Ch. 21 Oral-Health systemic connection

Diabetic patients should be examined for other oral complications, such as dry mouth, burning mouth syndrome, and fungal infections. T/F

True

Disruption of the atheroma can lead to the

formation of a blood clot that occludes or blocks the vessel

Diabetes affects how many people in the US?

29+ million adults

Periodontal treatment and maintenance should help improve blood glucose control, however:

3-month intervals for supportive care are recommended.

What is the flow cart associating periodontitis with atherothrombogensis?

1. Chronic oral infection 2. Oral bacteria enter bloodstream 3. Systemic inflammation 4. Formation of atherothrombotic lesion

What is a critical clinical indicator of disease?

BOP

A normal HbA1c in a nondiabetic patient is below

5.7%

Pregnancy gingivitis affects about __________ of all pregnant women

50%

For patients diagnosed with diabetes, an HbA1c of

7% or less is ideal

What are the three oral-systemic health connections?

ACVD (atherosclerotic cardiovascular disease); diabetes; adverse pregnancy outcomes

What is the term for: which the inside of the arteries narrows with a buildup of deposits called plaque or atheroma, is responsible for approximately one in four deaths in the United States and is the leading cause of death for both men and women

Atherosclerotic Cardiovascular Disease (ACVD)

When bacteria is in the periodontal pockets and enters the bloodstream its called?

Bacteremia

Preterm birth and low-birthweight babies are associated with which of the following?

Bacterial endotoxins associated with periodontitis in the blood that stimulate production of inflammatory mediators that induce labor.

What is a commonly reported symptom of gum disease which is often noticed after every day mechanical stimuli such as eating or tooth brushing?

Bleeding gums

Evidence suggest that periodontal infections contribute to heart disease with the presence of serum levels of

C-reactive protein, a systemic inflammatory marker, a risk factor for MI and Stroke

All of the following are true regarding ventilator-associated pneumonias EXCEPT one. Which one is the EXCEPTION?

Can be reduced by performing oral hygiene procedures on ICU patients.

All of the following describe individuals with uncontrolled or poorly controlled diabetes mellitus EXCEPT one. Which one is the EXCEPTION?

Can receive local anesthetics with vasoconstrictors without precaution.

Gingivitis

Discuss health promotion (prevention), antimicrobial mouthrinse or dentrifrice, effective OH practices. Monitor pt during pregnancy...intervene as needed.

Patients who are at risk of developing type 2 diabetes and have signs of periodontitis should be informed about their risk for diabetes and should have their heart tested. T/F

False; HbA1c values tested.

Patients with only Type 2 diabetes, should receive a comprehensive periodontal examination and have a continual follow-up plan. T/F

False; all diabetes (type 1, 2, and gestational)

Children and adolescents diagnosed with diabetes should have at least one annual oral screening for early signs of periodontal involvement, starting at the age of 12 years. T/F

False; starting at the age of 6 years

The high levels of sugar (hyperglycemia) in the circulating blood leads to high

Glycated hemoglobin A1C (HbA1C)

Oral hygiene care has a positive rate in reducing risks of

HAP

Chronic periodontitis has been suggested as a risk factor for all of the following systemic problems except which one?

Hemorrhagic stroke

Healthy

Inform pt about potential for increased vascularity, enlargement and bleeding during pregnancy. Assess MH for history of hypertension, diabetes, cv diseases-refer to physician if necessary. Go OHI esp IP care. Consider antimicrobial mouthrinse. Reassess close to end of pregnancy.

Ischemic strokes are caused by a sudden

Interruption of the brain's blood supply

Periodontitis

Perform NSPT. More invasive procedures delayed until after delivery.

What is nosocomial hospital-acquired pneumonia?

Pneumonia acquired during a hospital stay, exhibiting symptoms within 48 hours after admission

Diabetic patients with partial or total edentulism should be recommended for tooth replacement treatment to help ensure proper mastication and nutrition. T/F

True

Diabetic patients with periodontitis should be properly managed by the dental team. In addition, patients with diabetes and no periodontitis should be monitored periodically for possible intraoral changes. T/F

True

Limited or weak evidence suggests associations between periodontitis and rheumatoid arthritis and osteoporosis, chronic kidney disease, obesity, cancer, metabolic disease, obstructive sleep apnea, and cognitive impairment; more robust research is needed. T/F

True

Patients with diabetes should be informed that they are at increased risk for periodontitis. In addition, if they suffer from periodontitis, their glycemic control may become more difficult. They are at higher risk for other complications, such as cardiovascular and kidney diseases. T/F

True

Aspiration pneumonias occur most often in individuals who have all of the following EXCEPT one. Which one is the EXCEPTION?

