Diabetes and Periodontal Disease per final
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Questions and Answers

What is the relationship between diabetes mellitus and periodontitis?

  • There is no connection between diabetes and periodontal health.
  • Periodontitis does not affect individuals with diabetes.
  • Individuals with diabetes have a higher prevalence and severity of periodontitis. (correct)
  • Diabetes significantly reduces the risk of periodontitis.

    • Which of the following statements regarding types of diabetes mellitus is true?

  • Individuals with type I diabetes are generally not at risk for type II diabetes later in life.
  • Gestational diabetes occurs post-pregnancy.
  • Type II diabetes can develop when the body produces insufficient insulin. (correct)
  • Type I diabetes constitutes 90% to 95% of diabetes cases.

    • What impact does well-controlled diabetes have on periodontal disease risk?

  • Well-controlled diabetics are twice as likely to develop severe periodontitis.
  • There is no relationship between diabetes control and periodontal health.
  • Well-controlled diabetes results in no increased risk of periodontal disease. (correct)
  • Individuals with well-controlled diabetes have a significantly higher risk of periodontal disease.

    • How does smoking influence the risk of periodontitis in diabetics?

    <p>Smoking increases the risk of severe periodontitis by 20 times in diabetics.</p> Signup and view all the answers

    What is the glucose level goal for individuals with diabetes according to the information provided?

    <p>The goal is to maintain a hemoglobin Alc level of less than 7%.</p> Signup and view all the answers

    What physiological change occurs during puberty in relation to gingival tissues?

    <p>Increased blood circulation to gingival tissues</p> Signup and view all the answers

    What characterizes gingival inflammation during pregnancy?

    <p>It can occur with small amounts of biofilm present.</p> Signup and view all the answers

    Which factors are associated with the increase in gingival inflammation during the second and third trimesters of pregnancy?

    <p>Increased levels of estrogen and Prevotella intermedia</p> Signup and view all the answers

    What role does progesterone play in pregnancy-related gingival changes?

    <p>Suppresses immune response to dental biofilm</p> Signup and view all the answers

    What is a characteristic appearance of gingival tissues affected by pregnancy gingivitis?

    <p>Edematous and dark red tissues with bulbous interdental papillae</p> Signup and view all the answers

    What does a pyogenic granuloma, also referred to as a pregnancy tumor, typically present as?

    <p>Non-painful, tumor-like proliferation on gingiva</p> Signup and view all the answers

    How do periodontal pathogens potentially impact pregnancy outcomes?

    <p>They can enter the bloodstream affecting the fetus</p> Signup and view all the answers

    What effect do decreased hormone levels have on women during and after menopause?

    <p>Result in oral changes</p> Signup and view all the answers

    What is a primary cause of oral mucositis during chemotherapy?

    <p>Rapid cell death in mucous membranes</p> Signup and view all the answers

    Which medication types are most commonly associated with causing xerostomia?

    <p>Antihypertensives and antidepressants</p> Signup and view all the answers

    What oral complication is highly indicative of leukemia in patients?

    <p>Spontaneous gingival bleeding</p> Signup and view all the answers

    Which statement about gingival hyperplasia is correct?

    <p>It can result from certain medications.</p> Signup and view all the answers

    How does reduced salivary flow contribute to oral health issues?

    <p>It increases biofilm formation and root surface caries.</p> Signup and view all the answers

    What is an effective method for managing oral mucositis symptoms?

    <p>Prophylactic use of chlorhexidine</p> Signup and view all the answers

    Which of the following describes a consequence of xerostomia?

    <p>Increased risk of oral candidiasis</p> Signup and view all the answers

    What is the timeline for the onset of oral mucositis symptoms following chemotherapy?

    <p>10-14 days</p> Signup and view all the answers

    What is a characteristic appearance of gingiva affected by menopausal gingivostomatitis?

    <p>Pale, dry, and shiny</p> Signup and view all the answers

    Which medication is commonly associated with the development of osteonecrosis of the jaw (ONJ)?

    <p>Bisphosphonates</p> Signup and view all the answers

    What is one of the metabolic disturbances often included in the definition of metabolic syndrome?

    <p>High blood sugar</p> Signup and view all the answers

    Which oral manifestation is particularly associated with HIV infection?

    <p>Candidiasis</p> Signup and view all the answers

    What is a key characteristic of Linear Gingival Erythema (LGE)?

