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Hamamoto Y, Ouhara K, Munenaga S, Shoji M, Ozawa T, Hisatsune J, Kado I, Kajiya M, Matsuda S, Kawai T, Mizuno N, Fujita T, Hirata S, Tanimoto K, Nakayama K, Kishi H, Sugiyama E, Kurihara H. Effect of Porphyromonas gingivalis infection on gut dysbiosis and resultant arthritis exacerbation in mouse model. Arthritis Res Ther 2020; 22:249. [PMID: 33076980 PMCID: PMC7574451 DOI: 10.1186/s13075-020-02348-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 10/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Porphyromonas gingivalis (Pg) infection causes periodontal disease and exacerbates rheumatoid arthritis (RA). It is reported that inoculation of periodontopathogenic bacteria (i.e., Pg) can alter gut microbiota composition in the animal models. Gut microbiota dysbiosis in human has shown strong associations with systemic diseases, including RA, diabetes mellitus, and inflammatory bowel disease. Therefore, this study investigated dysbiosis-mediated arthritis by Pg oral inoculation in an experimental arthritis model mouse. METHODS Pg inoculation in the oral cavity twice a week for 6 weeks was performed to induce periodontitis in SKG mice. Concomitantly, a single intraperitoneal (i.p.) injection of laminarin (LA) was administered to induce experimental arthritis (Pg-LA mouse). Citrullinated protein (CP) and IL-6 levels in serum as well as periodontal, intestinal, and joint tissues were measured by ELISA. Gut microbiota composition was determined by pyrosequencing the 16 s ribosomal RNA genes after DNA purification of mouse feces. Fecal microbiota transplantation (FMT) was performed by transferring Pg-LA-derived feces to normal SKG mice. The effects of Pg peptidylarginine deiminase (PgPAD) on the level of citrullinated proteins and arthritis progression were determined using a PgPAD knockout mutant. RESULTS Periodontal alveolar bone loss and IL-6 in gingival tissue were induced by Pg oral infection, as well as severe joint destruction, increased arthritis scores (AS), and both IL-6 and CP productions in serum, joint, and intestinal tissues. Distribution of Deferribacteres and S24-7 was decreased, while CP was significantly increased in gingiva, joint, and intestinal tissues of Pg-inoculated experimental arthritis mice compared to experimental arthritis mice without Pg inoculation. Further, FMT from Pg-inoculated experimental arthritis mice reproduced donor gut microbiota and resulted in severe joint destruction with increased IL-6 and CP production in joint and intestinal tissues. The average AS of FMT from Pg-inoculated experimental arthritis was much higher than that of donor mouse. However, inoculation of the PgPAD knockout mutant inhibited the elevation of arthritis scores and ACPA level in serum and reduced CP amount in gingival, joint, and intestinal tissues compared to Pg wild-type inoculation. CONCLUSION Pg oral infection affected gut microbiota dysbiosis and joint destruction via increased CP generation.
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Affiliation(s)
- Yuta Hamamoto
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Kazuhisa Ouhara
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Syuichi Munenaga
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Mikio Shoji
- Department of Microbiology and Oral Infection, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Tatsuhiko Ozawa
- Department of Immunology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Jyunzo Hisatsune
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases (NIID), Toyama 1-23-1, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Isamu Kado
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical & Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Mikihito Kajiya
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Shinji Matsuda
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Toshihisa Kawai
- Department of Periodontology, Nova Southeastern University College of Dental Medicine, 3200 South University Drive, Fort Lauderdale, FL, 33328, USA
| | - Noriyoshi Mizuno
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Tsuyoshi Fujita
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kotaro Tanimoto
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical & Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Koji Nakayama
- Department of Microbiology and Oral Infection, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Hiroyuki Kishi
- Department of Immunology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Eiji Sugiyama
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hidemi Kurihara
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
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Effect of diode laser application as an adjunct to nonsurgical periodontal therapy on the reduction of red complex microorganisms in type 2 diabetics with chronic periodontitis. Lasers Med Sci 2020; 35:1403-1410. [PMID: 32193820 DOI: 10.1007/s10103-020-02997-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
Bactericidal and detoxification effects of diode laser (DL) have been reported in periodontal treatment. The objective of this study was investigating the additional effect of DL with nonsurgical periodontal treatment on the red complex bacteria in type 2 diabetes mellitus (DM) patients with chronic periodontitis (CP). Sixty type 2 DM patients with chronic periodontitis (CP) were randomly assigned in two parallel groups to receive scaling root planning (SRP, n = 30) or SRP followed by DL periodontal pocket irradiation (SRP + DL, n = 30). Recording of clinical parameters and subgingival plaque sampling were performed at baseline, and post therapy (1 and 3 months after treatment). Amounts of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia were evaluated with quantitative RT-PCR. Significant reductions for numbers of all three bacterial species were observed at 1 and 3 months compared with baseline for both treatments (p < 0.001), but no significant differences were found between two groups regarding bacterial reductions at these follow-up time points. No additional benefit of DL as an adjunct to nonsurgical periodontal therapy was recognized in the reduction of P. gingivalis, T. denticola, and T. forsythia for type 2 DM patients with CP. Further studies are required to clarify the effects of diode laser on the other periodontopathogens.
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Wei YS, Hsiao YC, Su GW, Chang YR, Lin HP, Wang YS, Tsai YT, Liao EC, Chen HY, Chou HC, Ko ML, Kuo WH, Chang SJ, Cheng WC, Chan HL. Identification of hyperglycemia-associated microbiota alterations in saliva and gingival sulcus. Arch Biochem Biophys 2020; 682:108278. [DOI: 10.1016/j.abb.2020.108278] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/27/2019] [Accepted: 01/20/2020] [Indexed: 01/15/2023]
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Mahalakshmi K, Arangannal P, Santoshkumari. Frequency of putative periodontal pathogens among type 1 diabetes mellitus: a case-control study. BMC Res Notes 2019; 12:328. [PMID: 31182149 PMCID: PMC6558758 DOI: 10.1186/s13104-019-4364-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/05/2019] [Indexed: 12/30/2022] Open
Abstract
Objective The aim of the present study is to compare and assess the risk of periodontitis due to the presence of four putative periodontopathic bacteria viz., Eikenella corrodens, Campylobacter rectus, Prevotella intermedia and Prevotella nigrescens. To fulfil the above objective, polymerase Chain reaction using the primers targeting 16S rRNA gene of the bacterial species was performed with the subgingival plaque collected from the permanent first molars of type 1 diabetic children and age matched healthy children. Results The prevalence of periodontal pathogens in diabetic and healthy children was 6% and 16% for E. corrodens, 18% and 36% for C. rectus, 2% and 2% for P. intermedia, 4% and 0%, for P. nigrescens respectively. Statistically, significant difference was not observed for the prevalence of all the four periodontal pathogens between type 1 diabetic and healthy children (P = 1.00). The results of the present study thus reveal a negative correlation of type I diabetes to periodontitis in association to Eikenella corrodens, Campylobacter rectus, Prevotella intermedia and Prevotella nigrescens.
