Diabetes Mellitus And Periodontal Disease

Diabetes Mellitus And Periodontal Diseases

, Volume 13, Issue3 , pp 445452 | Cite as Diabetes Mellitus and Periodontal Diseases Diabetes and Other DiseasesEmerging Associations (D Aron, Section Editor) A bidirectional relationship between diabetes mellitus (DM) and periodontal diseases (PDs) has been established. It is estimated that patients with poorly controlled DM are 3 times more likely to develop chronic PD compared with normoglycemic individuals despite similar composition in subgingival biofilms. Furthermore, these patients present with increased severity and rapid progression of attachment loss around teeth resulting in edentulism. Treatment of PD results in a modest but significant improvement in glycemic control in patients with DM reflected by a 0.4% reduction in HbA1cglycated hemoglobin levels. Compelling evidence from in vitro and animal studies supports a plausible biological explanation for the relationship between the 2 conditions centered on systemic low-grade inflammation. However, the limited number of comparable large randomized clinical trials is reflected in the limited specific guidelines offered by the international organizations for DM and PD regarding the management of the 2 diseases in an individual. Diabetes mellitusPeriodontal diseasesInflammationGlycemic controlHbA1c This is a preview of subscription content, log in to check access Corneliu Sima declares that he has no conflict of interest. Michael Glogauer declares that he has no conflict of interest. Papers of particular interest, published recently, have been highlighted as: Of importance Of major importance Glavind L, Lund B, Loe H. The relationship between periodontal state and diabetes duration, insulin dosage and retinal changes. J Periodontol. 1968;39(6):3417. PubMed Google Scholar Belting CM, Hiniker JJ, Dummett CO. Influ Continue reading >>

Periodontal Disease And Diabetes Mellitus

Go to: INTRODUCTION In the last decades health professionals have been often organized into many specialties and subspecialties directed to several body organs and systems. The human organism is a unity that is composed by an infinite number of biologic processes so strongly linked that abnormalities in any part of the body and/or its processes may have deep effects in many other body areas, exemplified in this review by two highly prevalent diseases: PD and DM25. PD is a chronic infectious disease, caused by Gram-negative microorganisms. An imbalance between a localized infection and an exaggerated host inflammatory response plays a pivotal role in determining gingival tissue damage. Recent evidence suggests that the effect of PD might not be limited just to the oral cavity but it might have systemic consequences. Indeed, PD has also been associated with a moderate systemic inflammatory response. Although, the mechanisms behind this association remain unclear, PD might represent one distant source of low-grade systemic inflammation. This association could explain the increased risk of impaired metabolic control in diabetes-related complications and the adverse effects of DM on periodontal health15. There is strong evidence that the prevalence, severity and progression of PD are significantly higher in people with DM97,98,101. In this review we describe the common processes involved in PD and DM and briefly review the evidence produced to support an association between PD, DM and diabetes-related complications. Periodontal disease PD is a chronic bacterial infection that affects both the gingiva and the bone that supports the teeth and is caused by anaerobic Gram-negative microorganisms that are present in the bacterial plaque that adheres to the teeth69. PD is a very p Continue reading >>

The Relationship Between Periodontal Disease And Diabetes Mellitus

Periodontitis is a common complication in patients with diabetes. Their classification is complex and it is based on the clinical presentation, rate of disease progression, age at diagnosis and local and systemic factors that may multiply the risk. The two major stages of periodontal diseases are gingivitis and periodontitis. The relationship between these two diseases appears bidirectional insofar that the existence of one disease tends to promote the other and that the meticulous management of either may help the treatment of the other. Treatment of periodontitis using a association of mechanical therapy, scaling and root planning, plus systemic tetracycline antibiotics has been demonstrated to have important reductions in HbA1c values. Therefore, for a better control of diabetes we suggest that periodontal patients with diabetes should be consulted and treated by a periodontist. 1. Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, and Taylor R. Periodontitis and diabetes: a two-way relationship, Diabetologia January; 55(1): 21-31, 2012. Continue reading >>

Original Article Interrelationships Of Periodontitis And Diabetes: A Review Of The Current Literature