    <p>2-3 mm band of intense erythema</p> Signup and view all the answers

    In the context of neutropenia, what is the most critical concern for a patient's immunity?

    <p>Abnormally low numbers of neutrophils</p> Signup and view all the answers

    What is one common medical concern associated with individuals who have Down Syndrome?

    <p>Congenital heart defects</p> Signup and view all the answers

    What typically characterizes gingivitis associated with leukemia?

    <p>Swollen, glazed, spongy tissues</p> Signup and view all the answers

    What is one complication of long-term bisphosphonate therapy?

    <p>Increased risk of osteonecrosis of the jaw</p> Signup and view all the answers

    Which aspect of metabolic syndrome can directly impact periodontal status?

    <p>Chronic low-grade inflammation</p> Signup and view all the answers

    What is a typical dental treatment approach for Linear Gingival Erythema (LGE)?

    <p>Standard periodontal therapy with chlorhexidine mouthwash</p> Signup and view all the answers

    What common oral manifestation may appear in individuals with Down Syndrome at an early age?

    <p>Periodontal disease</p> Signup and view all the answers

    What condition is indicated by increased attachment loss in individuals infected with HIV?

    <p>Periodontal disease</p> Signup and view all the answers

    What is the most common side effect of phenytoin?

    <p>Gingival hyperplasia</p> Signup and view all the answers

    What are the three major classes of medications that can trigger gingival hyperplasia?

    <p>Anticonvulsants, Immunosuppressives, Calcium channel blockers</p> Signup and view all the answers

    Which medication is commonly used for controlling seizures and convulsions in epilepsy patients?

    <p>Phenytoin</p> Signup and view all the answers

    What is the incidence rate of gingival hyperplasia for patients taking cyclosporine?

    <p>25%</p> Signup and view all the answers

    Which medication is associated with a 38% occurrence of gingival enlargement?

    <p>Nifedipine</p> Signup and view all the answers

    What is a recommended way to reduce the incidence of gingival hyperplasia in patients taking phenytoin?

    <p>Scrupulous home care</p> Signup and view all the answers

    What is the primary use of nifedipine?

    <p>As a coronary vasodilator</p> Signup and view all the answers

    What percentage of children and young adults taking phenytoin commonly experience gingival overgrowths?

    <p>More than 50%</p> Signup and view all the answers

    Study Notes

    Diabetes and Periodontal Disease

    • Individuals with diabetes have a higher prevalence of periodontitis and more severe symptoms compared to non-diabetics.
    • Diabetes mellitus leads to a hyperinflammatory response to oral microbial biofilms and impairs the resolution of inflammation and repair.
    • Individuals with well-controlled diabetes have no increased risk for periodontal disease than persons without diabetes.
    • Individuals with poorly controlled diabetes are 3 times more likely to develop periodontitis.
    • Individuals with diabetes and who smoke are 20 times more likely than non-diabetics to experience severe periodontitis.

    Types of Diabetes

    • Three types of diabetes exist: Type I, Type II, and gestational diabetes.
    • Type I diabetes is caused by damage to the pancreas, accounting for 5-10% of cases.
    • Type II diabetes develops when the body does not make enough insulin, accounting for 90-95% of cases.
    • Gestational diabetes occurs during pregnancy.
    • Studies show that patients with gestational diabetes are at an increased risk of developing Type II diabetes later in life.

    Puberty

    • Increased hormones during puberty cause increased blood circulation to gingival tissues, potentially leading to increased sensitivity to irritants like biofilm.
    • Pubertal gingivitis occurs equally in males and females.

    Pregnancy

    • If a patient practices good oral hygiene throughout pregnancy, there is usually no problem with periodontal health.
    • Inflammation of the gingiva increases during pregnancy, even with small amounts of biofilm.
    • Gingival inflammation increases in the 2nd and 3rd trimesters due to elevated estrogen levels, exaggerating the host response to biofilm.
    • The second trimester is associated with increased levels of Prevotella intermedia, which uses estrogen as a substitute for natural growth factor.
    • Elevated progesterone levels enhance capillary permeability and dilation, resulting in increased gingival exudate and edema.
    • High levels of progesterone and estrogen suppress the immune response to dental biofilm.

    Pregnancy Gingivitis

    • Gingival tissues appear edematous and dark red with bulbous interdental papillae.

