Oral Pathologies Associated with Diabetes

I have attached the three questions you need to answer and i copied and pasted the answers from the book for you. All you need to do is write in your own words please
1. Discuss three important oral clinical pathologies associated with diabetes mellitus. How would these effect yout patient care and management? What dental hygiene treatment modifications do you think you would have to make for your patient?
Answer: Write in your own words please
Increased colonization of the oral mucosa by Candida albicans and an increased prevalence of oral candidiasis have been reported in patients with diabetes mellitus, as has mucormycosis, a rare fungal infection that affects the palate and maxillary sinuses. These infections generally are seen in poorly controlled or uncontrolled diabetes mellitus. (Both oral candidiasis and mucormycosis are described in Chapter 4.) The presence of such fungal infections is indicative of the compromised innate and acquired immune responses that occur in diabetes mellitus.
Bilateral, asymptomatic parotid gland enlargement occurs in some patients; this results from either a deposition of fat or hypertrophy of the salivary gland tissue.
Xerostomia (dry mouth) is usually associated with uncontrolled diabetes mellitus. Dehydration of the oral tissues can result, increasing the risk of the development of oral candidiasis and dental caries, and may diminish taste sensation. Altered subgingival flora has been described in diabetes and may be the result of immunologic or salivary changes. Other significant oral findings include burning mouth syndrome, which may or may not be related to xerostomia. Burning mouth or tongue has been reported to occur in undiagnosed cases of type 2 diabetes. These may mostly resolve after medical diagnosis of the diabetes and subsequent treatment toward improving blood sugar control. Xerostomia can be a physically and psychologically debilitating condition.
Patients with diabetes mellitus have an accentuated response to plaque. The gingiva can be hyperplastic and erythematous, and acute and fulminating gingival abscesses can occur. Excessive periodontal bone loss, tooth mobility, and early tooth loss can also be associated with diabetes mellitus (Fig. 9.4). Periodontal disease is considered to be a significant complication of diabetes, and it also aggravates the control of diabetes—it is a destructive two-way relationship. Slow wound healing and increased susceptibility to infection occur as a result of the immunologic changes and defective collagen production. Periodontal disease is also a significant prognostic, or predictive, clinical marker for diabetes in those patients who have not yet developed it. Individuals who belong to certain ethnic groups in the United States—for example, Native Americans, African Americans, and Hispanic Americans—who are obese have a significant risk for developing type 2 diabetes. Periodontal disease in those individuals, however, should necessitate immediate referral to physicians or nurse practitioners for follow-up and diagnosis of diabetes before any dental treatment is initiated. In addition, if the patient is diabetic and not diagnosed and the disease is therefore not controlled, the dental clinician will never achieve control of periodontal conditions.
2. Explain a blood disorder that might present with oral signs and symptoms. What are these signs and sympotms?
Answer: Write in your own words
Iron deficiency anemia occurs when an insufficient amount of iron is supplied to the bone marrow for red blood cell development. It is the most common cause of anemia in the United States. This type of anemia can occur as a result of a deficiency of iron intake, excessive blood loss from heavy menstrual bleeding (menorrhagia) or chronic gastrointestinal bleeding, poor iron absorption, or an increased requirement for iron, as in pregnancy or infancy.
Plummer-Vinson syndrome is rare and can develop as a result of long-standing iron deficiency anemia. It most commonly occurs in Northern European and Scandinavian women. This syndrome includes dysphagia (difficulty swallowing), glossitis (inflammation of the tongue, causing a burning sensation), angular cheilitis, atrophy of the papilla on the dorsal tongue, atrophy of the upper alimentary tract, and a predisposition to the development of esophageal and oral cancer. In Plummer-Vinson syndrome evaluation of the esophagus is performed by endoscopy or esophageal barium, which will help to identify esophageal webs. These abnormal bands of tissue in the esophagus contribute to the diagnosis. Patients with Plummer-Vinson syndrome should be evaluated for oral and esophageal cancer because of their increased risk of developing these malignancies. Treatment of Plummer-Vinson syndrome usually involves increasing dietary iron.
3. Discuss a condition that may lead to secondary immunodeficiency.
Answer: write in your own words
Patients with cyclic neutropenia are usually managed by first determining the frequency of the cycles through periodic neutrophil counts and then instituting preventive antibiotic therapy to protect against secondary opportunistic infections. Over time, episodes of neutropenia and associated ulcerative gingivitis lead to severe periodontal disease, with loss of alveolar bone, tooth mobility, and exfoliation of teeth. Corticosteroid therapy is used to attempt to decrease the frequency of recurrent neutropenia. Supplements help maintain adequate nutrition. Dental hygiene treatment should be initiated when the circulating neutrophil count is normal to reduce the risk of complications such as gingival hemorrhage and secondary infection. Frequent dental hygiene appointments for removal of local irritants and maintenance of optimal oral hygiene reduce the risk of opportunistic infections in patients with cyclic neutropenia.