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Diabetes Mellitus Periodontitis

The Innate Immune System And Diabetes Mellitus: The Relevance Of Periodontitis? A Hypothesis

The Innate Immune System And Diabetes Mellitus: The Relevance Of Periodontitis? A Hypothesis

About a decade ago, a hypothesis was proposed suggesting that the innate immune system, including acute-phase reactants, contribute to the development of T2DM [Type 2 DM (diabetes mellitus)] and the metabolic syndrome. In this model, it was hypothesized that the innate immune system modulates the effects of many factors, including genes, fetal programming, nutrition and aging, upon the later development of metabolic problems associated with insulin resistance. In this present article, we expand this hypothesis by looking at the involvement of periodontitis in DM and its complications. Periodontitis is a common inflammatory process involving the innate immune system and is associated with DM. We will also illustrate how dental disease is important in patients with DM and could be implicated in various diabetic complications. Abbreviations: AGE, advanced glycation end product; CRP, C-reactive protein; DM, diabetes mellitus; ESRD, end-stage renal disease; HbA1c, glycated haemoglobin; HDL, high-density lipoprotein; HGF, human gingival fibroblast; IL, interleukin; LDL, low-density lipoprotein; T2DM, Type 2 DM Continue reading >>

Summary, Discussion & Conclusion

Summary, Discussion & Conclusion

Periodontitis, Diabetes Mellitus, Cardiovascular Disease W.J. Teeuw 225 Over the last decades, the relation between periodontitis, diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ACVD) has been extensively studied. Periodontitis is a common chronic multifactorial inflammatory disease of the supporting structures of the teeth and is a major cause of tooth loss (Pihlstrom et al., 2005). Besides the possibility that systemic diseases, such as DM (Preshaw et al., 2012), may contribute to the onset and/or progression of periodontitis, inflamed periodontal tissues open the possibility for oral bacteria to enter the circulation and induce systemic inflammation. It is now widely accepted that a low grade systemic inflammation contributes to metabolic dysregulation (King, 2008, Pradhan et al., 2001) and atherogenesis (Kaptoge et al., 2010, Friedewald et al., 2009). Although many investigations suggest several pathways that might explain the link between periodontitis and DM, and periodontitis and ACVD, the biological mechanisms, clinical relevance and implications of these interactions are still not well understood. The aim of this thesis was to contribute to the understanding of the complex relationship between these three disease states intricately caught in a ‘Bermuda Triangle’. PERIODONTITIS AND DIABETES MELLITUS DM and periodontitis are two chronic diseases that have long been considered to be biologically linked in a bi-directional way (Llambes et al., 2015, Preshaw et al., 2012, Lalla and Papapanou, 2011) (Figure 1). Figure 1 The bi-directional link between diabetes mellitus and periodontitis. First, periodontitis is considered as a complication of diabetes mellitus. Second, periodontitis, as a chronic inflammatory disease, might contribute Continue reading >>

Periodontitis As A Possible Early Sign Of Diabetes Mellitus

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 >>

The Relationship Between Periodontal Disease And Diabetes Mellitus

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 >>

Diabetes And Periodontal Disease The Relation

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 >>

Diabetes Mellitus And Periodontal Diseases.

Diabetes Mellitus And Periodontal Diseases.

Abstract BACKGROUND: The purpose of this review is to provide the reader with practical knowledge concerning the relationship between diabetes mellitus and periodontal diseases. Over 200 articles have been published in the English literature over the past 50 years examining the relationship between these two chronic diseases. Data interpretation is often confounded by varying definitions of diabetes and periodontitis and different clinical criteria applied to prevalence, extent, and severity of periodontal diseases, levels of glycemic control, and complications associated with diabetes. METHODS: This article provides a broad overview of the predominant findings from research published in English over the past 20 years, with reference to certain "classic" articles published prior to that time. RESULTS: This article describes current diagnostic and classification criteria for diabetes and answers the following questions: 1) Does diabetes affect the risk of periodontitis, and does the level of metabolic control of diabetes have an impact on this relationship? 2) Do periodontal diseases affect the pathophysiology of diabetes mellitus or the metabolic control of diabetes? 3) What are the mechanisms by which these two diseases interrelate? and 4) How do people with diabetes and periodontal disease respond to periodontal treatment? CONCLUSIONS: Diabetes increases the risk of periodontal diseases, and biologically plausible mechanisms have been demonstrated in abundance. Less clear is the impact of periodontal diseases on glycemic control of diabetes and the mechanisms through which this occurs. Inflammatory periodontal diseases may increase insulin resistance in a way similar to obesity, thereby aggravating glycemic control. Further research is needed to clarify this aspect of Continue reading >>

