Archive for the ‘Heart Disease’ Category

DIABETES AND DENTISTRY

Tuesday, March 9th, 2010

                                             DIABETES AND DENTISTRY

                     By Dr. Richard H Nagelberg, Dental Economics, February 2010

     Periodontal patients often present treatment and maintenance challenges due to the chronic, non curable nature of periodontal disease.  When managing a perio patient with diabetes, the challenges go up several notches due to the mutually destructive effects of these wo diseases.  Favorable treatment outcomes may not occur if we fail to take blood sugar control into account.  Managing these patients is a very large responsibility, but it is also a great opportunity to impact patients’  health beyond  the oral cavity.

     Diabetes is characterized by disorders  in the metabolism of carbohydrate,  fat, and protein.  Diabetic complications,  which are life changing and life threatening, are directly related to blood sugar control.  Poorly controlled individuals have a higher incidence of complications such as retinopathy, nephropathy, neuropathy, cardiovascular disease, infections, cataracts, and periodontal disease.

     It is important to recognize that diabetes cannot cause periodontal disease, but it can increase the likelihood of disease development and progression.  Similarly, periodontal disease cannot cause diabetes, but it can increase the likelihood of diabetic complications by increasing insulin resistance, leading  to hyperglycemia.

     Factoring the level of glycemic control into treatment planning decisions for perio patients with diabetes is important  because the likelihood of a favorable  treatment outcome is much lower when the patient has hyperglycemia.  When diabetic patients are well controlled, the  risk of periodontal disease development  and progression is the same as a nondiabetic individual.

      Diabetes and periodontal disease share several  important properties.  Both diseases are chronic, noncurable, and controllable.  The most significant similarity is the adverse effect each has on the other.  These mutually destructive effects are the crux of the problem with diabetes and periodontal  disease.  Diabetes is the No. 1 systemic risk factor for periodontal disease through several mechanisms.

     In hyperglycemic conditions, the body’s ability to kill perio pathogens and repair damaged gingival tissue is severely impaired.  Additionally, the inflammatory mediators responsiable  for perio tissue destruction are elevated in hyperglycemic states.

     On the other hand,  perodontal disease worsens blood sugar control by increasing insulin resistance, which prevents the transport of glucose from the blood vessels into the cells.  The resulting sugar  back-up in the bloodstream creates he hyperglycemic conditions.

     The significant problems associated with these two diseases emphasize the critical importance of preventing perio disease from developing  in the first place, and treating and maintaining oral health for those with periodontitis.  Identifying and aggressively addressing gingivitis takes on additional importance for these patients.  Utilizing the various tools in our ever-expanding toolbox is important to tip the balance in our  patients’  favor.

     Items  including power brushes, antimicrobial rinses,  interdental cleaners, and locally applied and systemic antibiotics are among the choices available to all clinicians.  Bacterial DNA testing of diabetic individuals with perio disease is vitally important to determine if we have truly reached the endpoint of therapy.  We may achieve favorable clinical resolution, but if we fail to achieve bacterial reduction, as determined by per- and post-op DNA testing, the likelihood of disease recurrence is elevated  (Oral DNA Labs, Nashville, Tenn., ww.oraldna.com).

     Periodontal maintenance and daily plaque control are the two primary determinants of the longevity of successful treatment results.  Elevated risk of perio disease recurrence will impact our decisions regarding maintenance interval and protocol, and home-care recommendations.

     Complications of poorly controlled  diabetes are life changing.  In the United States, diabetic retinopathy is the leading cause of  blindness, diabetic nephropathy is the primary reason for kidney dialysis, and diabetic neuropathy is he leading cause of amputations.  Successfully managing the oral contribution to blood sugar control, by preventing and aggressively treating periodontal disease, can improve the quality of life for these patients.

     The primary reason why it is so important to prevent periodontal disease from developing  in the firs place, and aggressively addressing existing periodontitis in diabetic  individuals, is because 65% of poorly controlled diabetics die from a heart attack or stroke.  Further research should fill in the gaps in our knowledge of the bidirectional relationship between periodontal disease and diabetes.  Trying to manage these two  diseases is an enormous responsibility,  but we should welcome the opportunity to improve our patients’  health beyond he oral cavity.  We are treating people not mouths.