Introduction Diabetesis a disease of metabolic dysfunction characterized by hyperglycemia, giving rise to the risk of several complications including retinopathies, neuropathies, nephropathies, cardiovascular complications,1 and delayed wound-healing.2 It is associated with a reduced life expectancy, significant morbidity due to specific diabetes-related microvascular complications, increased risk of macrovascular complications, such as ischemicheart disease, stroke, and peripheral vascular disease, and a diminished quality of life. Currently, there are three types of diabetes recognized by the World Health Organization (WHO)3: (1) type I diabetes, previously known as insulin-dependent or childhood-onset diabetes (IDDM), is characterized by a lack of insulin production due to destruction of β-cells; (2) type II diabetes, formerly termed non-insulin-dependent diabetes (NIDDM), or adult-onset diabetes, is caused by increasing insulin resistance. It is the major type of diabetes in the adult population and is closely related to obesity4; (3) a third category, hyperglycemia secondary to systemic diseases or conditions,5 includes gestational diabetes3 and diabetes associated with diseases involving the pancreas and destruction of β-cells,6 endocrine diseases,7 tumors,8 a pancreatectomy,9 and drug- or chemical-induced insulin insensitivity or resistance.10 Periodontitis is the consequence of local infections in the oral cavity resulting in irreversible destruction of the tooth attachment apparatus (i.e., alveolar bone, root cementum, and the periodontal ligament).11 One clinical manifestation of periodontitis is the appearance of periodontal pockets, enabling further microbial colonization and challenge. Other manifestations include redness and gingival swelling, pain, and Continue reading >>

Diabetes And Periodontal Disease

If you have diabetes, you know the disease can harm your eyes, nerves, kidneys, heart and other important systems in the body. Did you know it can also cause problems in your mouth? People with diabetes have a higher than normal risk of periodontal diseases. Periodontal diseases are infections of the gum and bone that hold the teeth in place. In advanced stages, they lead to painful chewing problems and even tooth loss. Like any infection, gum disease can make it hard to keep your blood sugar under control. Diabetic Control. Like other complications of diabetes, gum disease is linked to diabetic control. People with poor blood sugar control get gum disease more often and more severely, and they lose more teeth than do persons with good control. In fact, people whose diabetes is well controlled have no more periodontal disease than persons without diabetes. Children with IDDM (insulin-dependent diabetes mellitus) are also at risk for gum problems. Good diabetic control is the best protection against periodontal disease. Studies show that controlling blood sugar levels lowers the risk of some complications of diabetes, such as eye and heart disease and nerve damage. Scientists believe many complications, including gum disease, can be prevented with good diabetic control. Blood Vessel Changes. Thickening of blood vessels is a complication of diabetes that may increase risk for gum disease. Blood vessels deliver oxygen and nourishment to body tissues, including the mouth, and carry away the tissues' waste products. Diabetes causes blood vessels to thicken, which slows the flow of nutrients and the removal of harmful wastes. This can weaken the resistance of gum and bone tissue to infection. Bacteria. Many kinds of bacteria (germs) thrive on sugars, including glucose -- the Continue reading >>

Oxidative Stress: A Link Between Diabetes Mellitus And Periodontal Disease

International Journal of Endocrinology Volume 2014 (2014), Article ID 917631, 4 pages 1Department of Odontology and Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy Târgu Mureș, 38 Gheorghe Marinescu Street, 540114 Târgu Mureș, Romania 2Department of Morphopathology, Faculty of Medicine, University of Medicine and Pharmacy Târgu Mureș, 38 Gheorghe Marinescu Street, 540114 Târgu Mureș, Romania 3Department of Prosthetics and Oral Rehabilitation, Faculty of Dental Medicine, University of Medicine and Pharmacy Târgu Mureș, 38 Gheorghe Marinescu Street, 540114 Târgu Mureș, Romania Academic Editor: Nikolaos Papanas Copyright © 2014 Adriana Monea et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Objective. To investigate oxidative stress (OS) and histological changes that occur in the periodontium of subjects with type 2 diabetes mellitus without signs of periodontal disease and to establish if oxidative stress is a possible link between diabetes mellitus and periodontal changes. Materials and Methods. Tissue samples from ten adult patients with type 2 diabetes mellitus (T2D) and eight healthy adults were harvested. The specimens were examined by microscope using standard hematoxylin-eosin stain, at various magnifications, and investigated for tissue levels of malondialdehyde (MDA) and glutathione (GSH). Results. Our results showed that periodontal tissues in patients with T2D present significant inflammation, affecting both epithelial and connective tissues. Mean MDA tissue levels were 3.578 ± 0.60 SD in diabetics versus 0.406 ± 0.27 SD in controls ( Continue reading >>

