Systemic Risk factors 2

Question 1

What is diabetes mellitus characterised by?

Answer 1

Chronic hyperglycaemia from insulin deficiency or impaired utilisation of insulin

Question 2

How many people world wide are estimated to suffer from diabetes?

Answer 2

451 million

Question 3

How many people in the uK are estimated to have diabetes?

Answer 3

3.7 million

Question 4

What percentage of diabetics in the UK have type 1 diabetes?

Answer 4

10%

Question 5

What percentage of diabetics in the UK have type 2 diabetes?

Answer 5

90%

Question 6

Describe type 1 diabetes

Answer 6

It is the destruction of beta cells in the pancreas
It is a genetic autoimmune disease that affects the islet cell antibodies
It has an abrupt early onset

Question 7

Describe type 2 diabetes

Answer 7

It is a defect in beta cells and insulin resistance
It usually manifests mid life
it does have a genetic influence but is affected by your lifestyle

Question 8

What increases your risk of developing type 2 diabetes?

Answer 8

1. If you’re obese
2. If you have a sedentary lifestyle
3. If you are of asian or afro Caribbean descent

Question 9

How can you diagnose diabetes?

Answer 9

1. By checking a patients venous plasma glucose concentrations
2. We can use Haemoglobin A1c (HbA1C)

Question 10

How high would a diabetic patients venous plasma glucose concentrations at a random time of the day and after fasting?

Answer 10

Random venous plasma glucose > 11.1 mmol/litre,

or fasting venous plasma glucose >7.0mmol/litre,

Question 11

How high would a normal patients venous plasma glucose concentrations before and 2 hours after a meal

Answer 11

4–5.5 mmol/l before meals,

<8mmol/l two hours after meals

Question 12

What symptoms are associated with diabetes?

Answer 12

1. Unexplained weight loss
2. Polyuria
3. Polydipsia

Question 13

Why can we use Haemoglobin A1c to diagnose diabetes?

Answer 13

As glucose binds to blood haemoglobin within circulating erythrocytes for lthe life span of a RBC

Question 14

What is the life span of a red blood cell?

Answer 14

8-12 weeks

Question 15

How can we use Haemoglobin A1c to diagnose diabetes?

Answer 15

We can measure how much of the haemoglobin is glycated

Question 16

What is the cut of concentration when testing for Haemoglobin A1c?

Answer 16

4.8mmol/mol which is 6.5%

Question 17

What should you ask a patient who has diabetes?

Answer 17

Which type of diabetes they have and how well is their diabetes controlled
Also ask for their HbA1c levels

Question 18

How is type one diabetes mellitus treated/controlled?

Answer 18

Treated by insulin injections/insulin pump

Patients need to balance carbohydrate intake and insulin levels

Question 19

How is type two diabetes mellitus treated/controlled?

Answer 19

Treated by diet control and exercise (in some cases oral hypoglycaemic drugs may be prescribed)
25% of patients may go o to need insulin injections

Question 20

When using a home blood glucose monitoring kit what concentration of blood glucose should a patient aim for?

Answer 20

4-7 mmol/ litre

Question 21

What are some of the complication of diabetes?

Answer 21

1. Cardiovascular diseases
2. Peripheral vascular disease
3. Cerebrovascular disease & stroke
4. Retinopathy (blindness)
5. Nephropathy (renal failure)
6. Neuropathy (painful nerve damage)

Question 22

What problems can poorly controlled diabetes lead to in dentistry?

Answer 22

Periodontal disease As patients have more attachment loss and more bone loss

Question 23

What implications does diabetes have on the NHS?

Answer 23

1. Diabetes cost estimated £23.7 billion in UK (80% on complications)
2. 10% NHS budget & 19% hospital beds accounted for by patients with diabetes

Question 24

What increases the severity of periodontal disease?

Answer 24

Increased age and increases with diabetes duration

Question 25

What links diabetes mellitus and periodontitis?

Answer 25

Inflammation is key to the pathogenesis of both diabetes and periodontitis

Question 26

What do periodontal infection induce?

Answer 26

Systemic inflammatory response

Question 27

What does an increased inflammatory response lead to?

Answer 27

Increases levels of acute phase proteins and pro pro-inflammatory cytokines

Question 28

An increase in which acute phase protein can lead to insulin resistance?

Answer 28

Increased IL-6 and TNF

Question 29

An increase in which acute phase protein can lead to pancreatic beta cell destruction?

Answer 29

Increased IL-18

Question 30

What does AGE stand for?

Answer 30

Advanced Glycation End products

Question 31

What leads to an AGE interaction?

