1. Definition
Brain degenerative disorder that gradually destroys
the ability to remember, reason, learn, and imagine.
Stages/ Symptoms
• Stage 1: Early/Mild Stage
• Noticed in conversation
• Increased forgetfulness
• Losing everyday objects
• Stage 2: Middle/Moderate stage
• Longest stage
• Difficult to communicate
• Losing direction easily
• Mood/behavior changes
• Disorientation/confusion
• Stage 3: Severe/ Late Stage
• Difficulty swallowing, walking,
speaking
Prevention
• Regular exercise
• Mind-stimulating activities
• Diet modifications
Prevalence
• Affects approximately 5 million Americans
• Sixth leading cause of death in the United
States
Definition
Disorder which is characterized by abnormally high
blood sugar due to defective insulin secretion,
action, or both.
General Symptoms
• Polyuria
Symptoms associated with Type II
• Weight gain • Darkened skin • Fatigue
• Slow healing • Blurry vision
Prevention
• Type I: non-preventable
• Type II: weight management, healthy diet, and
exercise
Etiology
• Type I: autoimmune; pancreatic insulin
producing cells are destroyed
• Type II: inability to produce enough insulin
Type II
• Increase glucose
• Glucose in gingiva causes periodontium to heal
slowly
• Created an ongoing inflammation in the mouth
• Inflammatory cells travel throughout the body
Prevalence
• Affects 25.8 million people in the United States
Bridging the Gap
History
• Type III Diabetes hypothesis was developed in 2005 with research at Brown University
• Research is relatively new and does not give a conclusive link
Pathogenesis
• Developing Type II Diabetes puts individuals at an increased risk of developing Alzheimer’s
disease later in life
• Patients with Type II Diabetes are at an increased risk of Alzheimer’s Disease
• Type I Diabetics exhibit more control of their blood glucose because of insulin use
and therefore are less likely to develop Alzheimer’s disease
• Hyperglycemic diabetic patients have increased oxidative stress
• Neurotoxins are released which decreases acetylcholine production
• Compromises endothelial lining of cerebral blood vessels
• Decreased acetylcholine production and compromised endothelium encourages the
formation of deadly beta-amyloid plaques
• Beta-amyloid plaque accumulates in the brain causing
neurofibrillary tangles
• Leads to deterioration of white matter
• Exacerbates Diabetes by killing beta islet cells
Dental Considerations
• The comorbidity of Alzheimer’s and Diabetes puts patients at
a greater risk for tooth loss
• Dental hygiene appointments are more frequent than doctor
visits
• Disease can be detected earlier
• Hygienists can detect mental and physical changes with their patients
• Referrals may be necessary
TYPE III DIABETES: ALZHEIMER’S
TIFFANYKONG,LEANNAMYERS,JACOBREXING
UNIVERSITYOFSOUTHERNINDIANA
COLLEGEOFNURSINGANDHEALTHPROFESSIONS
Alzheimer’sDiabetes
Diabetic patient (on the left) shows less brain activity compared to
a healthy patient (on the right). The Alzheimer’s brain (on the right) is significantly smaller than its
healthy counterpart (on the left).
Dental Hygiene Intervention
Dental teams have an opportunity to be proactive towards each patient’s overall health and well-being.
Glucose testing is important for offices to include as a part of each patient’s clinical assessment. Testing will
allow the dental hygienist to make the connection between a patient’s physical assessment and the state of
their oral cavity, including inflammation and periodontal status. If a patient is currently diagnosed with Type II
Diabetes Mellitus, it is our responsibility to be aware of possible cognitive decline issues. Dental Hygienist
must pay attention to the signs of this condition and how it can lead to dementia, and eventually Alzheimer’s.
While these subjects can be difficult to address, it is our duty to help our patients understand the signs and
symptoms for these conditions, as well as interventions they can use to cope with their diagnosis. Dental
Hygienist can recommend a physician consult and further cognitive testing with a specialist if necessary.
Dental Implications
• Xerostomia
• Enlarged salivary
glands
• Fungal infections
• Increased glucose in
saliva
• Increased caries risk
• Periodontal disease
• Increase healing time
Dental Considerations
• Morning
appointments allow
for better glucose
control
• Educate patients
about importance of
oral care
• Add Doxycycline for
periodontitis control
Dental Considerations
• Morning
appointments
• Recommend
powered
toothbrushes
• Communicate with
caregivers if needed
• Focus on oral health
education
Dental Implications
• Lack of oral care at
home
• Sporadic dental
appointments
• Forget dental
routine
• Xerostomia
• Gingival diseases
• Increased caries risk
• Polydipsia • Polyphagia
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