Periodontal Disease And Control Of Diabetes Mellitus

Data from the Centers for Disease Control and Prevention indicate that more than 20 million people (approximately 7% of the population) in the United States have diabetes mellitus. Physicians often fail to examine the mouths and teeth of their patients, even though the condition of the mouth and teeth have clinical relevance for the treatment of patients with diabetes mellitus. The authors examine the current state of knowledge regarding periodontal disease and the effect of periodontal disease on worsening of glycemic control. They review several studies investigating how the management of periodontal disease affects the ability of patients to control symptoms of diabetes mellitus. The authors conclude with several recommendations for the treatment of patients with periodontal disease to improve glycemic control. A physician's examination of the mouth usually involves a “Say `Ahh...'” and a quick look at the pharynx. Unfortunately, this brief examination is likely to miss important, clinically relevant information.1,2 For example, periodontal disease has the potential to have an adverse impact on glycemic control in patients with diabetes mellitus. Data from the Centers for Disease Control and Prevention (CDC) indicate that more than 20 million people (approximately 7% of the population) in the United States have diabetes mellitus.3 Diabetes mellitus remains undiagnosed in more than 6 million of these individuals, according to CDC estimates.3 Figure 1 lists a number of medical conditions, including periodontitis, gingivitis, lesions, and pigmentation changes, that can be revealed with a thorough examination of the mouth. Family physicians need to recognize how such conditions can affect various disease processes, including that of diabetes mellitus, and refer their Continue reading >>

Periodontitis And Diabetes: A Two-way Relationship

Go to: Abstract Periodontitis is a common chronic inflammatory disease characterised by destruction of the supporting structures of the teeth (the periodontal ligament and alveolar bone). It is highly prevalent (severe periodontitis affects 10–15% of adults) and has multiple negative impacts on quality of life. Epidemiological data confirm that diabetes is a major risk factor for periodontitis; susceptibility to periodontitis is increased by approximately threefold in people with diabetes. There is a clear relationship between degree of hyperglycaemia and severity of periodontitis. The mechanisms that underpin the links between these two conditions are not completely understood, but involve aspects of immune functioning, neutrophil activity, and cytokine biology. There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control. Incidences of macroalbuminuria and end-stage renal disease are increased twofold and threefold, respectively, in diabetic individuals who also have severe periodontitis compared to diabetic individuals without severe periodontitis. Furthermore, the risk of cardiorenal mortality (ischaemic heart disease and diabetic nephropathy combined) is three times higher in diabetic people with severe periodontitis than in diabetic people without severe periodontitis. Treatment of periodontitis is associated with HbA1c reductions of approximately 0.4%. Oral and periodontal health should be promoted as integral components of diabetes management. Keywords: Diabetes, Diabetes complications, Periodontal diseases, Periodontitis, Type 1 diabetes mellitus, Type 2 diabetes mellitus Periodontitis (r Continue reading >>

Diabetes And Periodontal Disease: An Update For Health Care Providers

In Brief Periodontitis has been identified as the sixth complication of diabetes. Advanced glycation end-products, altered lipid mechanisms, oxidative stress, and systemically elevated cytokine levels in patients with diabetes and periodontitis suggest that dental and medical care providers should coordinate therapies. Inflammation of the Periodontium Periodontitis is a chronic inflammatory disease of the mouth that involves the gingiva (gum tissues), teeth, and supporting bone. Periodontitis is clinically defined as the loss of connective tissue attachment to the teeth and alveolar bone loss. If periodontitis is left untreated, the involved teeth will exfoliate. In many cases, periodontitis is the second stage of an inflammatory process that begins with gingivitis. From a clinical perspective, gingivitis presents with swollen tissues and increased redness but with no loss of connective tissue attachment between root surfaces and bone. The inflammatory cell infiltrate in gingivitis is dominated by a polymorphonuclear neutrophil infiltrate (acute inflammation), whereas the histopathology of periodontitis is dominated by a plasma cell infiltrate (chronic inflammation).1 The clinical signs of periodontitis include swelling, redness and bleeding from the gums, spacing between teeth, loose teeth, and exposure of root surfaces through loss of bone around the teeth. The disease can present locally, involving a few teeth, or be more generalized. Figure 1 shows the severity of gingival inflammation in a patient who had received initial periodontal non-surgical treatment 3 months before the photo was taken. In patients with a systemic disease such as diabetes, the disease is often more generalized. Patients with poor glycemic control often present with severely inflamed gum tissu Continue reading >>