Answer 31

Hyperglycaemia cashless collagen to undergo non enzymatic glycation to Advanced Glycation End products (AGES)

Question 32

What change occurs in collagen during hyperglycaemia?

Answer 32

1. Increased cross linking (but not in a +way) 2. Increased cytokine production (microvascular complications) 3. Atherosclerosis 4. Decreased production of collagen in bone matrix

Question 33

What do AGEs activate?

Answer 33

Receptors for AGEs also known as RAGEs

Question 34

What do interactions between RAGEs and AGEs impact?

Answer 34

Impacts vascular and inflammatory cell function which lead to accelerated periodontal tissue breakdown

Question 35

What can obesity lead to?

Answer 35

Insulin resistance and therefore type 2 diabetes

Question 36

What is BMI linked to?

Answer 36

Severity of attachment loss in NHANES studies

Question 37

What is obesity a significant predictor of?

Answer 37

Periodontal disease

Question 38

An increase in IL6 and TNF can lead to what?

Answer 38

Insulin resistance

Question 39

An increase in IL-18 can lead to what?

Answer 39

Pancreatic beta cell destruction

Question 40

What causes an increase in acute phase proteins?

Answer 40

Inflammation

Question 41

What does PMN stand for?

Answer 41

Polymorphonuclear leukocytes

Question 42

What effect does diabetes have on PMNs?

Answer 42

1. Decreases PMN function leading to increased periodontitis 2. Enhances respiratory burst 3. Delays apoptosis thus increasing tissue destruction

Question 43

What do PMNs do?

Answer 43

They are our first line fo defence

Question 44

What is there a bi directional relationship between?

Answer 44

Between the effect of periodontal diseases and treatment and diabetes control

Question 45

What does it mean when we say theres a bi directional relationship between the effect of periodontal diseases and treatment and diabetes control

Answer 45

It means that not only does diabetes lead to periodontal destruction but periodontal disease and its treatment can impact on the diabetes

Question 46

What has research suggested periodontal disease can have an effect on in regards to diabetes?

Answer 46

Diabetes: control complications Incidences

Question 47

What is a decrease in HbA1c by 1% associated with?

Answer 47

Decreased risk of: 1. Deaths related to diabetes 2. Myocardial infarction 3. Microvascular complications

Question 48

How would you manage hypoglycaemia?

Answer 48

Give 3-6 glucose tablets (10-20G glucose) | Or give a glucose drink like lucozade

Question 49

What is hypoglycaemia characterised by?

Answer 49

``` Patient will be: Pale Shaky Clammy May be aggressive/confused Will have a blood glucose of les than 4mmol/l ```

Question 50

How would you mange SEVERE hypoglycaemia?

Answer 50

1. Give glucagon IM, SC or IV injection (1mg if adult or 0.5mg fro patients under 8) 2. Get a doctor or call 999 if theres no recovery in 10 mins 3. If they remain unconscious they'll need a glucose IV

Question 51

Name some other systemic diseases that affect periodontal disease

Answer 51

1. Cardiovascular disease 2. Ischaemc heart disease 3. Cerebrovascular disease 4. Chronic Obstructive Pulmonary Disease (COPD)

Question 52

Is periodontitis genetic?

Answer 52

Theres is some sort of genetic factor Cases of periodontitis in younger patients family aggregation has been seen so some aspects of periodontitis could be ascribed to genetics

Question 53

How may genetics play a role in periodontal disease

Answer 53

Genetic factors may increase the suthe susceptibility to other associated chronic conditions like cancer, heart disease and diabetes These condition scan increase a persons risk of developing periodontal disease

Question 54

Give some other risk factors of periodontal disease

Answer 54

``` Osteoporosis Dietary Calcium Vitamin D Obesity See lecture on nutrition and periodontal disease IBMS ```

Question 55

What is Osteoporosis?

Answer 55

It is a conditions where bone mineral density is reduced | this leads to increase risk of fractures

Question 56

In which population is Osteoporosis most common

Answer 56

post-menopausal women

Question 57

Why are post-menopausal women more lily to have Osteoporosis?

Answer 57

Reduced oestrogen production after menopause results in increased bone resorption

Question 58

How does Osteoporosis affect the mouth?

Answer 58

Theres Systemic bone resorption associated with mandibular bone resorption Some studies suggest theres a correlation between systemic bone loss and periodontal disease

Question 59

What should you tell patients that have diabetes?

Answer 59

1. They are at grater risk of periodontitis 2. Glycaemic control may be more difficult 3. At higher risk of other complications eg cardiovascular disease