Periodontal Therapy And Systemic Inflammation In Type 2 Diabetes Mellitus: A Meta-analysis

Periodontal Therapy And Systemic Inflammation In Type 2 Diabetes Mellitus: A Meta-analysis

Abstract The aim of this systematic review was to assess the effect of periodontal therapy (PT) on serum levels of inflammatory markers in people with type 2 diabetes mellitus (T2DM). A literature search was carried out using MEDLINE via Pubmed, EMBASE, LILACS and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Randomized-controlled trials (RCTs) and controlled clinical trials (CCTs) evaluating the effect of PT on systemic inflammatory markers were deemed eligible. Case series (CS), reports and pilot trials were excluded. Study quality was assessed using the Cochrane Collaboration’s risk assessment tool. Meta-analysis was carried out using random effect methods. The search strategy identified 3,164 potential studies of which 61 were assessed for eligibility and 9 (6 RCTs and 3 CCTs) were included in this systematic review. Three RCTs were classified by the authors as being at low risk of bias and three were “unclear” and classified as uncertain risk of bias. All CCTs were considered to be at a high risk of bias. The meta-analysis showed a statistically significant mean difference (MD) for TNF- α (-1.33 pg/ml, 95% CI: -2.10; -0.56, p<0.001) and CRP (-1.28 mg/l, 95% CI: -2.07; - 0.48, p<0.001) favoring periodontal intervention versus control. The results of this meta-analysis support the hypothesis that PT reduces serum levels of TNF- α and CRP in T2DM individuals. The decrease of inflammatory burden has important implications for metabolic control and can, in part, explain the mechanisms linking periodontitis and increased risk for complications in people with T2DM. Figures Citation: Artese HPC, Foz AM, Rabelo MdS, Gomes GH, Orlandi M, Suvan J, et al. (2015) Periodontal Therapy and Systemic Inflammation in Type 2 Diabetes Mellitus: A Meta-Anal Continue reading >>

Diabetes Mellitus And Periodontitis – Signs Of A Bidirectional Relationship

Diabetes Mellitus And Periodontitis – Signs Of A Bidirectional Relationship

Pınar Gümüş, Nurcan Buduneli Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey Disclosure: No potential conflict of interest. Received: 15.05.13 Accepted: 30.10.13 Citation: EMJ Diabet. 2013;1:30-36. Periodontitis is a multifactorial, irreversible and cumulative condition, initiated and propagated by bacteria and host factors. The multifactorial nature of periodontitis is related with the complex interactions between microorganisms in the microbial dental plaque and host response mechanisms, as well as environmental factors. Progression of periodontal disease is very much dependent on host response. Diabetes mellitus (DM), a complex metabolic disorder characterised by prolonged hyperglycaemia, has long been recognized as one of the leading causes of morbidity and mortality globally. DM is a complex metabolic syndrome that affects both the quality and length of life with major complications. Periodontal disease and diabetes are highly prevalent chronic diseases and inflammation may play a critical role in their relationship. Prospective clinical studies with larger scale and greater statistical power are required to better clarify the mechanisms of possible effects of chronic periodontitis on diabetes. Continue reading >>

Periodontal Disease And Diabetes Mellitus

Periodontal Disease And Diabetes Mellitus

Abstract Infections of the tissue surrounding the teeth (periodontitis) are usually caused by anaerobic gram-negative microorganisms. This infection causes destruction of the supporting alveolar bone and can lead to tooth loss. Removal of these microorganisms can slow or arrest the progression of periodontitis. Diabetes patients are at greater risk of developing periodontitis, may not respond as well to periodontal therapy as nondiabetic patients, and may require more aggressive treatment to manage periodontitis. Microorganisms that cause periodontitis and the host response to these may increase insulin resistance in diabetic patients. Treatment of periodontitis could improve glycemic control. A model is presented in which periodontal pathogens may cause increases in proinflammatory cytokines that mediate increases in insulin resistance, resulting in an increase in blood glucose. Following periodontal therapy, this process may be reversed. Preview Unable to display preview. Download preview PDF. Continue reading >>