Who are susceptible to infections

Body mass index

a measure of body weight relative to height

Type I diabetic patients

cannot produce adequate insulin, less common (5%)

What is ACVD?

an inflammatory disease where coronary arteries thicken in response to chronic injury (not fats and lipids)

An inflammatory thickening of the blood vessel wall triggered by injured endothelial cells is called a/an

atheroma

Coronary heart disease is also called

atherosclerosis

Type II diabetic patients

cannot use the insulin they produce, common, (90-95%)

The entry and presence of bacteria in the bloodstream, a common occurrence in patients with periodontitis, is called

bacteremia

What is a common occurrence in a patient with periodontitis with the epithelial lining of the soft-tissue wall of the pocket being thin and ulcerated?

bacteremia

Diabetes and Perio have a

bidirectional relationship

Preterm birth

birth of an infant less than 37 weeks after conception

C-reactive protein (CRP)

blood test used to measure the level of inflammation in the body; may indicate conditions that lead to cardiovascular disease

Aspiration pneumonias may develop when

both A and B. Metabolic control of diabetes is unrelated to aspiration of oral fluids.

aspiration pneumonia

caused by foreign matter that is inhaled into the lungs like saliva; common in nursing homes and those who have difficulty swallowing

CAP

community acquired pneumonia

The presence of infection increases the risk of

delivering a preterm low-birth weight baby

Injured endothelial cells trigger inflammation of the blood vessel wall that leaders to the

development of an atheroma (internal thickening of vessel wall)

Injury of endothelial cells may be caused by all of the following EXCEPT one. Which one is the EXCEPTION?

drinking bottled water

Indirect pathway

in which inflammatory mediators from the periodontal tissues or liver travel via the bloodstream to the fetal-placental unit. Examples of these mediators include prostaglandin E2 (PGE2) and tumor necrosis factor-α (TNF-α).

Direct Pathway

in which oral bacteria reach the fetal-placental unit via the bloodstream or via an ascending infection from the vagina. This infection leads to an immune or inflammatory response, resulting in APOs.

Periodontitis-associated atherosclerotic changes in blood vessels are characterized by vascular

inflammation

Periodontal bacteria produce

inflammatory mediators: cytotoxins, proteases and others that migrate

Invasion of blood-born bacteria result in

injury single layer of endothelial cells

Preclampsia

is a pregnancy complication in which the mother experiences high blood pressure, in addition to signs of damage to other organs—often to the kidneys or liver.

The "blood-brain barrier" refers to

junctions between the choroids plexus and capillary endothelial cells in the brain.

Low birth weight

less than 5.5 pounds

Ventilator-associated pneumonias

most often long-term ICU patients, increases in patients who are intubated and get pneumonia in 48 hours or longer after intubation

Coronary heart disease is

multi-factorial (many factors play a role)

Lipids covered with fibrous cap surround a

necrotic cone laden with scavenging macrophages

Atherosclerotic changes in blood vessels that lead to coronary heart disease are also the main cause of which of the following?

nonhemorrhagic stroke

HAP

nosocomial hospital-acquired pneumonia

What are the risk factors for diabetes?

overweight/obesity, physical inactivity, family history, race (African american and Asians)

A serious periodontitis-associated complication of pregnancy characterized by hypertension, swelling of the ankles, and proteinuria is which of the following?

preclampsia

Pregnant women with periodontal disease may be ______ times more likely to have a baby thats born prematurely, likely due to the presence of ______________________________, a labor-inducing chemical found in oral bacteria

seven; prostaglandin

Thickening may totally occlude blocking blood supply to a portion of the heart leading to

stroke, MI, disability, or death

What does the presence of bleeding strongly suggest?

sufficient gingival inflammation to cause pocket wall ulcerations that lead to repeated episodes of bacteremia throughout the day

HbA1c values indicate how much _________ is attached to the patient's hemoglobin and is reflective of _______________________ over the previous few months.

sugar; blood glucose control

Biologic plausibility

the idea that the mechanism of association seems reasonable in light of normal biologic processes

The presence of bleeding gums suggests that the epithelial lining of the pocket wall is

thin and ulcerated

What is community-acquired pneumonia?

when a person NOT in a hospital or care setting is infected and develops pneumonia