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Diabetes Mellitus Periodontitis

Periodontal Disease: The Sixth Complication Of Diabetes Mellitus

Periodontal Disease: The Sixth Complication Of Diabetes Mellitus

Periodontal disease is a chronic inflammatory condition characterized by destruction of the periodontal tissues and resulting in loss of connective tissue attachment, loss of alveolar bone, and the formation of pathological pockets around the diseased teeth. Some level of periodontal disease has been found in most populations studied and is responsible for a substantial portion of the tooth loss in adulthood. Continue reading >>

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

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 >>

Periodontitis And Diabetes: A Two-way Relationship

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

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 >>

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 >>

Oxidative Stress: A Link Between Diabetes Mellitus And Periodontal Disease

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 >>

Type 2 Diabetes Mellitus With Periodontal Disease

Type 2 Diabetes Mellitus With Periodontal Disease

E11.630 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. This is the American ICD-10-CM version of E11.630 - other international versions of ICD-10 E11.630 may differ. Approximate Synonyms Periodontal disease due to diabetes type 2 Periodontal disease due to type 2 diabetes mellitus ICD-10-CM E11.630 is grouped within Diagnostic Related Group(s) (MS-DRG v35.0): Code History 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM) 2017 (effective 10/1/2016): No change 2018 (effective 10/1/2017): No change Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. Continue reading >>

Zinc And Type 2 Diabetes Mellitus With Periodontitis- A Systematic Review

Zinc And Type 2 Diabetes Mellitus With Periodontitis- A Systematic Review

Abstract: Diabetes mellitus has been increasing rapidly worldwide, making it a huge health pressure on society in both the developed and developing countries. During the last thirty years, diabetes mellitus, a chronic metabolic disease characterized by hyperglycemia is proving itself to be fatal. Periodontitis was considered as one of the main, oral health problems encountered in patients with diabetes mellitus. There exists a direct relation between the risk of complications of diabetes and periodontitis over time. The present review gives an outline of the features that govern the interrelationship between zinc and diabetes mellitus with periodontal disease, including the physiologic mechanisms and clinical studies, and presents scientific evidences. The disturbance in the zinc micronutrient and increased oxidative stress in type 2 diabetes may bring about insulin resistance and the creation of diabetic complications. The progression of diabetes mellitus may bring about perturbation in micronutrient metabolism and status. Keywords: Micronutrients, oxidative stress, periodontitis, tissue damage, type 2 diabetes mellitus, zinc. Rights & PermissionsPrintExport Article Details Continue reading >>

Periodontal Disease And Diabetes Mellitus

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 >>

Diabetes Mellitus And Periodontitis: A Tale Of Two Common Interrelated Diseases

Diabetes Mellitus And Periodontitis: A Tale Of Two Common Interrelated Diseases

Diabetes mellitus (a group of metabolic disorders characterized by hyperglycemia) and periodontitis (a microbially induced inflammatory disorder that affects the supporting structures of teeth) are both common, chronic conditions. Multiple studies have demonstrated that diabetes mellitus (type 1 and type 2) is an established risk factor for periodontitis. Findings from mechanistic studies indicate that diabetes mellitus leads to a hyperinflammatory response to the periodontal microbiota and also impairs resolution of inflammation and repair, which leads to accelerated periodontal destruction. The cell surface receptor for advanced glycation end products and its ligands are expressed in the periodontium of individuals with diabetes mellitus and seem to mediate these processes. The association between the two diseases is bidirectional, as periodontitis has been reported to adversely affect glycemic control in patients with diabetes mellitus and to contribute to the development of diabetic complications. In addition, meta-analyses conclude that periodontal therapy in individuals with diabetes mellitus can result in a modest improvement of glycemic control. The effect of periodontal infections on diabetes mellitus is potentially explained by the resulting increase in levels of systemic proinflammatory mediators, which exacerbates insulin resistance. As our understanding of the relationship between diabetes mellitus and periodontitis deepens, increased patient awareness of the link between diabetes mellitus and oral health and collaboration among medical and dental professionals for the management of affected individuals become increasingly important. 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 >>

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 >>

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 >>

Periodontitis And Diabetes Mellitus: A Complex Relationship

Periodontitis And Diabetes Mellitus: A Complex Relationship

Abstract This chapter explores the complex relationship between diabetes mellitus and periodontal diseases. When either disease is undiagnosed or poorly managed, risk for the other disease increases. In addition, the optimal management of both diseases is essential to prevent adverse sequelae that can occur in a bidirectional manner. Studies in this area have been confounded by variability in the type of diabetes studied, diabetes treatment regimens, the level of diabetic control, the presence or absence of diabetic complications, periodontal disease severity, the periodontal therapy used, and the numbers of subjects enrolled with vastly different inclusion and exclusion criteria. Despite these challenges, the preponderance of evidence supports a bidirectional relationship requiring collaboration between medical and dental practitioners for the provision of optimal healthcare services to the growing population of patients with both diabetes and periodontal diseases. A better understanding of the mechanisms involved in these disease processes would enable a multidisciplinary team of healthcare providers including the dentist and hygienist to provide optimal therapy for this complex patient population. In addition, the challenges faced in interprofessional management of patients with diabetes and periodontal diseases will also be addressed. Continue reading >>

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 >>

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