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Affiliation(s)
- Krishnan Mahalakshmi
- Department of Microbiology/Research Lab for Oral-Systemic Health, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery - Tambaram Road, Chennai, Tamilnadu, 600100, India.
| | - Ponnudurai Arangannal
- Department of Paedodontics and Preventive Dentistry, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery - Tambaram Road, Chennai, 600100, India
| | - Santoshkumari
- Department of Paedodontics and Preventive Dentistry, Sri Venkateswara Dental College and Hospital, Thalambur, Chennai, India
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Miranda TS, Feres M, Retamal-Valdés B, Perez-Chaparro PJ, Maciel SS, Duarte PM. Influence of glycemic control on the levels of subgingival periodontal pathogens in patients with generalized chronic periodontitis and type 2 diabetes. J Appl Oral Sci 2017; 25:82-89. [PMID: 28198980 PMCID: PMC5289404 DOI: 10.1590/1678-77572016-0302] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/30/2016] [Indexed: 01/04/2023] Open
Abstract
Objective This study evaluated the influence of glycemic control on the levels and frequency of subgingival periodontal pathogens in patients with type 2 diabetes mellitus (DM) and generalized chronic periodontitis (ChP). Material and Methods Fifty-six patients with generalized ChP and type 2 DM were assigned according to the levels of glycated hemoglobin (HbA1c) into one of the following groups: HbA1c<8% (n=28) or HbA1c≥8% (n=28). Three subgingival biofilm samples from sites with probing depth (PD)<5 mm and three samples from sites with PD≥5 mm were analyzed by quantitative Polymerase Chain Reaction (PCR) for the presence and levels of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Eubacterium nodatum, Parvimona micra, Fusobacterium nucleatum ssp. and Prevotella intermedia. Results The mean counts of F. nucleatum ssp. were statistically significantly higher in the sites with PD≥5 mm of the HbA1c≥8% group (p<0.05). Frequencies of detection of T. forsythia, E. nodatum, P. micra and F. nucleatum ssp. were all higher in the sites with PD≥5 mm of the patients with HbA1c≥8%, compared with those of patients with HbA1c<8% (p<0.05). Frequency of detection of P. intermedia was higher in the sites with PD<5 mm of the patients with HbA1c≥8% than those of the patients with HbA1c<8% (p<0.05). Conclusions Poor glycemic control, as indicated by HbA1c≥8%, is associated with increased levels and frequencies of periodontal pathogens in the subgingival biofilm of subjects with type 2 DM and ChP.
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Affiliation(s)
| | - Magda Feres
- Universidade Guarulhos, Centro de Pós-Graduação e Pesquisa, Guarulhos, SP, Brasil
| | - Belén Retamal-Valdés
- Universidade Guarulhos, Centro de Pós-Graduação e Pesquisa, Guarulhos, SP, Brasil
| | | | - Suellen Silva Maciel
- Universidade Guarulhos, Centro de Pós-Graduação e Pesquisa, Guarulhos, SP, Brasil
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Taylor JJ, Preshaw PM, Lalla E. A review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes. J Clin Periodontol 2016; 40 Suppl 14:S113-34. [PMID: 23627323 DOI: 10.1111/jcpe.12059] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/16/2022]
Abstract
AIMS To review the evidence for the molecular and cellular processes that may potentially link periodontal disease and diabetes. The pathogenic roles of cytokines and metabolic molecules (e.g. glucose, lipids) are explored and the role of periodontal bacteria is also addressed. Paradigms for bidirectional relationships between periodontitis and diabetes are discussed and opportunities for elaborating these models are considered. METHODS Database searches were performed using MeSH terms, keywords, and title words. Studies were evaluated and summarized in a narrative review. RESULTS Periodontal microbiota appears unaltered by diabetes and there is little evidence that it may influence glycaemic control. Small-scale clinical studies and experiments in animal models suggest that IL-1β, TNF-α, IL-6, OPG and RANKL may mediate periodontitis in diabetes. The AGE-RAGE axis is likely an important pathway of tissue destruction and impaired repair in diabetes-associated periodontitis. A role for locally activated pro-inflammatory factors in the periodontium, which subsequently impact on diabetes, remains speculative. CONCLUSION There is substantial information on potential mechanistic pathways which support a close association between diabetes and periodontitis, but there is a real need for longitudinal clinical studies using larger patient groups, integrated with studies of animal models and cells/tissues in vitro.
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Affiliation(s)
- John J Taylor
- Centre for Oral Health Research and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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Gupta N, Gupta ND, Garg S, Goyal L, Gupta A, Khan S, Moin S. The effect of type 2 diabetes mellitus and smoking on periodontal parameters and salivary matrix metalloproteinase-8 levels. J Oral Sci 2016; 58:1-6. [DOI: 10.2334/josnusd.58.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Namita Gupta
- Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Aligarh Muslim University
| | - Narinder D. Gupta
- Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Aligarh Muslim University
| | - Sagar Garg
- Department of Periodontics, Tamil Nadu Government Dental College
| | - Lata Goyal
- Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Aligarh Muslim University
| | - Akash Gupta
- Department of Biochemistry, Subharti Medical College
| | - Saif Khan
- Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Aligarh Muslim University
| | - Shagufta Moin
- Department of Biochemistry, Jawaharlal Nehru Medical College, Aligarh Muslim University
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Duarte PM, Sowa MG, Xiang X, Zhang C, Santos VR, Miranda TS, Reis AF, Liu KZ. Assessment of the hemodynamic profile in periodontal tissues of diabetic subjects with periodontitis by optical spectroscopy. J Periodontal Res 2014; 50:594-601. [PMID: 25369875 DOI: 10.1111/jre.12239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The influence of diabetes mellitus (DM) on the hemodynamics of periodontal tissues has not been assessed previously. The primary objective of this study was to validate optical spectroscopy as a periodontal diagnostic tool for subjects with type 2 DM and chronic periodontitis. MATERIAL AND METHODS Using a portable optical near-infrared spectrometer, optical spectra were obtained from healthy (n = 127), gingivitis (n = 115), and periodontitis (n = 109) sites of 65 subjects with type 2 DM and chronic periodontitis. Healthy (n = 65) sites of 15 nondiabetic subjects without periodontitis were used as controls. A modified Beer-Lambert unmixing model that incorporates a nonparametric scattering-loss function was used to determine the relative contribution of deoxygenated hemoglobin and oxygenated hemoglobin (HbO2 ) to the overall spectrum. The balance between tissue oxygen delivery and oxygen utilization in periodontal tissues was assessed. RESULTS In diabetic subjects, tissue oxygen saturation and HbO2 concentration were significantly decreased in the periodontitis sites (p < 0.01) compared with the healthy and gingivitis sites. Furthermore, tissue oxygenation in healthy sites of control subjects was significantly higher than that in sites of diabetic subjects (p < 0.01). CONCLUSION In summary, the results of this study suggest that optical spectroscopy can monitor the hemodynamic profile in diabetic subjects with chronic periodontitis. Furthermore, healthy sites of diabetic subjects presented lower tissue oxygenation than did those of nondiabetic subjects.