Posted in Amputations, Blood Sugar, DNA Testing, General Dental Health, General Health, Glucose, Heart Disease, Insulin Resistance, Kidney Dialysis, Neuropathy, Oral Health, Oral Hygiene, Periodontal Disease, diabetes, inflammation, stroke | No Comments »

Inflammation and Your Health

Tuesday, February 23rd, 2010

                                     INFLAMMATION AND YOUR HEALTH*

            Inflammation is the body’s response to any challenge.  That challenge may be mechanical, bacterial, or viral.  The classic symptoms of inflammation are swelling, heat, and pain.  The object of inflammation is to limit the challenge to the body.

     Longevity in humans is dependent on a reduction of inflammation.  Today there are 50.000 people in the worked that are over 100 years old.  By the end of 2010, of those people that are over 65 years old, 3 million will live to be 100 years old or older.  Chronic disease  of aging correlates to the inflammation process.

     A long term study of Kaiser Permanente patients looked at people that had heart attacks and those that did not.  Analysis of this data indicated that there were two curves of disease susceptibility, one for those that had heart attacks and those that did not.  Those that had heart attacks demonstrated a much higher incidence of overall medical problems than those that had no heart attacks.  Further, in looking at blood levels of C reactive protien (CRP, a marker for inflammation) it was found that those that had heart atacks had high leves of CRP and those that no heart attacks showed low levels of CRP.  Inflammation is an essential element for heart attacks.

     The periodontal disease process is the most common inflammation process of man.  It is ethimated that 80% of humans have periodontal disease.  The inflammation present in periodontal disease makes those people with it susceptable to other diseases, i.e. diabetes, stroke, heart disease, arthritis.

       For the first time  in a 2009 the American Journal of Cardiology has made recommendations concerning periodontal disease and heart disease.  Their recommendations are as follows:

               1.  Patients with periodontal disease should be informed of    increasing  risk of cardiovascuoar disease (CVD).         

               2.  Patients with periodontal disease shoud have regular physical exams.

               3.  Patients with periodontal disease have increased inflammation associated with increasing congestive heart disease and myocardial infarctions.

              4.  Patients with periodontal disease should investigate risk facors for cardiovascular disease and take the Rynold’s Risk Factor Test or the Cholesterol Education Program of the Risk Collation.

              5.  Stop smoking.

              6.  Cooperate with your physicians in managing CVD (strokes and MI’s).

               7.  Periodontal evaluation should be focused on the reduction of constant bacterial accumulation and a reduction of inflammation.

     There are multiple elements in managing chronic inflammation:

                1.  Ethnicity- the incidence of inflammation is as follows:  African Americans > Hispanics > Caucasians > Chinese > Japanese.

                2.  Gender- premenopausal females > males.

                3.  Smoking increases chronic inflammation.

                 4.  Body fat around the waist increases the presence of inflammation.

                 5.  Decreasing Body Mass Index is a sign of reduced inflammation.

                  6.  Increasing CRP is a sign of increasing inflammation.

                 7.  Exercise- regular exercise reduces inflammation.

                  8.  Nutrients regulate the expression of genes that influnce the level of inflammation.

     Several elements of nutrition help reduce inflammation.  Omega 3 fatty acids effect the expfressin of genes in activation of receptos that start the inflammation process.  Flavanoids (green tea), red wine, and soy reduce inflammation.  Antioxidants alter signals that modulate inflammation.  Vitamin D helps regulate inflammation and the immune system.  Carbohydrates  influence the inflammation mechanism.

      Can we cure periodontal disease?  Local acute inflammation resolves when challenges end.  Daily removal of deposits from the sulcus around the teeth help eliminate the formation of deposits on the tooth surfaces that begin the mechanical element of the periodontal process.  Also, a low daily dose of asprin (81 mg), a daily d0se of vitamin D, a daily dose of 3 omega fish oil, calorie restriction, and elements in red wine help combat the inflammation element of periodontal disease.

          * Infomation taken from a lecture by Dr. Ken Kornman, a dentist, a periodontist, and a researcher for a drug company.

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Posted in Aging, Antioxidants, Arthritis, Body Fat, Body Mass Index, C Reactive Protien, Caardovascuar disease, Cholesterol Education Program of the Risk Collation, Chronic Disease, Congestive Heart Disease, Ethnicity, Exercise, Flavanoids, General Dental Health, General Health, Hear Attacks, Heart Disease, Longeviety, Myocardial infarctions, Nurtition, Omega 3 fatty acids, Oral Hygiene, Periodontal Disease, Physical exam, Rynold's Risk Factor Test, Smoking, Vitamin D, inflammation | No Comments »