Power Point not covered in lecture & other misc. Flashcards
Diabetes Mellitus?
- refers to a group of disorders exhibiting a defective/deficient insulin secretory resonse, glucose underutilization, and hyperglycemia
- net effect is a chronic disorder of carbohydrate, fat, and protein metabolism w/ long-term complications
Diabetes Alert?
- family history
- age > 40 yrs
- classic symptoms (3 P’s)
- periodontal abscesses (multiple recurrent)
- rapid alveolar bone loss
- poor response to treatment
Type 1 Diabetes?
- Beta-cell destruction
- Defective beta-cells
- result= insulin deficiency
- fatty acids (energy source) = ketones, ketoacidosis
- diabetic ketoacidosis (DKA)
Type 2 Diabetes?
- beta cells release insulin but cell receptors are insulin resistant
- glucose transport variable and ineffective
- less risk for DKA
- HHNS = hyperglycemic hyperosmolar nonketotic syndrome
Oral S/S?
- xerostomia
- burning mouth
- periodontal abscesses
- dental caries candidiasis
Periodontal Considerations?
- impaired wound healing
- increased plaque activity (xerostomia)
- periodontal abscesses
- altered PMN chemotaxis
- increased bone resorption
How does patient monitor condition? - Glycosylated Hb Assay?
- self-monitoring by patient
- “point-in-time” fasting, 2 hour PP
- over a period of time (10-12) weeks
- glycosylated Hb
- good long-term monitor
- Glycosylated Hb Assay
- 5-6% = normal
- 6-7% = moderate control
- > 8% = need to improve control
- each 1% change in HbA1C = 25-35 mg/dl glucose
Periodontal Treatment?
- determine the “control” status
- consultation if necessary
- schedule short appointments
- maximize stress reduction
- plan to treat before or shortly after peak insulin activity
- use antibiotics only as necessary
Periodontal Disease - Diabetes Mellitus ?
- periodontitis associated w/ poor glycemic control in Type 2 patients
- increased insulin resistance
- treatment improves glycemic control
PREGNANCY?
● low-birth-weight < 2500g ● multiple factors ● bacterial vaginosis ● gram (-) MO ● cytokines, PGE2 ● preterm labor
when we treat diabetics there are two values we ask?
- what is your blood glucose level (am glucose)
- What does this tell us? (doesn’t say anything about long term control
- We want Hemoglobin A1C measurements (most crucial information)
Who is on anticoagulants?
- Angina, heart patients, transplant patients etc.
- NEED to know INR (valid of 24 hours) to assess bleeding risk
- Less than 2.5 is safe for bleeding/ procedures
- Even for an injection
- INR of 4 means blood is very thin, no coagulation, at risk for bleeding even if they cut themselves shaving, danger range. Refer case to Skip and Joe our resident OMSs
- Coumadin is vitamin K dependent (therefore extremely diet sensitive)
Questions to never miss again?
- Proper diagnosis is the most important factor in treating PD.
- Primary bacteria associated with gingivitis is NOT anaerobic rods
- There is an equal balance of G+ and G- - Tetracycline (apparently the same as doxycycline) is given in low does systemically to treat/regulate MMP.
- Biological width= 2-3mm
- MGJ is the demarcation between attached gingiva and alveolar mucosa
How does Gram (-) periodontal infection affect glycemic control?
Gram (-) periodontal infection—> Increased insulin resistance–>Worsened glycemic control
What can improve glycemic control ?
Periodontal treatment—>Improved insulin sensitivity–>Improved glycemic control
How can a bacterial infection affect pre-term labor?
Bacterial infection—> Bacteria and products in amnion–>inflammatory response w/ cytokine production in amnion—> Increased amnionic prostaglandin production–>Preterm labor