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Affiliation(s)
- P M Duarte
- Dental Research Division, Department of Periodontology, Guarulhos University, Guarulhos, SP, Brazil
| | - M G Sowa
- Medical Devices Portfolio, National Research Council of Canada, Winnipeg, Manitoba, Canada
| | - X Xiang
- Department of Dental Diagnostics and Surgical Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - C Zhang
- The Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - V R Santos
- Dental Research Division, Department of Periodontology, Guarulhos University, Guarulhos, SP, Brazil
| | - T S Miranda
- Dental Research Division, Department of Periodontology, Guarulhos University, Guarulhos, SP, Brazil
| | - A F Reis
- Dental Research Division, Department of Operative Dentistry, Guarulhos University, Guarulhos, SP, Brazil
| | - K-Z Liu
- Medical Devices Portfolio, National Research Council of Canada, Winnipeg, Manitoba, Canada.,Department of Dental Diagnostics and Surgical Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Silva-Boghossian CM, Orrico SRP, Gonçalves D, Correa FOB, Colombo APV. Microbiological changes after periodontal therapy in diabetic patients with inadequate metabolic control. Braz Oral Res 2014; 28:S1806-83242014000100222. [PMID: 24918369 DOI: 10.1590/1807-3107bor-2014.vol28.0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 01/28/2014] [Indexed: 11/22/2022] Open
Abstract
The present study investigated the effect of non-surgical periodontal treatment (SRP) on the composition of the subgingival microbiota of chronic periodontitis (CP) in individuals with type 2 diabetes (DM2) with inadequate metabolic control and in systemically healthy (SH) individuals. Forty individuals (20 DM2 and 20 SH) with CP underwent full-mouth periodontal examination. Subgingival plaque was sampled from 4 deep sites of each individual and tested for mean prevalence and counts of 45 bacterial taxa by the checkerboard method. Clinical and microbiological assessments were performed before and 3 months after SRP. At baseline, those in the DM2 group presented a significantly higher percentage of sites with visible plaque and bleeding on probing compared with those in the SH group (p<0.01). Those in the DM2 group presented significantly higher levels of C. rectus and P. gingivalis, and lower prevalence of P. micra and S. anginosus, compared with those in the SH group (p≤0.001). At the 3-month visit, both groups showed a significant improvement in all clinical parameters (p<0.01). Those in the DM2 group showed significantly higher prevalence and/or levels of A. gerencseriae, A. naeslundii I, A. oris, A. odontolyticus, C. sputigena, F. periodonticum, and G. morbillorum compared with those in the SH group (p≤0.001). However, those in the DM2 group showed a significant reduction in the levels of P. intermedia, P. gingivalis, T. forsythia, and T. denticola (p≤0.001) over time. Those in the SRP group showed improved periodontal status and reduced levels of putative periodontal pathogens at 3 months' evaluation compared with those in the DM2 group with inadequate metabolic control.
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Affiliation(s)
- Carina Maciel Silva-Boghossian
- Department of Medical Microbiology, Institute of Microbiology Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Silvana Regina Perez Orrico
- Department of Diagnosis and Surgery, Faculdade de Odontologia de Araraquara, Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Daniela Gonçalves
- Department of Diagnosis and Surgery, Faculdade de Odontologia de Araraquara, Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Fernanda Oliveira Bello Correa
- Department of Diagnosis and Surgery, Faculdade de Odontologia de Araraquara, Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Ana Paula Vieira Colombo
- Department of Medical Microbiology, Institute of Microbiology Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Abstract
Periodontitis is a common, chronic, inflammatory disease in which the supporting apparatus of the teeth is gradually destroyed, resulting in tooth mobility and tooth loss. Susceptibility to periodontitis is increased approximately three-fold in people with diabetes. Hyperglycemia leads to exacerbated tissue destruction and the clinical signs of periodontitis. There is evidence to support a two-way relationship between periodontitis and diabetes; not only does diabetes increase the risk for periodontitis, but periodontitis is associated with compromised glycemic control. Cooperation between health care teams would benefit the treatment of patients with diabetes and periodontitis.
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Affiliation(s)
- Philip M Preshaw
- School of Dental Sciences, Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4BW, UK.
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Castrillon CA, Hincapie JP, Yepes FL, Roldan N, Moreno SM, Contreras A, Botero JE. Occurrence of red complex microorganisms and Aggregatibacter actinomycetemcomitans in patients with diabetes. ACTA ACUST UNITED AC 2013; 6:25-31. [PMID: 23857867 DOI: 10.1111/jicd.12051] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 03/18/2013] [Indexed: 11/29/2022]
Abstract
AIM The aim of the present study was to analyze the occurrence of Porphyromonas gingivalis (P. gingivalis), Tannerella forsythia (T. forsythia), Treponema denticola (T. denticola), and Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) in patients with diabetes. METHODS Periodontal and diabetic parameters and subgingival biofilm samples were obtained from 60 patients with diabetes and 62 patients without diabetes. By using polymerase chain reaction, the prevalence of red complex microorganisms (P. gingivalis, T. forsythia, and T. denticola) and A. actinomycetemcomitans were determined. Descriptive and non-parametric statistical analyses between groups were performed (Kruskal-Wallis, Mann-Whitney U-test, and Fisher's exact test). RESULTS Patients with diabetes presented significantly higher periodontal attachment loss levels compared to patients without diabetes. Red complex microorganisms were detected in lower frequencies in patients with diabetes. The detection of A. actinomycetemcomitans was higher in patients with diabetes and periodontitis compared to systemically-healthy patients without periodontitis (P < 0.05). P. gingivalis was associated with periodontitis in non-diabetic patients (P < 0.05), whereas A. actinomycetemcomitans was associated with periodontitis in diabetic patients (P < 0.05). CONCLUSIONS The findings of the present study indicate that there might be differences in the subgingival microbiota between diabetic and non-diabetic patients. In addition, P. gingivalis and A. actinomycetemcomitans were associated with periodontitis in patients without diabetes and patients with diabetes, respectively.
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Affiliation(s)
- Cesar A Castrillon
- Department of Periodontics, Faculty of Dentistry, Universidad de Antioquia, Medellin, Colombia
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Aemaimanan P, Amimanan P, Taweechaisupapong S. Quantification of key periodontal pathogens in insulin-dependent type 2 diabetic and non-diabetic patients with generalized chronic periodontitis. Anaerobe 2013; 22:64-8. [PMID: 23827459 DOI: 10.1016/j.anaerobe.2013.06.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/28/2013] [Accepted: 06/23/2013] [Indexed: 10/26/2022]
Abstract
Periodontitis is a common problem in patients with diabetes mellitus (DM), however, differences in the putative periodontal pathogens in subjects with DM compared to non-DM subjects are still inconclusive. The red complex, which includes Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, encompasses the most important pathogens in adult periodontal disease. The aim of the present study was to compare cell numbers of P. gingivalis, T. denticola, T. forsythia and Aggregatibacter actinomycetemcomitans in gingival sulcus of healthy, gingivitis and periodontitis sites of non-diabetes mellitus (NDM), controlled and poorly controlled insulin-dependent DM (CDM and PDM) patients with generalized chronic periodontitis. Subgingival plaque samples were collected from 19 CDM, 19 PDM and 19 NDM patients. Taqman real time-PCR was used to determine bacterial cell number. At subject level, the quantity of red complex bacteria was significantly higher in PDM than those of NDM and positively correlated with HbA1c. At site level (total 342 sites), cell numbers of T. denticola and T. forsythia in healthy sites of CDM and PDM were significantly higher than those of NDM. In gingivitis sites, the numbers of P. gingivalis in CDM and PDM and T. forsythia in PDM were significantly higher than those of NDM while in periodontitis sites, higher quantity of P. gingivalis in PDM was observed. Our study indicated that poor glycemic control is associated with increasing cell numbers of red complex bacteria in subgingival biofilm.