Periodontitis As A Possible Early Sign Of Diabetes Mellitus

Abstract Objective The early diagnosis of (pre)diabetes mellitus is essential for the prevention of diabetes complications. It has been suggested that gum disease (periodontitis) might be an early complication of diabetes and may be a useful risk indicator for diabetes screening. Therefore, a dental office could be a good location for screening for (pre)diabetes in patients with periodontitis using a validated glycated hemoglobin (HbA1c) dry spot analysis. Research design and methods A total of 313 individuals from a university dental clinic participated. From 126 patients with mild/moderate periodontitis, 78 patients with severe periodontitis and 109 subjects without periodontitis, HbA1c values were obtained by the analysis of dry blood spots. Differences in mean HbA1c values and the prevalence of (pre)diabetes between the groups were analyzed. Results The mild/moderate and severe periodontitis groups showed significantly higher HbA1c values (6.1%±1.4% (43 mmol/mol±15 mmol/mol) and 6.3%±1.3% (45 mmol/mol±15 mmol/mol), respectively) compared with the control group (5.7%±0.7% (39 mmol/mol±8 mmol/mol), p=0.003). In addition, according to the American Diabetes Association (ADA) guidelines for diagnosis, there was a significant over-representation of subjects with suspected diabetes (23% and 14%) and pre-diabetes (47% and 46%) in the severe periodontitis group and mild/moderate periodontitis groups, respectively, compared with the control group (10% and 37%, p=0.010). Notably, 18.1% of patients with suspected new diabetes were found among subjects with severe periodontitis compared with 9.9% and 8.5% among subjects with mild/moderate periodontitis and controls, respectively (p=0.024). Conclusions The dental office, with particular focus on patients with severe periodo Continue reading >>

Diabetes And Periodontal Disease The Relation

1. Periodontal Inflammation and Diabetes: a two way relationshipKaumudi Joshipura BDS, MS, ScD Center for Clinical Research and Health PromotionSchool of Dental MedicineUniversity of Puerto RicoHarvard University 2. Biological Pathways: Periodontal Disease, Systemic Inflammation and Cardiometabolic ConditionsCommon Risk FactorsAgeSmokingObesity, DiabetesPhysical ActivityGeneticsRaceAlcoholComorbidityMedicationsFluorideMicrobesAccess to CarePeriodontitisCariesToothlossSystemic Inflammation Nutrition (Body Composition,(Biomarkers) Dietary intake; Nutritional Status) Dyslipidemia Arterial StiffnessObesityAdverse Pregnancy OutcomesHypertensionPre-diabetesAtherosclerosis DiabetesCHDPADStrokeGestationalDiabetesPre-eclampsia2Kidney DiseaseCancer 3. Dental CariesCavities are holes or structural damage to the teeth.There may be no symptoms, but if present, may include:Toothache or painful sensation in the teeth, especially after consuming sweet drinks or hot or cold foodRisk factors include: Poor oral hygiene Fermentable carbohydrates 4. It is an infection and inflammation affecting the soft tissues and bone that support the teeth.Periodontitis occurs when infection and inflammation of the gums (gingivitis) progresses to involve other surrounding tissues. Periodontitis 5. Healthy GingivaPeriodontal Disease 6. Pocket DepthHealthy gingivaPeriodontal Pocket 7. Attachment Level6mm6mm 8. Bone Loss 9. Gingival RecessionCauses:

• Periodontal Disease 10. Traumatic tooth cleaning technique 11. Local irritants (plaque or calculus) 12. Orthodontic tipping 13. Provisional crowns 14. Extraction of adjacent teeth 15. Occlusal forces

9 16. U.S. Adults PeriodontalDiseasePrevalence (≥1 site Pocket Depth ≥4mm)NHANES III, 1988-94Adapted: Burt and Eklund, 2005 17. U.S. Adults Cum Continue reading >>

Treatment Of Periodontal Disease For Glycaemic Control In People With Diabetes Mellitus

Treatment of periodontal disease for glycaemic control in people with diabetes mellitus Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Cochrane Oral Health, Manchester, UK Jo C Weldon, Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, JR Moore Building, Oxford Road, Manchester, M13 9PL, UK. [email protected] . Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Cochrane Oral Health, Manchester, UK Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Cochrane Oral Health, Manchester, UK Cited by (CrossRef): 10 articles Check for updates Glycaemic control is a key issue in the care of people with diabetes mellitus (DM). Periodontal disease is the inflammation and destruction of the underlying supporting tissues of the teeth. Some studies have suggested a bidirectional relationship between glycaemic control and periodontal disease. This review updates the previous version published in 2010. The objective is to investigate the effect of periodontal therapy on glycaemic control in people with diabetes mellitus. We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 31 December 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2014, Issue 11), MEDLINE via OVID (1946 to 31 December 2014), EMBASE via OVID (1980 to 31 December 2014), LILACS via BIREME (1982 to 31 December 2014), and CINAHL via EBSCO (1937 to 31 December 2014). ZETOC (1993 to 31 December 2014) and Web of Knowledge (1990 to Continue reading >>