    Pyogenic Granuloma (Pregnancy Tumor)

    • A tumor-like proliferation on the interdental gingiva or gingival margin.
    • Non-cancerous and not painful.

    Premature Labor and Low Birth Weight (PLBW)

    • Research suggests that periodontal pathogens can enter the bloodstream, affecting the developing fetus, and potentially leading to premature labor and low-birth-weight babies.

    Menopause and Postmenopause

    • Decreased levels of circulating hormones result in oral changes including dry mouth, burning sensation, altered taste, and exacerbated bone loss.

    Menopausal Gingivostomatitis

    • Characterized by gingiva that bleeds readily, with an abnormally pale, dry, and shiny erythematous appearance.

    Medication-Induced Osteonecrosis of the Jaw (ONJ)

    • Bisphosphonates are commonly prescribed medications to inhibit systemic bone resorption.
    • Bisphosphonates cause a rare disorder called ONJ, characterized by painful exposed bone in the mouth that fails to heal after extraction or oral surgery.
    • Increased risk of ONJ is associated with IV Bisphosphonates used for cancer treatment and patients taking Bisphosphonates for osteoporosis for more than 3 years.

    Metabolic Syndrome

    • Closely related metabolic disturbances increase the risk of heart disease, stroke, and diabetes.
    • These disturbances include increased blood pressure, high blood sugar, excess body fat around the waist, abnormal cholesterol or triglyceride levels, proinflammatory state, and increased tendency toward thrombosis.
    • One out of three adults in the United States has metabolic syndrome.
    • This condition has an impact on periodontal status through chronic low-grade inflammation of prolonged duration.
    • Adipocytes (fat cells) release adipokines, which cause sustained inflammation, insulin resistance, and an increased susceptibility to periodontitis.
    • Hypertension impairs the blood flow supplying the periodontium.

    Acquired Immunodeficiency Syndrome (AIDS)

    • AIDS is a communicable disease caused by the HIV virus.
    • HIV infection has a profound effect on cellular immunity, increasing periodontal attachment loss in HIV-infected individuals.

    Periodontal and Oral Manifestations of HIV Infection

    • Hairy leukoplakia
    • Candidiasis
    • Herpes labialis
    • Herpes zoster
    • Recurrent aphthous ulcers
    • Kaposi sarcoma
    • Linear Gingival Erythema (LGE)

    Linear Gingival Erythema (LGE)

    • Characterized by a 2-3 mm marginal band of intense erythema, usually in the free gingiva, but may extend to attached gingiva or beyond the mucogingival line into alveolar mucosa.
    • The intensity of inflammation is exaggerated in relation to the amount of biofilm present.
    • Not associated with pocketing and does not affect clinical attachment levels or alveolar bone levels.

    HIV-Infected Individuals: Implications for the Dental Hygienist

    • Safe to perform periodontal therapy as long as the immune system is competent.
    • LGE is treated with standard periodontal therapy plus the use of chlorhexidine gluconate.
    • Frequent maintenance visits are recommended.
    • Stress meticulous self-care.
    • Coordinate care with other health care professionals.

    Neutropenia

    • Characterized by abnormally low numbers of neutrophils in the blood, lower than 1500 cells/µL of blood.
    • Leads to increased susceptibility for infection.
    • Can be the result of bone marrow failure or congenital.

    Neutropenia and Periodontitis

    • Neutrophils are the first responders to fight off microbial invasion, fewer numbers mean poor immunity.
    • Patients with neutropenia should be considered immunocompromised.

    Down Syndrome

    • Down syndrome is a genetic disorder that happens before birth.
    • Individuals with Down syndrome have 47 chromosomes instead of 46, usually with three copies of the 21st chromosome.
    • Also called trisomy 21.
    • Lifelong and variable in severity, causing intellectual disability and developmental delays.

    Characteristic Facial Features of Down Syndrome

    • Underdeveloped midfacial region.
    • Palate may appear highly vaulted and narrow due to unusual thickness of the sides of the palate.
    • Lips may be large and thick with decreased muscle tone, potentially leading to drooling.
    • Tongue may appear cracked with fissures.
    • Malocclusion due to delayed eruption.

    Medical Concerns of Down Syndrome

    • Increased risk for congenital heart defects.
    • Susceptibility to infection.
    • Respiratory problems.
    • GI abnormalities.
    • Leukemia.
    • Abnormal number of PMNs.
    • Mild to moderate mental retardation.

