen
• reduction in fibroblasts needed for healing and formation of gingival collagen
• poor wound healing

Question 8

how can periodontal disease affect CVD?

Answer 8

• hyper responsive monocytes- release excessive cytokines into blood stream due to increase vascularity and leakiness- causing systemic inflammation and worsening of systemic diseases
• periopathogens such as p gingivalis have surface proteins that trigger thrombosis of platelets which can lead to MI/stroke if bacteria enters blood stream
• periopathogens such as p.gingivalis can invade endothelial cells in vessel lining triggering immune response causing damage to tissue and contribute to plaque formation in vessels- atherosclerosis

Question 9

what is pregnancy gingivitis?

Answer 9

increased progesterone levels during pregnancy leads to increase sensitivity to plaque

Question 10

why is their an increase sensitivity to plaque?

Answer 10

• increases vascularity and vasodilation
• reduces keratinisation of gingivae- reduced barrier to bacteria

Question 11

if patient has good OH will pregnancy gingivitis returns to normal ?

Answer 11

yes after birth

Question 12

if more sever pregnancy gingivitis what should you do?

Answer 12

• OHI
• Debridement

Question 13

what can periodontal disease during pregnancy increase the chances of?

Answer 13

• low birth weight and early labour due to stimulated prostaglandins due to increased inflammatory response
• miscarriage
• high blood pressure

Question 14

what anaesthetic should be avoided and why?

Answer 14

prilocaine with felypressin- induce early labour

articaine not licensed for pregnancy

Question 15

how should a patient lie on the chair?

Answer 15

with right hip elevated- avoid compression of inferior vena cava and aorta

Question 16

how can pregnancy affect dentistry?

Answer 16

• morning sickness/acid reflux- erosion
• teratogenic effects of certain drugs especially during first trimester
• uncomfortable lying in dental chair
• drug contraindications
• higher caries risk due to poor tb (nausea), sugary snacks

Question 17

what can lying supine do in later pregnancy?

Answer 17

hypotension/ acid reflux

Question 18

are radiographs safe during pregnancy?

Answer 18

yes

Question 19

what should be given if acid reflux/erosion/morning sickness?

Answer 19

• OHI- don’t brush straight after
• fluoride mouthwash

Question 20

why may pregnant pt be taking fragmin and aspirin?amo

Answer 20

• previous miscarriages
• p gingivalis has surface proteins which trigger thrombosis so periodontal disease should be treated before progression

Question 21

what antibiotics are safe during pregnancy?

Answer 21

amoxycillin
clindamycin

Question 22

what may a pregnant patient present with on gum?

Answer 22

epulis- bleeding but no pain caused by changes in hormones

Question 23

how are epulis treated?

Answer 23

OHI as will resolve after birth- if not surgery

Question 24

why should periodontal disease treatment in pregnant patients be done and why in small sections and why not in first trimester?

Answer 24

• prevent progression
• increases bacteria in blood and systemic inflammation
• increases foetal stress due to increased inflammatory response

Question 25

amalgams should be avoided during pregnancy- when is the exception? can u do it if breast feeding?

Answer 25

• remove amalgam if in pain
• no mercury can be passed through breast milk

Question 26

what antibiotics should be avoided in pregnancy?

Answer 26

• zoles
• tetracycline

Question 27

if periodontal disease left untreated what may this cause?

Answer 27

• increased inflammatory response- stimulate prostaglandins causing low birth weight and premature birth

Question 28

how should amalgam be removed?

Answer 28

• rubber dam and good suction