METABOLIC SYNDROME: WHAT THE DENTAL TEAM SHOULD KNOW?
start to the dental profession dating back to 1846 with the removal of a neck tumor by a dentist and has helped humanity achieve many impressive feats in healthcare since.2
Pablo Adler, MD, MA Delaware, USA
As a person endures a surgical procedure, gives birth, or faces a traumatic event, anesthesiologists create conditions that allow for surgeons of one kind or another to intervene in a disease process. In doing this, we often are directly contradicting the body's evolutionarily derived physiologic response to stress. Normally, the human body is designed to selfregulate independently to achieve a healthy function, this is what physiologic homeostasis is and why we use various vital signs to monitor well-being. A sudden assault on our body such as trauma, an acute disease, labor/delivery, or surgery can push the healthy limits of our organ systems to an extreme where death may ensue if the proper parameters are not corrected. There are also gradual changes that can evolve into life-threatening conditions resulting in the disruption of homeostasis as well. Some before an operation. Some after one. Life is at risk when the delicate balance orchestrated by our organ systems begins to fail, and unfortunately, almost nothing interferes with the above like the ravages of metabolic syndrome. Consider the nervous system, for example. Most people will know that diabetes causes neuropathy of the extremities, but in truth, it causes neuropathy in all the different neurological systems in the body, both peripheral and autonomic. It can cause autonomic dysregulation, by which blood pressure and heart rate do not respond appropriately to stimuli. It can cause impotence. It can cause incontinence. But metabolic syndrome is not just diabetes, so untreated hypertension, for example, can also change the autoregulation of blood flow to the brain and other vital organs. And that is just one system. It is beyond the scope of this paper to go into all the different physiological manifestations of metabolic syndrome, but suffice it to say that there are few it does not touch, from obvious ones like cardiovascular and immune systems to less obvious ones like endocrine. Metabolic syndrome even can have psychological and psychiatric consequences, like depression.
Tyrone Fernando Rodriguez, DDS, FACD, FPFA, FAAPD Abstract Hispanics are disproportionately affected by metabolic syndrome. Metabolic syndrome is diagnosed by having three or more of the following conditions: abdominal obesity, low high-density lipoprotein (HDL) cholesterol, hypertriglyceridemia, hypertension, and/or impaired glucose tolerance.1 The dental team is in a unique position by evaluating intra-oral and extra-oral conditions pertinent to the condition. Early prevention and diagnosis provide a lifesaving service to our at-risk communities. Key Words Hispanics, Anesthesiologist, Metabolic Syndrome, LDL, hypertension, glucose, Oral diseases, IDDM, NIDDM, Diabetes, Dental team Introduction As an anesthesiologist for the last two decades, keeping thousands of people sedated, unconscious, and at times alive for hours at a time, I have a unique perspective on the physiology of the human species and its many aberrations. Anesthesiologists are part of a multidisciplinary team, working with various specialists on each specific case. In general, anesthesiologists keep people alive by mitigating the stresses placed on the organ systems of the body, a process normally known as physiologic homeostasis. Think of physiologic homeostasis as keeping things running properly, where values such as blood glucose, body temperature, heart rate, blood pressure, oxygenation, perfusion, and other activities are kept within a range considered compatible with human life. That is the short term. But homeostasis is not just perturbed acutely, there are intermediate and long-term changes as well. Curiously, anesthesia owes its
So why should we care? Alarmingly, over 1/3 of Hispanic adults over the age of 18, in the United States, have metabolic syndrome
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