Diabetes Mellitus Related Bone Metabolism And Periodontal Disease

International Journal of Oral Science volume 7, pages 6372 (2015) Diabetes mellitus and periodontal disease are chronic diseases affecting a large number of populations worldwide. Changed bone metabolism is one of the important long-term complications associated with diabetes mellitus. Alveolar bone loss is one of the main outcomes of periodontitis, and diabetes is among the primary risk factors for periodontal disease. In this review, we summarise the adverse effects of diabetes on the periodontium in periodontitis subjects, focusing on alveolar bone loss. Bone remodelling begins with osteoclasts resorbing bone, followed by new bone formation by osteoblasts in the resorption lacunae. Therefore, we discuss the potential mechanism of diabetes-enhanced bone loss in relation to osteoblasts and osteoclasts. Diabetes mellitus is a heterogeneous group of disorders and is characterized by high blood glucose levels. 1 Type 1 diabetes mellitus (T1DM) results from an absolute deficiency of insulin, which is most commonly due to auto-immunological destruction of the insulin-producing pancreatic cells but which can be caused by other etiologies. In type 2 diabetes mellitus (T2DM), muscle, fat and other cells become resistant to the actions of insulin. This results in the activation of a compensatory mechanism that induces cells to secrete more insulin. T2DM occurs when the compensatory increase in insulin is insufficient to maintain blood glucose levels within a normal physiological range. 2 , 3 By 2025, 300 million people are projected to be afflicted with diabetes worldwide, with a prevalence of 6.4%. 4 , 5 The countries with the most people suffering from diabetes by the year 2025 are predicted to be India, China and the United States. T1DM represents 5%10% of the total number Continue reading >>

Diabetes And Periodontal Disease

Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications. People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk. Research has suggested that the relationship between diabetes and periodontal disease goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications. Continue reading >>

The Influence Of Type 2 Diabetes Mellitus On Periodontal Disease

Endocrine Abstracts (2014) 35 P460 | DOI: 10.1530/endoabs.35.P460 The influence of type 2 diabetes mellitus on periodontal disease Joo Silva1,2, Diana Correia1,2, Mafalda Marcelino1, Ana Lopes1, Nicholas Fernandes1, Ana Lucia Ferreira1, Tiago Troles1, Andreia Domingues1, Dolores Passos1, Luis Lopes1, Joana Figueiredo1, Henrique Luis3, Nuno Silva1, Jos Joo Mendes1 & Joo Jcome de Castro1 1Armed Forces Hospital, Lisbon, Portugal; 2CINAMIL Military Academy, Lisbon, Portugal; 3University of Dental Medicine, Lisbon, Portugal. The relationship between periodontitis and diabetes mellitus (DM) is widely accepted. Several studies identified a greater incidence of periodontitis and an increase of its severity in diabetic patients, approximately threefold. In this study, we want to investigate the influence of type 2 DM (T2DM) in the development of periodontitis. Single center, randomized trial with 90 patients T2DM. Exclusion criteria: chronic renal disease (GFR<90); pregnancy; antibiotics (last 3 months); hemoglobinopathies; bleeding disorders; less than three teeth; periodontal treatment (last 6 months) and smoking habits. Metabolic and biometric parameters were registered and used a computerized periodontal probe to record periodontal status. Variables were analyzed by 2 tests and multivariable regression with a significance level of 5%. A total of 90 individuals were observed: 70 males (77.8%); mean age of 64.3 years (9.95), BMI of 29.1 kg/m2 (4.42), waist circumference of 103.4 cm, HbA1c of 6.69% (0.95), T2DM was diagnosed for 11.3 years (8.66), and 84% had dyslipidemia. Patients had in average 21.4 teeth (7.1), 98.1% of teeth had bleeding on probing, 11.1% had suppuration and 100% had dental plaque. CAL ranged from 0 to 11 mm. PD was present in 98% of T2DM patients: 55% had Continue reading >>