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Sjödin B, Edblad E, Sondell K, Dahlén G. Minor manifestations of periodontal diseases in young adults with type 1 diabetes mellitus. Periodontal and microbiological findings. Acta Odontol Scand 2012; 70:589-96. [PMID: 22364291 DOI: 10.3109/00016357.2011.640288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate periodontal status and microbiological conditions in young adults with insulin-dependent diabetes (IDDM) in comparison with age- and sex-matched non-diabetic controls. MATERIALS AND METHODS Forty-one patients, 18-24 years of age with IDDM since childhood, were examined and the results were compared to those of a group of 41 sex- and age-matched non-diabetic controls. According to the HbA(1c) %, the group of diabetic patients was divided into two groups, with good or poor metabolic control. RESULTS Periodontal health, expressed in probing pocket depths and marginal bone loss, was fairly good in all patients. Fifty per cent of the patients in the study and control groups displayed probing pocket depths ≥4 mm, mostly pocket depths 4 mm. These findings were also equally distributed among the patients with good and poor metabolic control. No significant differences were found between the groups regarding bleeding on probing, but in the number of sites with excessive bleeding the study group exhibited higher scores than the healthy controls. Different microbiological species were equally distributed between the groups. CONCLUSION Neither periodontal nor microbiological status in young adults with IDDM differs from that of healthy controls.
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Affiliation(s)
- Bengt Sjödin
- Department of Periodontology, Postgraduate Education Center, County of Örebro, Sweden.
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Casarin RCV, Barbagallo A, Meulman T, Santos VR, Sallum EA, Nociti FH, Duarte PM, Casati MZ, Gonçalves RB. Subgingival biodiversity in subjects with uncontrolled type-2 diabetes and chronic periodontitis. J Periodontal Res 2012; 48:30-6. [PMID: 22762355 DOI: 10.1111/j.1600-0765.2012.01498.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE There is a bidirectional relationship between periodontal disease and type-2 diabetes mellitus (DM). Inflammatory mediators may negatively affect glycemic control, and increased glucose levels and resultant glycation end-products may alter the host response against bacterial infection. However, no agreement has been reached regarding the effect of DM on periodontal subgingival microbiota. Therefore, the purpose of the present study was to compare the subgingival biodiversity in deep periodontal pockets of subjects with chronic periodontitis and either uncontrolled type-2 diabetes or no diabetes using 16S rRNA gene cloning and sequencing. MATERIAL AND METHODS Twelve subjects with uncontrolled type-2 diabetes (glycated hemoglobin > 8%) and eleven nondiabetic subjects presenting severe and generalized chronic periodontitis were selected. Subgingival biofilm from periodontal pockets > 5 mm were assessed using the 16S rRNA gene cloning and sequencing technique. RESULTS Significant differences were observed in subgingival microbiota between diabetic and nondiabetic subjects. Diabetic subjects presented higher percentages of total clones of TM7, Aggregatibacter, Neisseria, Gemella, Eikenella, Selenomonas, Actinomyces, Capnocytophaga, Fusobacterium, Veillonella and Streptococcus genera, and lower percentages of Porphyromonas, Filifactor, Eubacterium, Synergistetes, Tannerella and Treponema genera than nondiabetic individuals (p < 0.05). Moreover, some phylotypes, such as Fusobacterium nucleatum, Veillonella parvula, V. dispar and Eikenella corrodens were detected significantly more often in diabetic subjects than in nondiabetic subjects (p < 0.05). CONCLUSION Subjects with uncontrolled type-2 diabetes and chronic periodontitis presented significant dissimilarities in subgingival biodiversity compared with nondiabetic subjects.
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Affiliation(s)
- R C V Casarin
- Division of Periodontics, Paulista University, São Paulo, Brazil.
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15
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Field CA, Gidley MD, Preshaw PM, Jakubovics N. Investigation and quantification of key periodontal pathogens in patients with type 2 diabetes. J Periodontal Res 2012; 47:470-8. [DOI: 10.1111/j.1600-0765.2011.01455.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Kesić L, Petrović D, Obradović R, Gasić J, Todorović K. [Diabetes mellitus and periodontal disease]. MEDICINSKI PREGLED 2009; 62:534-538. [PMID: 20491379 DOI: 10.2298/mpns0912534k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION This review highlights the relations between diabetes mellitus and periodontal disease, as well as the pathogenic mechanisms which are still the subject of investigations. The possible pathogenic mechanisms important for developing periodontal disease in the diabetics are: vascular gingival changes, the disorders in the metabolism of the collagen, disorders in the function of the polimorphonuclear leukocytes and specific microbial flora in the parodontal pockets. CONCLUSION It is clear that adequate early recognition and good treatment are very important and significant for treatment of diabetic periodontal disease.
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Affiliation(s)
- Ljiljana Kesić
- Odeljenje za oralnu medicinu i parodontologiju, Medicinski fakultet, Klinika za stomatologiju, Nis
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17
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Makiura N, Ojima M, Kou Y, Furuta N, Okahashi N, Shizukuishi S, Amano A. Relationship of Porphyromonas gingivalis with glycemic level in patients with type 2 diabetes following periodontal treatment. ACTA ACUST UNITED AC 2008; 23:348-51. [PMID: 18582336 DOI: 10.1111/j.1399-302x.2007.00426.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this study was to assess the relationship between serum glycemic levels and subgingival microbial profile alteration following periodontal treatment in patients with type 2 diabetes mellitus. METHODS We studied 30 periodontitis patients with type 2 diabetes mellitus who received full-mouth subgingival debridement by analyzing their subgingival microbial profiles using a polymerase chain reaction method at baseline and various time-points for 12 months following treatment. Concurrently, probing pocket depth, bleeding on probing, and metabolic parameters, including glycated hemoglobin A1c (HbA1c), blood sugar level, C-reactive proteins, total cholesterol, triglyceride, and high-density and low-density lipoprotein cholesterol, were recorded. RESULTS Periodontal conditions were significantly improved after treatment, and the occurrence rates of periodontal bacterial species, including Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, and Prevotella intermedia, were also reduced. Interestingly, P. gingivalis was detected more frequently in subjects with increased HbA1c values after periodontal treatment than in those patients with decreased HbA1c values. Furthermore, P. gingivalis with type II fimbriae was detected only in HbA1c-increased subjects, while improvements in HbA1c values were observed only in subjects without type II clones. CONCLUSIONS These results suggest that glycemic level in diabetes is affected by the persistence of P. gingivalis, especially clones with type II fimbriae, in periodontal pockets.
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Affiliation(s)
- N Makiura
- Department of Oral Frontier Biology, Osaka University Graduate School of Dentistry, Suita-Osaka 565-0871, Japan
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18
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Ebersole JL, Holt SC, Hansard R, Novak MJ. Microbiologic and immunologic characteristics of periodontal disease in Hispanic americans with type 2 diabetes. J Periodontol 2008; 79:637-46. [PMID: 18380556 DOI: 10.1902/jop.2008.070455] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The microbiology of periodontitis in type 1 diabetes has been reported, but less is known about type 2 diabetes. Moreover, these data have not linked microbial colonization, host response, and clinical presentation in type 1 or type 2 diabetes. The objectives of this study were to relate periodontal status, periodontal microorganisms, and host-response characteristics in Hispanic Americans with type 2 diabetes. METHODS Plaque and serum samples were obtained from 63 Hispanic American subjects with and without type 2 diabetes. The microbiology of subgingival plaque samples was evaluated using DNA checkerboard hybridization, and serum antibody to a battery of oral microorganisms was determined using an enzyme-linked immunosorbent assay. RESULTS In general, similar pathogens were present in periodontitis sites from subjects with and without type 2 diabetes, although the periodontitis sites in diabetes showed a higher frequency of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), and Campylobacter spp. Serum antibody to Campylobacter rectus was elevated in type 2 diabetes, whereas antibody to P. gingivalis and C. rectus were elevated in subjects with periodontitis, irrespective of diabetes status. Stratification of the population based upon antibody to P. gingivalis or C. rectus suggested a linkage between elevated antibody to P. gingivalis, increased frequency of diabetes, and significantly worse periodontitis. CONCLUSION The increased severity of periodontal disease with type 2 diabetes may reflect an alteration of the pathogenic potential of periodontal bacteria and/or a modification of the characteristics of the host's inflammatory response that may contribute to a breakdown in the homeostasis of the periodontium.
