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IBICL - Case 4 (My Wobbly Teeth), Background/Patient History, Chief…

- - - - Diabetic Retinopathy is the LEADING cause of blindness.
    - - Non-Modifiable
        
        Pre-diabetesPre-diabetes
        
        Genetics, increased age, male, low socioeconomic status
        
        Previous History of Gestational Diabetes
      - Modifiable
        
        Low activity levels, increased alcohol consumption, excessive refined sugar consumption
        
        Obesity/High Visceral Fat
  - - - PKC
        
        Synthesis of DAG in response to an increase in intracellular glucose thereby blocking the intake of glucose into the cell.
        
        This will activate PKC causing:
        
        Altered enzyme activities
        
        Cell proliferation and turnover
        
        Production of inflammatory cytokines
      - Abnormalities in the Polyol Pathway
      - AGE (advanced glycation end products)
        
        Excess glucose in the blood can attach to amino acid groups via
        a ketoamine bond
        
        This causes the production of Amadori products and advanced glycation end products
        
        Amadori products cause
        
        ◊ Impaired enzyme activity
        
        ◊ Conformational changes
        
        ◊ Ligand bondig
        
        ◊ Glycated LDLs are not recognized by receptors and are therefore trapped in ECM and arteries
        
        ◊ Amadori produces are able to be oxidised
        
        AGE causes
        
        ◊ Stiffening, thickening, decreased digestibility and decreased extracellular matrix turnover in diabetes
        
        ◊ Act as recognition signals for uptake and degradation of proteins by macrophages which can contributed to release of cytokines and oxidative stress causing disease
        
        ◊ Leads to increased protein cross linking
        
        Bind to specific receptor (RAGE) on macrophages, t cells, endothelial cells and vascular smooth muscles cells
    - - ○ increase in obesity decreases sensitivity of peripheral tissues to insulin
        
        ○ this occurs when there is an increase in Non-esterified fatty acids in combination with insulin sensitivity and a decrease in glucose utilisation
        
        ○ Adipokines which were once predisposed to release anto-inflammatory cytokines, will no release inflammatory cytokines instead.
- - - - Diabetes also increases the risk of tooth loss, which interferes with diet, often resulting in poor glycemic control.
        
        Our patient had LONG-term Diabetes, studies indicate that DM is a RISK FACTOR for Periodontitis and that it PRECEDES Periodontitis.
        
        CYCLIC interaction that worsens both conditions. Also note the risk factors are higher age and male gender, which our patient checks off.
        
        IF our patient is on medication, these often cause dry mouth, a STRONG risk factor for both Periodontitis and Caries.
- - - - MMP-8 is the main collagenase in periodontitis
        90% to 95% of collagenolytic activity in gingival crevicular fluid originated from MMP-8.