52 yr old female pt came wt pus discharge from gingival.. fbs 506 mg



Classic case of explanation.......why such high sugar levels !! AGE-RAGE interaction on monocytes increases cellular oxidant & activates the transcription factors, nuclear factor- kB, resulting in increased production of pro inflamatory cytokines....interlukin-1beta & TNF alfa. Advanced glycation end products (AGEs) are proteins or lipds that become glycated as a result of exposure to sugars. They can be a factor in aging & worsening degenerative diseases ...diabetes/ atheroslerosis/kidney dieses/ Alzheimer These AGEs activate receptorAGEs (RAGE) which are found on surface of smooth muscles- neurons /endothelial cells/periodontium Hyperglycemia results in increased expressions of RAGEs & AGE-RAGE interactions on endothelium increasing vascular permiability. Both these TNF alfa & IL6 impair intracellular signalling leading to insulin resistance. Periodontal diseases & diabetes are both associated with increase in pro-inflammatory & decrease in anti-inflammatory cytokines......which increases hormones such as cortisol & adrenalin which work against the action of insulin & thus body production of glucose increases!! Which results in high blood sugar levels!!! Again this high sugar levels leads to?.....progressions of infection....a vicious cycles & goes out of control added pain & stress play havoc. It's clearly proved that inflammatory mediators TNF alfa induced insulin resistance! Probably via this disruption of signal transduction pathways Yes, deep cleaning of their gums can lead to a drop in blood sugar levels!! This benifits in the same way as you might find -adding another drug to diabetes medicine In fact endocrinologist need to make patients to take good dental care before prescribing medications. This reverse causation helps in finalising their therapeutic approach & prognosis. This was my lecture in recent CME.

Gum disease is a silent killer It complicates with.. 1.Heart disease 2.Endocarditis 3.Stroke 4.Alzheimer's disease 5.Parkinsonism 6.Diabetes mellitus 7.Poor glycemic control in diabetic patients 8.Chronic obstructive pulmonary disease (COPD) 9.allergic rhinits 10.Kidney failure 11.Preterm delivery 12.Low birth weight babies. 13.ERECTILE dysfunction. 14.RHEUMATOID arthritis 15.pneumonia 16.pancreatic cancer 17.colon cancer 18.urticaria 19.obesity 20.skin to look older BRUSH UR TEETH TWICE DAILY

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First of all take the expert opinion of a medical specialist.....control the diabetes first.......consult a dietician for diet modification.......start a light exercise...walk ....avoid sweets ........on the other side start with tab.metrogyl 400mg 1 tds and tab.cefixzime 200mg 1 bd for 5 days as soon as the sugar levels are back in the normal range ....start with oral prophylaxis.....good luck

Nice case of extreme negligencies.. agree with @Dr. Amardeep Singh Sir.

Nicely explained @Dr. Narayana S sir..

Classic example of diabetes associated periodontitis Multi prong approach suggested Control of diabetes Antibiotics prophylaxis suggested antibiotics r azithromycin along with ornidazole Proper brushing method to be demonstrated to the Pt for long term success Phase 1 therapy for starters followed by surgical evaluation in 4 -5 months OPG required to overrule any perio endo involvements

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