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Affiliation(s)
- Jeffrey L Ebersole
- Center for Oral Health Research, University of Kentucky, Lexington, KY, USA
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19
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Qvarnstrom M, Janket S, Jones JA, Nuutinen P, Baird AE, Nunn ME, Van Dyke TE, Meurman JH. Salivary lysozyme and prevalent hypertension. J Dent Res 2008; 87:480-4. [PMID: 18434581 DOI: 10.1177/154405910808700507] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although the etiology of essential hypertension is not clearly understood, endothelial dysfunction from chronic infection and/or impaired glucose metabolism may be involved. We hypothesized that salivary lysozyme, a marker for oral infection and hyperglycemia, might display a significant relationship with hypertension, an early stage of cardiovascular disease. Logistic regression analyses of the Kuopio Oral Health and Heart Study demonstrated that persons with higher lysozyme levels were more likely to have hypertension, after adjustment for age, gender, smoking, BMI, diabetes, the ratio of total cholesterol to HDL cholesterol, and C-reactive protein. The exposure to increasing quartiles of lysozyme was associated with adjusted Odds Ratios for the outcome, hypertension, 1.00 (referent), 1.25, 1.42, and 2.56 (linear trend p < 0.003). When we restricted the sample to the individuals without heart disease (N = 250), we observed a non-significant trend for increasing odds. Our hypothesis--"high salivary lysozyme levels are associated with the odds of hypertension"--was confirmed.
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Affiliation(s)
- M Qvarnstrom
- Otorhinolaryngology/Oral and Maxillofacial Surgery, Kuopio University, Kuopio, Finland
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20
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Lalla E, Kaplan S, Chang SMJ, Roth GA, Celenti R, Hinckley K, Greenberg E, Papapanou PN. Periodontal infection profiles in type 1 diabetes. J Clin Periodontol 2007; 33:855-62. [PMID: 17092237 DOI: 10.1111/j.1600-051x.2006.00996.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We investigated the levels of subgingival plaque bacteria and serum IgG responses in patients with type 1 diabetes and non-diabetic controls of comparable periodontal status. MATERIAL AND METHODS Fifty type 1 diabetes patients (mean duration 20.3 years, range 6-41) were age-and gender-matched with 50 non-diabetic individuals with similar levels of periodontal disease. Full-mouth clinical periodontal status was recorded, and eight plaque samples/person were collected and analysed by checkerboard hybridization with respect to 12 species. Homologous serum IgG titres were assessed by checkerboard immunoblotting. In a sub-sample of pairs, serum cytokines and selected markers of cardiovascular risk were assessed using multiplex technology. RESULTS Among the investigated species, only levels of Eubacterium nodatum were found to be higher in diabetic patients, while none of the IgG titres differed between the groups, both before and after adjustments for microbial load. Patients with diabetes had significantly higher serum levels of soluble E-selectin (p=0.04), vascular cell adhesion molecule-1 (VCAM-1; p=0.0008), adiponectin (p=0.01) and lower levels of plasminogen activator inhibitor-1 (PAI-1; p=0.02). CONCLUSIONS After controlling for the severity of periodontal disease, patients with type 1 diabetes and non-diabetic controls showed comparable subgingival infection patterns and serum antibody responses.
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Affiliation(s)
- Evanthia Lalla
- Division of Periodontics, Section of Oral and Diagnostic Sciences, College of Dental Medicine, Columbia University, New York, NY 10032, USA.
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Kim J, Amar S. Periodontal disease and systemic conditions: a bidirectional relationship. Odontology 2006; 94:10-21. [PMID: 16998613 PMCID: PMC2443711 DOI: 10.1007/s10266-006-0060-6] [Citation(s) in RCA: 336] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 04/24/2006] [Indexed: 12/22/2022]
Abstract
For decades, physicians and dentists have paid close attention to their own respective fields, specializing in medicine pertaining to the body and the oral cavity, respectively. However, recent findings have strongly suggested that oral health may be indicative of systemic health. Currently, this gap between allopathic medicine and dental medicine is quickly closing, due to significant findings supporting the association between periodontal disease and systemic conditions such as cardiovascular disease, type 2 diabetes mellitus, adverse pregnancy outcomes, and osteoporosis. Significant effort has brought numerous advances in revealing the etiological and pathological links between this chronic inflammatory dental disease and these other conditions. Therefore, there is reason to hope that the strong evidence from these studies may guide researchers towards greatly improved treatment of periodontal infection that would also ameliorate these systemic illnesses. Hence, researchers must continue not only to uncover more information about the correlations between periodontal and systemic diseases but also to focus on positive associations that may result from treating periodontal disease as a means of ameliorating systemic diseases.
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Affiliation(s)
- Jemin Kim
- Boston University Goldman School of Dental Medicine, Department of Periodontology and Oral Biology, Boston, MA, USA
| | - Salomon Amar
- Boston University Medical Center, 700 Albany Street, W201E, Boston, MA 02118, USA Tel. +1−617−638−4983; Fax +1−617−638−8549 e-mail:
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Tan WC, Tay FBK, Lim LP. Diabetes as a Risk Factor for Periodontal Disease: Current Status and Future Considerations. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n8p571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Introduction: Over the past decade, there has been an emerging interest in the interrelationship between systemic conditions and oral health. Diabetes is perhaps one of the best documented conditions that have been closely linked with periodontal disease. This paper reviews the role of diabetes as a risk factor in periodontal disease. The treatment implications in the management of periodontal disease as an integral component of diabetes care is also discussed in light of the current understanding of the pathogenesis of these 2 chronic conditions.
Materials and Methods: Epidemiological, clinical and laboratory studies examining the relationship between diabetes and periodontal diseases were selected from both medical and dental journals.
Results: The severity of periodontal destruction has been shown to be related to the direct and indirect effects of glycaemic control, with other factors also being implicated. Although some studies have pointed towards a bi-directional relationship between glycaemic control and periodontal health, it is still not clear if improvement in periodontal health could lead to improved metabolic control.
Conclusion: Diabetes and periodontal disease are closely related in many ways, though the effect of periodontal disease on diabetes control remain to be determined, with larger intervention studies. In light of the increasing evidence of the relationship between diabetes and periodontal disease, management of oral health should form an integral part of diabetes management.
