systemic diseases & perio Flashcards
(9 cards)
what is the classical study showing diabetes as a risk factor for perio
Pima indian study
- they had a high rate of diabetes
- showed that diabetic had 2.6x higher prevalence of perio disease
overall smokers have …?
effects on perio
- more advanced perio disease than non-smokers & formers smokers
- more tooth loss
- more pathogenic oral flora
- less favourable tx outcomes after perio therapy (surg & non surg)
what systemic conditions have strong rs between perio ?
down syndrome
diabetes
3 main mechanisms showing that diabetes is a risk factor for Perio
think of the problems of diabetes
- Up-regulated inflammatory response
- Altered collagen metabolism
- Impaired immune response
Explain the pathogenesis of upregulated inflammatory response (diabetes –> perio)
- In perio, inflammation is stimulated by** long-term** presence of subg biofilm. Leads to dysregulated production of inflammatory mediators & tissue breakdown
- Inflammation is the central feature of pathogenesis of perio & diabetes
- Hyperglycaemic Condition
- Hyperglycaemia associated with elevated levels of CRP, IL-6 and TNF-a. (pro-inflammatory mediators)
- Pro-inflammatory mediators play key role in pathogenesis of perio
- TNF-a stimulates increased release of MMP (matrix metalloprotienases), cause ECM degradation (collagen, CT, periodontium). Exacerbates tissue destruction - AGE/RAGE
- Hyperglycaemia leads to accumulation of AGE ijn perio tissues
- AGE receptor (RAGE) found in macrophages
- AGE binds to RAGE:
–> Increase production of inflammatory mediators (1L-1b, 1L-6, TNF-a)
–> Increased production of ROS, increase oxidative stress and inflammation
–> Impaired repair and bone formation
- Overall increase inflammation and periodontal breakdown - RANKL/ OPG
- Hyperglycaemia –> reduce production of OPG by fibroblasts –> increased RANK/RANKL binding
(OPG inhibits binding of RANK/RANKL)
- Increased levels of pro-inflammatory cytokines –> Increase production of RANKL –> Upregulate RANK/RANKL pathway and –> Increased bone loss/ osteoclastogenesis
OVERALL:
- diabetes causes a dysregulated inflammatory response and periodontal destruction
AGE: advanced glycated end products
ROS: reactive o2 species
Diabetes –> Perio link
Hyperglycaemia associated with elevated levels of what cytokines/ molecules?
3!!!!
- IL-6
- TNF-a (tumor necrosis factor) –> promotes inflammation
- C-reactive protein (CRP)
Diabetes –> Perio
What TNF-a do when released
TNF-a stimulates increased release of MMP, breakdown of ECM.
Increased periodontal tissue destruction and disease progression
Diabetes –> Perio
Explain altered collagen metabolism in diabetes pt. Linked to Perio.
- Chronic hyperglycaemia
- thickened basement membrane of cells
- impaired cell migration
- poor O2 perfusion
- poor waste elimination - AGE accumulation
- AGE aids in collagen cross-linking
- Accumulation of AGE –> more crosslinking and collagen less soluble, less likely to be replaced - Dysfunction of gingival fibroblasts
- reduced proliferation and increased apoptosis of fibroblasts
- overall reduced collagen production
OVERALL
- damaged collagen due to diabetes, remains in tissues
- impaired tissue integrity, more susceptible to pathogenic breakdown
Explain impaired immune response in diabetes –> Perio
Metabolic changes in diabetes may cause PMN defects
Defective PMNs (neutrophils):
- reduced chemotaxis to site of inflammation
- redcued phagocytosis
- reduced microbicidal function (inhibit growth of organisms)
- defective apoptosis
- Increased retention of PMN in periodontal tissues, leads to continued release of MMP and ROS by neutrophils (PMNs) –> further tissue destruction
OVERALL:
- Impaired host response, reduced resistance to infection, increased bacteria proliferation (neutrophils cannot attack)