Diabetes And Periodontal Disease

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 >>

The Influence Of Type 2 Diabetes Mellitus On Periodontal Disease

The Influence Of Type 2 Diabetes Mellitus On Periodontal Disease

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 χ2 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 initial PD, 30% moderate and 15% severe. There is an association between metabolic control (HbA1c) and the severity of PD (P<0.001) but not with the duration of T2DM (P=0.415). From multivariable analysis it was found that regardless metabolic control, diabetic patients had a higher risk of develop PD if they were obese or with higher waist measure (P<0.001) and dyslipidemia (P=0.025). We conclude that patients with T2DM had a high prevalence of PD and similar to other diabetes complications, susceptibility t Continue reading >>

Evidence-based Guidelines For The Diagnosis And Treatment Of Diabetes Mellitus

Evidence-based Guidelines For The Diagnosis And Treatment Of Diabetes Mellitus

11 Diabetes and Periodontitis 1. Relationship between Diabetes and Periodontitis ï¬ Diabetes and periodontitis adversely affect each other. 1-3 Therefore, patients with diabetes should be informed about their relationship, consult dentists regularly to have themselves examined for oral cavity status and undergo dental care as required. (grade A; consensus) 2. Periodontitis in Patients with Diabetes ï¬ Periodontitis is more frequently seen and severer among patients with diabetes (particularly those with poor glycemic control and at risk of disease progression) than among healthy individuals. 1-3(grade A) ï‚™ In a Japanese study comparing patients with diabetes and healthy individuals for prevalence of periodontitis, likewise, periodontitis was shown to be higher in prevalence among both patients with type 1 and type 2 diabetes than among healthy individuals.1 3. Influence of Periodontitis on the Onset of Diabetes and on its Disease Condition ï¬ Individuals with periodontitis are more likely to have diabetes4 and are at a higher risk of developing diabetes than those without.5 Severe periodontitis may adversely affect glycemic control in diabetes if left untreated.2 (grade B; consensus) ï‚™ In the Hisayama cohort study, periodontitis was shown to be higher in frequency among those who developed glucose intolerance over a 10-year period than among those who did not.6 4. Influence of Periodontal Care on Glycemic Control ï¬ Periodontal care in type 2 diabetes may lead to improvements in their HbA1c values.7(grade B) ï‚™ A meta-analysis/systematic review suggests that periodontal care in type 1 diabetes has little or no influence on their glycemic control, while periodontal care in type 2 diabetes is shown to improve their HbA1c values by a mean of 0.6 Continue reading >>

Bacteremia After Chewing In A Patient With Severe Chronic Periodontitis And Diabetes Mellitus Type 2: A Brief Report

Bacteremia After Chewing In A Patient With Severe Chronic Periodontitis And Diabetes Mellitus Type 2: A Brief Report

1. Introduction Oral health microbiota consists of about 700 species [3] and there is probably a different core microbiome for health [4] and for disease depending on physiological status and lifestyle [4]. Chronic periodontitis an oral infection-inflammatory disease leads to destruction of tooth support tissue integrity [1]. It is caused by interactions among microbial agents, host susceptibility and environmental factors. Periodontitis has a prevalence of 47% in the USA and it is a frequent cause of tooth loss [2]. Keystone pathogens for periodontitis are Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans[5]. Since they have been identified in bloodstream they may be involved in distant-site infections [6]. The oral origin of bacteremia may be due to “everyday” oral activities (i.e., tooth brushing, chewing) or dental procedures [7,8]. In periodontitis, the disruption of periodontal tissues integrity could lead to bacteremia [9], resulting in focal infections, such as endocarditis [10]. It has been suggested that 8–10% of bacterial endocarditis is associated with oral infections in the absence of dental manipulations [10]. In this context, oral activities can cause small tooth and gingival movements, developing microscopic vascular lesions through which bacteria gain access to the bloodstream [11]. These events rarely exceed 15 minutes and occur in low intensity [12], but are cumulative and provide clinical relevance [11]. Evidences suggest a bidirectional and potentially causal association between Type 2 Diabetes Mellitus (T2DM) and periodontal status [12]. T2DM is a metabolic disease characterized by hyperglycemia due to defects in insulin secretion and/or action [13]. Poor metabolic control has been associated with periodontitis [14], consider Continue reading >>