Key words: Diabetes mellitus, Infection, Periodontitis
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Affiliation(s)
- Wah Ching Tan
- Department of Restorative Dentistry National Dental Centre, Singapore
| | | | - Lum Peng Lim
- Faculty of Dentistry, National University of Singapore, Singapore
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23
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Takeda M, Ojima M, Yoshioka H, Inaba H, Kogo M, Shizukuishi S, Nomura M, Amano A. Relationship of serum advanced glycation end products with deterioration of periodontitis in type 2 diabetes patients. J Periodontol 2006; 77:15-20. [PMID: 16579698 DOI: 10.1902/jop.2006.77.1.15] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND A close relationship between diabetes and chronic periodontitis has been demonstrated. We previously found that Porphyromonas gingivalis with the type II fimA gene is an infectious factor closely associated with the deterioration seen in diabetic periodontitis patients. In the present study, we examined whether other biomarkers are related to the development and deterioration of periodontitis often seen in type 2 diabetic individuals. METHODS A total of 97 type 2 diabetes patients with and without periodontitis were recruited, and their periodontal and diabetic conditions were analyzed. The ratio (%) of teeth with an attachment loss >5 mm among all teeth in each subject was used as an index of periodontal deterioration. Peripheral blood was tested for levels of glycated hemoglobin (HbA1c), advanced glycation end products (AGEs), C-reactive protein (CRP), and cytokines (tumor necrosis factor [TNF]-alpha and interleukin [IL]-1beta). Subgingival plaque samples were also examined for the occurrences of Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Treponema denticola, and Prevotella intermedia. RESULTS Serum AGEs were significantly associated with deterioration of periodontitis, whereas no other serum biochemical marker or bacterial occurrence showed a clear relationship with that condition. CONCLUSION AGEs may be factors associated with diabetic periodontitis and may be useful as biomarkers that reflect such deterioration.
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Affiliation(s)
- Munehiro Takeda
- Department of Oral Frontier Biology, Graduate School of Dentistry, Osaka University, Suita-Osaka, Japan
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Ojima M, Takeda M, Yoshioka H, Nomura M, Tanaka N, Kato T, Shizukuishi S, Amano A. Relationship of periodontal bacterium genotypic variations with periodontitis in type 2 diabetic patients. Diabetes Care 2005; 28:433-4. [PMID: 15677809 DOI: 10.2337/diacare.28.2.433] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Miki Ojima
- Department of Oral Frontier Biology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita-Osaka 565-0871, Japan
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25
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Ciantar M, Gilthorpe MS, Hurel SJ, Newman HN, Wilson M, Spratt DA. Capnocytophagaspp. in Periodontitis Patients Manifesting Diabetes Mellitus. J Periodontol 2005; 76:194-203. [PMID: 15974842 DOI: 10.1902/jop.2005.76.2.194] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The subgingival microflora in patients presenting concurrently with periodontitis and diabetes mellitus (DM) are poorly understood. While traditional putative periodontal pathogens are implicated, research involving other oral organisms; e.g., Capnocytophaga spp., is lacking. These organisms produce a range of bacterial enzymes relevant to periodontal breakdown. It is inferred that periodontal bacteria acquire systemic access through the ulcerated periodontal pocket surface; conclusive evidence supporting this notion is limited. The aims of this investigation were to: 1) quantify and identify Capnocytophaga spp. present in healthy and diseased sites in periodontitis patients with and without DM, and 2) isolate periodontal pathogens from these patients' blood. METHODS Twenty-one DM-periodontitis and 25 periodontitis patients were recruited. Subgingival plaque was collected from three healthy and three diseased sites per subject. Capnocytophaga spp. and total (facultative and obligate) anaerobic counts from each site were estimated. Capnocytophaga spp. were identified using 16S rRNA polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP). Statistical analyses were performed using multilevel modeling. Blood samples were subjected to HbA(1c) estimation and bacterial culture. RESULTS A total of 848 Capnocytophaga spp. were isolated and identified. Significantly higher numbers of Capnocytophaga spp. (P <0.001) and anaerobes (P <0.001) were present in diseased sites in DM-periodontitis subjects compared to healthy sites in non-DM-periodontitis and DM-periodontitis subjects. C. ochracea (and variant) and C. granulosa were the most prevalent species. Blood samples were negative for Capnocytophaga spp. CONCLUSIONS Total mean counts for Capnocytophaga spp. were significantly higher in DM-periodontitis subjects versus non-DM-periodontitis (P = 0.025) and at diseased sites versus healthy sites (P <0.001). Analysis of individual species revealed that the outcome varied with site status and DM status.
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Affiliation(s)
- Marilou Ciantar
- Division of Microbial Diseases, Eastman Dental Institute for Oral Health Care Sciences, University College London, UK
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26
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Engebretson SP, Hey-Hadavi J, Ehrhardt FJ, Hsu D, Celenti RS, Grbic JT, Lamster IB. Gingival crevicular fluid levels of interleukin-1beta and glycemic control in patients with chronic periodontitis and type 2 diabetes. J Periodontol 2004; 75:1203-8. [PMID: 15515334 DOI: 10.1902/jop.2004.75.9.1203] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with diabetes have increased incidence and severity of periodontal disease not accounted for by differences in the subgingival microbial infection. Poor glycemic control has been consistently associated with periodontal disease severity. Also, recent evidence suggests that hyperglycemia may induce inflammatory cytokine production. Few studies, however, have examined local biochemical measures of periodontal inflammation in patients with type 2 diabetes. The aim of this study was to determine whether glycemic control was related to gingival crevicular fluid (GCF) levels of interleukin-1beta (IL-1beta). METHODS GCF samples were collected from 45 patients with type 2 diabetes and untreated chronic periodontitis. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and attachment level (AL) were recorded at six sites per tooth. IL-1beta levels were determined from individual GCF samples by enzyme-linked immunoabsorbent assay (ELISA). Individual site and mean patient values were calculated. Glycated hemoglobin (HbA1c) levels were measured from anticoagulated whole blood using an automated affinity chromatography system. Serum glucose was also determined. RESULTS Clinical periodontal measures (PD, AL, BOP) and measures of glycemic control (HbA1c, random glucose) were significantly correlated with GCF IL-1beta. Patients with greater than 8% HbA1c had significantly higher mean GCF IL-1beta levels than patients with less than 8% HbA1c. In a multivariate model adjusting for age, gender, PD, AL, BOP, and PI, HbA1c and random glucose were independent predictors of high GCF IL-1beta. CONCLUSIONS Poor glycemic control is associated with elevated GCF IL-1beta. These data are consistent with the hypothesis that hyperglycemia contributes to an heightened inflammatory response, and suggests a mechanism to account for the association between poor glycemic control and periodontal destruction.
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Affiliation(s)
- Steven P Engebretson
- Columbia University School of Dental & Oral Surgery, Division of Periodontics, New York, NY 10032, USA.
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Manfredi M, McCullough MJ, Vescovi P, Al-Kaarawi ZM, Porter SR. Update on diabetes mellitus and related oral diseases. Oral Dis 2004; 10:187-200. [PMID: 15196139 DOI: 10.1111/j.1601-0825.2004.01019.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Diabetes mellitus (DM) is a group of complex multisystem metabolic disorders characterized by a relative or absolute insufficiency of insulin secretion and/or concomitant resistance to the metabolic action of insulin on target tissues. The chronic hyperglycaemia of diabetes is associated with long-term systemic dysfunction. The present article summarizes current knowledge of DM and details the oral and dental implications of this common endocrine disorder.
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Affiliation(s)
- M Manfredi
- Oral Medicine Department, Eastman Dental Institute, UCL, London, UK.