    Down Syndrome and Periodontitis

    • Individuals with Down syndrome often develop rapidly progressive periodontitis.
    • Substantial biofilm formation.
    • Periodontal pathogens colonize gingival tissues in early childhood years, possibly leading to the loss of permanent anterior teeth.

    Leukemia

    • Signs in the gingiva include swollen, glazed, spongy tissues, red to deep purple in color.
    • Gingival enlargement is occasionally seen.

    Oral Mucositis

    • Inflammation of oral mucous membranes caused by chemotherapy attacking rapidly dividing cells in the mucous membranes, leading to cell death.
    • Sloughing of mucosa can be localized or generalized.

    Xerostomia

    • Occurs when salivary glands are damaged during radiation therapy, reducing salivary flow.
    • Reduced salivary flow encourages the growth of Candida albicans, causing oral candidiasis.

    Leukemia: Implications for the Dental Hygienist

    • Monitor for spontaneous gingival bleeding and gingival enlargement for no apparent reason.
    • Refer to a physician if oral signs are seen first in the dental office.
    • Good oral care is essential to prevent the spread of serious infections from the oral cavity to other parts of the body.
    • Chemotherapy causes sore and sensitive mouths that bleed easily.

    Pain Management

    • Topical anesthetics are often limited in success.
    • Prophylactic use of chlorhexidine may reduce the frequency of oral mucositis and oral pathogens.

    Effects of Oral Medications

    • Medications used to treat systemic conditions can cause oral complications including alteration of biofilm composition or pH, effect on salivary flow, and effect on gingival tissues.

    Xerostomic Effects

    • Over 400 over-the-counter and prescription drugs reduce salivary flow.
    • Common medications causing xerostomia include blood pressure medicines, diuretics, and antidepressants.
    • Patients with xerostomia experience an increase in oral candidiasis, root surface caries, and excess biofilm formation.

    Reduced Salivary Flow

    • Medications known to cause xerostomic effects include antihypertensives, narcotic analgesics, tranquilizers, diuretics, antimetabolites, antihistamines, and sedatives.

    Overgrowth of the Gingival Tissues

    • The most dramatic medication-related change observed in the gingiva is gingival hyperplasia.
    • Drug-influenced gingival hyperplasia is an overgrowth of the gingiva that is a side effect associated with certain medications.

    Gingival Overgrowth

    • Gingival overgrowth begins in the interdental papillae area.
    • Enlarged papillae fuse mesially and distally, partially covering the anatomical crown.

    Medications and Gingival Enlargement

    • 20 medications have the potential to trigger gingival hyperplasia.
    • Three major classes include anticonvulsants, immunosuppressives, and calcium channel blockers.

    Phenytoin (FEN-i-toyn)

    • Most commonly used anticonvulsant medication to control convulsions and seizures.
    • Gingival hyperplasia is a common side effect.
    • Overgrowths are common in children and young adults taking the drug.
    • It is marketed under various trade names, including Dilantin 4 and Dilantin Kapseals 4.

    Phenytoin-Influenced Gingival Hyperplasia

    • Characterized by overgrowth of the gingiva.

    Phenytoin (cont.)

    • Scrupulous home care reduces the incidence of gingival hyperplasia in patients who take phenytoin.

    Cyclosporine (SIGH-kloe-spor-een)

    • Immunosuppressive agent.
    • Reduces the body's immune response in organ transplants.
    • Gingival hyperplasia occurs in 25% of those taking the medication.
    • Gingival hyperplasia resembles that from phenytoin.

    Cyclosporine-Influenced Gingival Overgrowth

    • Characterized by overgrowth of the gingiva.

    Nifedipine (nye-FED-I-peen)

    • Calcium channel blocker.
    • Coronary vasodilator used to treat individuals with hypertension, angina, and cardiac arrhythmias.
    • 38% of patients taking the drug experience gingival enlargement.
    • Gingival overgrowth resembles that from phenytoin.

    Nifedipine-Associated Gingival Enlargement

    • Characterized by overgrowth of the gingiva.

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    Description

    This quiz explores the relationship between diabetes and periodontal disease, focusing on how diabetes impacts the severity and prevalence of periodontitis. It also examines the various types of diabetes and their implications on oral health. Test your knowledge on the effects of diabetes on gum disease and its risk factors.

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