Effect Of Periodontal Therapy On Type 2 Diabetes Mellitus Patients With Chronic Periodontitis With The Evaluation Of Hba1c

Effect Of Periodontal Therapy On Type 2 Diabetes Mellitus Patients With Chronic Periodontitis With The Evaluation Of Hba1c

Context: In the recent years, a two-way correlation has been postulated between periodontitis and systemic conditions. One such condition is diabetes mellitus (DM). Several studies have demonstrated a close relationship between DM and chronic periodontitis. Aims: To assess the effect of periodontal therapy and scaling and root planing (SRP) on the metabolic control in type 2 DM patients with chronic periodontitis based on the estimation of glycated hemoglobin (HbA1c). Settings and Design: A prospective, comparative, clinical study was performed on 50 patients suffering from type 2 DM with moderate, generalized chronic periodontitis. The study period was 6 months. Type 2 moderately controlled diabetic patients with glycated hemoglobin values within the range of 6-8% were selected. Patients with major diabetic complications, history of any antibiotic intake or periodontal treatment within the last 4 months, and smoking habits were excluded. Materials and Methods: The parameters recorded were gingival index (GI), plaque index (PI), sulcus bleeding index (SBI), probing pocket depth (PPD), clinical attachment level (CAL), and glycated hemoglobin. The recordings were done at baseline and 6 months after scaling and root planing procedures. HbA1c was measured by NycoCard Reader. Statistical Analysis Used: Karl-Pearson coefficient test, Z-test, and paired t-test. Results: Reductions in all the clinical parameters were observed and were found to be statistically significant (P < 0.005). Conclusions: Scaling and root planing resulted in a statistically significant reduction in the clinical parameters and HbA1c. So, periodontal treatment should be included in the management of diabetic patients. Table 2: The correlation between differences in the mean values of different periodonta Continue reading >>

The Relationship Between Gestational Diabetes Mellitus And Periodontal Health: A Case-control Study

The Relationship Between Gestational Diabetes Mellitus And Periodontal Health: A Case-control Study

IJEDS RESEARCH ARTICLE The Relationship between Gestational Diabetes Mellitus and Periodontal Health: A Case-Control Study Nilsun Bagis, Hamit Selim Bostanci ABSTRACT Introduction: Gestational diabetes mellitus (GDM) is carbohydrate intolerance of various degrees occurring or being observed during pregnancy for the first time. The aim of the present study is to investigate the relationship between periodontal health and GDM, which is one of the most important medical complications of pregnancy. Materials and methods: One hundred and sixty-five pregnant women, 80 healthy and 85 with gestational diabetes, between the ages of 18 and 30, with a mean age of 25.85 ± 2.96 were included in the study. It was first pregnancy of all individuals and none of them received periodontal treatment 6 months prior to the study. Clinical evaluations were made by using plaque index (PI), gingival index (GI), probing pocket depth, bleeding on probing (BOP) index. Results: The results of our study revealed that, compared to healthy pregnant women, the values of body mass index, weight, GI and BOP were significantly higher for women with GDM. Keywords: Gestational diabetes mellitus, Oral glucose tolerance test, Periodontal health, Pregnancy, Diabetes mellitus. How to cite this article: Bagis N, Bostanci HS. The Relationship between Gestational Diabetes Mellitus and Periodontal Health: A Case-control Study. Int J Experiment Dent Sci 2013;2(2):71-75. Source of support: Nil Conflict of interest: None declared INTRODUCTION Periodontal disease is one of the most common chronic disorders of infectious origin known in humans and refers to an inflammatory condition of the soft tissues surrounding the teeth, (i.e. gingivitis) and the destruction of the supporting structures of the teeth, including t Continue reading >>

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