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Syrjälä AMH, Ylöstalo P, Niskanen MC, Knuuttila MLE. Role of smoking and HbA1c level in periodontitis among insulin-dependent diabetic patients. J Clin Periodontol 2004; 30:871-5. [PMID: 14710767 DOI: 10.1034/j.1600-051x.2003.00396.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim was to analyse the role of smoking and HbA1c level in attachment loss (AL) and probing depths (PDs) among insulin-dependent diabetic patients. MATERIAL AND-METHODS: The study subjects were selected from a group of 149 insulin-dependent diabetic patients and included 64 patients (39 men and 25 women) aged 30 years or older. Data were obtained from patient records and by clinical examination. The outcome variables were the number of sites with AL and PDs of 5-9 mm. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated using Poisson regression models. RR was adjusted for the number of teeth, dental calculus and age. RESULTS RR for AL among the smokers was 4.15 (95% CI: 2.30-7.63) and that for PD among the smokers was 7.96 (95% CI: 4.91-13.19). HbA1c was not related to AL or PD. Among smokers with HbA1c > 8.5, RR for AL was 12.34 (95% CI: 4.14-39.35), but RR was not elevated for PD. CONCLUSIONS It can be concluded that the poor metabolic control together with smoking is extremely detrimental for AL.
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Affiliation(s)
- Anna-Maija H Syrjälä
- Department of Periodontology, Institute of Dentistry, University of Oulu, Finland.
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Mealey BL, Moritz AJ. Hormonal influences: effects of diabetes mellitus and endogenous female sex steroid hormones on the periodontium. Periodontol 2000 2003; 32:59-81. [PMID: 12756034 DOI: 10.1046/j.0906-6713.2002.03206.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Brian L Mealey
- Chairman, Department of Periodontics and Program Director, US Air Force Periodontics Residency, Wilford Hall Medical Center, Lackland Air Force Base San Antonio, Texas, USA
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Persson RE, Hollender LG, MacEntee MI, Wyatt CCL, Kiyak HA, Persson GR. Assessment of periodontal conditions and systemic disease in older subjects. J Clin Periodontol 2003; 30:207-13. [PMID: 12631178 DOI: 10.1034/j.1600-051x.2003.00237.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND An increased risk for periodontitis has been associated both with type-1 or insulin dependent diabetes (IDDM) and with type-2 or non-insulin dependent diabetes (NIDDM). AIMS 1) To describe and analyze periodontal conditions in older low-income ethnic diverse subjects with or without a diagnosis of diabetes. 2) To assess to what extent diabetes mellitus is associated with periodontal status, and 3) how periodontitis ranks as a coexisting disease among other diseases in subjects with diabetes mellitus. MATERIAL AND METHODS Radiographic signs of alveolar bone loss were studied in 1101 older subjects 60-75 years old (mean age 67.6, SD+/-4.7). The number of periodontal sites and the proportions of teeth with probing depth (PD) > or =5 mm, clinical attachment levels (CAL) > or =4 mm were studied in a subset of 701 of the subjects. RESULTS IDDM was reported by 2.9% and NIDDM by 9.2% of the subjects. The number of remaining teeth did not differ by diabetic status. The number of sites with PD > or =5 mm and the proportion of PD with > or =5 mm was significantly smaller in the non-diabetic group (chi2=46.8, p<0.01, and chi2=171.1, p<0.001, respectively). Statistical analysis failed to demonstrate group differences for the number and proportions of sites with CAL > or =4 mm and for radiographic findings of alveolar bone loss. Combining all periodontal parameters revealed that the Mantel-Haenszel common odds of having IDDM/NIDDM and periodontitis was 1.8 : 1 (95% CI: 1.1-3.1, p<0.03). The common odds ratio estimate of an association between heart disease and diabetes was 3.6 : 1 (95% CI: 2.1-2.6, p<0.001). CONCLUSIONS Probing depth differences between IDDM/NIDDM vs. non-diabetic subjects may reflect the presences of pseudo-pockets and not progressive periodontitis in many subjects with diabetes mellitus. Periodontitis is not a predominant coexisting disease in older subjects with diabetes mellitus.
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Affiliation(s)
- R E Persson
- Departments of Oral Medicine, University of Washington, Seattle, WA 98195-7444, USA.
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Abstract
Periodontitis is a chronic bacterial infection of the supporting structures of the teeth. The host response to infection is an important factor in determining the extent and severity of periodontal disease. Systemic factors modify periodontitis principally through their effects on the normal immune and inflammatory mechanisms. Several conditions may give rise to an increased prevalence, incidence or severity of gingivitis and periodontitis. The effects of a significant number of systemic diseases upon periodontitis are unclear and often it is difficult to causally link such diseases to periodontitis. In many cases the literature is insufficient to make definite statements on links between certain systemic factors and periodontitis and for several conditions only case reports exist whereas in other areas an extensive literature is present. A reduction in number or function of polymorphonuclear leukocytes (PMNs) can result in an increased rate and severity of periodontal destruction. Medications such as phenytoin, nifedipine, and cyclosporin predispose to gingival overgrowth in response to plaque and changes in hormone levels may increase severity of plaque-induced gingival inflammation. Immuno-suppressive drug therapy and any disease resulting in suppression of the normal inflammatory and immune mechanisms (such as HIV infection) may predispose the individual to periodontal destruction. There is convincing evidence that smoking has a detrimental effect on periodontal health. The histiocytoses diseases may present as necrotizing ulcerative periodontitis and numerous genetic polymorphisms relevant to inflammatory and immune processes are being evaluated as modifying factors in periodontal disease. Periodontitis severity and prevalence are increased in diabetics and worse in poorly controlled diabetics. Periodontitis may exacerbate diabetes by decreasing glycaemic control. This indicates a degree of synergism between the two diseases. The relative risk of cardiovascular disease is doubled in subjects with periodontal disease. Periodontal and cardiovascular disease share many common risk and socio-economic factors, particularly smoking, which is a powerful risk factor for both diseases. The actual underlying aetiology of both diseases is complex as are the potential mechanisms whereby the diseases may be causally linked. It is thought that the chronic inflammatory and microbial burden in periodontal disease may predispose to cardiovascular disease in ways proposed for other infections such as with Chlamydia pneumoniae. To move from the current association status of both diseases to causality requires much additional evidence. Determining the role a systemic disease plays in the pathogenesis of periodontal disease is very difficult as several obstacles affect the design of the necessary studies. Control groups need to be carefully matched in respect of age, gender, oral hygiene and socio-economic status. Many studies, particularly before the aetiological importance of dental plaque was recognised, failed to include such controls. Longitudinal studies spanning several years are preferable in individuals both with and without systemic disease, due to the time period in which periodontitis will develop.
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Affiliation(s)
- D F Kinane
- Glasgow Dental Hospital and School, Scotland, UK
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Collin HL, Uusitupa M, Niskanen L, Kontturi-Närhi V, Markkanen H, Koivisto AM, Meurman JH. Periodontal findings in elderly patients with non-insulin dependent diabetes mellitus. J Periodontol 1998; 69:962-6. [PMID: 9776023 DOI: 10.1902/jop.1998.69.9.962] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The periodontal status of 25 patients with non-insulin dependent diabetes mellitus (NIDDM) (age range 58 to 76) was investigated and compared with 40 non-diabetic control subjects (age range 59 to 77). Surfaces with visible plaque and bleeding after probing, calculus, recessions, and pathological pockets were examined. The total attachment loss was calculated as a sum of recessions and pockets in millimeters. Mesial and distal bone loss was measured from panoramic radiographs and mean alveolar bone loss was calculated. Periodontal disease was considered advanced when mean alveolar bone loss was over 50%, or 2 or more teeth had pockets > or = 6 mm. Microbiological analysis comprised the detection of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Bacteroides forsythus by a polymerase chain reaction (PCR) method. Patients with NIDDM had significantly more often advanced periodontitis than control subjects, 40.0% and 12.5%, respectively. Diabetic patients did not harbor more pathogens than the control subjects. The HbA1C level deteriorated in patients with advanced periodontitis, but not in other patients with NIDDM, when compared to the situation 2 to 3 years earlier. Advanced periodontitis seems to be associated with the impairment of the metabolic control in patients with NIDDM, and a regular periodontal surveillance is therefore necessary.
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Affiliation(s)
- H L Collin
- Department of Oral and Dental Diseases, University of Kuopio, Finland
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Christgau M, Palitzsch KD, Schmalz G, Kreiner U, Frenzel S. Healing response to non-surgical periodontal therapy in patients with diabetes mellitus: clinical, microbiological, and immunologic results. J Clin Periodontol 1998; 25:112-24. [PMID: 9495610 DOI: 10.1111/j.1600-051x.1998.tb02417.x] [Citation(s) in RCA: 168] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of the present study was to monitor clinical, microbiological, medical, and immunological effects of non-surgical periodontal therapy in diabetics and healthy controls. 20 IDDM (insulin dependent, n = 7) or NIDDM (non-insulin dependent, n = 13) diabetic patients (median duration 11.5 years, range of HbA1C: 4.4-10.6%) with moderate to advanced periodontal disease and 20 matched healthy control patients, were subjected to supragingival pretreatment and subsequent subgingival therapy. Periodontal examinations (API, PBI, BOP, PPD, PAL), microbiological examinations (culture), medical routine examinations, and immunological examinations (oxidative burst response of PMNs to TNF-alpha and FMLP) were performed at baseline, 2 weeks after supragingival, and 4 months after subgingival therapy. 4 months after completion of non-surgical therapy, the following compared to baseline significant (p < or = 0.05) changes (delta) of clinical parameters (median) were found in diabetic patients versus control patients: deltaAPI (30.4% versus 36.3%), deltaPBI (22.9% versus 24.2%), deltaBOP (39.5% versus 46.9%). The median % per patient of pockets with PPD > or = 4 mm decreased from 41.9% to 28.3% in diabetics, and from 41.6% to 31.8% in controls. Microbiologically, similar reductions of periopathogenic bacteria were found in diabetics and controls. Neither periodontal data nor the oxidative burst response of PMNs showed any significant difference (p > 0.05) between diabetics and control patients. In this study, periodontal therapy had no significant influence on medical data of diabetics. In conclusion, this study indicates that metabolically well-controlled diabetics might respond to non-surgical periodontal therapy as well as healthy control patients.
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Affiliation(s)
- M Christgau
- Department of Operative Dentistry and Periodontology, University of Regensburg, Germany.
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Sbordone L, Ramaglia L, Barone A, Ciaglia RN, Iacono VJ. Periodontal status and subgingival microbiota of insulin-dependent juvenile diabetics: a 3-year longitudinal study. J Periodontol 1998; 69:120-8. [PMID: 9526910 DOI: 10.1902/jop.1998.69.2.120] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study examined for 3 years the changes in periodontal status and the possible correlations with selected subgingival microbiota and diabetic conditions in a group of 16 insulin-dependent diabetes mellitus (IDDM, JD) patients as compared with their 16 healthy cohabiting siblings (HS). JD patients were monitored every 3 months for levels of glycosylated hemoglobin (HbA1C). Clinical and microbiological parameters were measured 6 weeks before drawing blood to determine levels of HbA1C. Periodontal parameters were measured at baseline (TO), year 2 (T2), year 3 (T3) and included: probing depth (PD), attachment level (AL), sulcus bleeding index (SBI), and plaque index (PI). Two sites in each patient were selected for microbial samples: a mesio-facial aspect of the maxillary right first molar (defined as constant site, CS) and a site with the greatest probing depth (defined as deepest site, DS). Microbial samples were analyzed by culture techniques. No significant differences in clinical parameters were found between diabetics and healthy siblings at any examination. The SBI in the non-diabetic group at T2 and at T3 was significantly lower than at baseline. PD and AL of constant sites in the diabetic group at T3 were significantly higher than baseline. There was a significant increase in Prevotella intermedia at T3 as compared with baseline for deepest sites in the diabetic group. Cluster analysis revealed, in a former study, two clusters (IV and V) at baseline which were significantly different from the overall mean regarding composition of Porphyromonas gingivalis and Capnocytophaga spp. They were not significantly different for periodontal parameters from TO to T3. These data would suggest no significant differences in clinical parameters between the diabetics and non-diabetic siblings throughout this 3-year longitudinal study.
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Affiliation(s)
- L Sbordone
- Cattedra di Parodontologia, Facolta di Medicina e Chirurgia, Universitá di Pisa, Italy.
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Finney LS, Finney MO, Gonzalez-Campoy JM. What the mouth has to say about diabetes. Careful examinations can avert serious complications. Postgrad Med 1997; 102:117-26. [PMID: 9406568 DOI: 10.3810/pgm.1997.12.384] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Periodontal disease is a major but preventable complication of diabetes mellitus. Patient education, good glycemic control, regular dental care, appropriate diet, and a team approach that involves physicians, dietitians, dentists, and other health professionals offer the best chance for optimum care for these patients. Other oral complications of diabetes include tooth decay, xerostomia, candidiasis, and oral peripheral neuropathy. The mouth may also reflect secondary causes of diabetes, and oral examination may provide clues to diseases that coexist with type 1 diabetes. Truly, the mouth has much to say about diabetes.
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Affiliation(s)
- L S Finney
- University of Minnesota Medical School-Minneapolis, USA
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Salvi GE, Lawrence HP, Offenbacher S, Beck JD. Influence of risk factors on the pathogenesis of periodontitis. Periodontol 2000 1997; 14:173-201. [PMID: 9567971 DOI: 10.1111/j.1600-0757.1997.tb00197.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G E Salvi
- Department of Dental Ecology University of North Carolina, Chapel Hill, USA
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Affiliation(s)
- J J Zambon
- Department of Periodontology, State University of New York, School of Dental Medicine, Buffalo, USA
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Affiliation(s)
- E B Hancock
- Department of Periodontology, School of Dentistry, Indiana University, Indianapolis, USA
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Abstract
1. The interpretation of epidemiological data of periodontal disease is difficult, due to inconsistencies in the methodology used. It is not possible, therefore, to accurately assess if the prevalence of the periodontal diseases shows a world-wide decline. As long as the disease is assessed through accumulated clinical attachment loss, retention of the natural dentition in older ages entails increased prevalence in these cohorts. Contemporary epidemiological studies should ideally employ full-mouth examination of the periodontal tissues. Partial recording estimates are generally biased, especially when the prevalence of the disease is low. 2. Early-onset periodontitis is infrequent in all populations. Adult periodontitis is rather prevalent; however, advanced disease affects limited subfractions of the population (probably less than 10 to 15%). Although prevalence figures vary with race and geographic region, in most cases, the progression pattern of the disease seems compatible with the retention of a functional dentition throughout life. 3. Of a plethora of behavioral and environmental risk markers identified by multi-variate analysis, smoking and presence of certain subgingival microorganisms have been proven to be true risk factors. The same holds true for diabetes mellitus, a systemic condition that confers a risk for periodontal disease which is independent of the effect of other significant factors. 4. In certain cases, periodontal infections appear to have a systemic impact on the host. Most recent data indicate that periodontal disease may confer risk for coronary heart disease and pre-term low birth weight.
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Affiliation(s)
- P N Papapanou
- University of Göteborg, Department of Oral Microbiology, Sweden
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