151
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Engebretson S, Kocher T. Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta-analysis. J Clin Periodontol 2016; 40 Suppl 14:S153-63. [PMID: 23627325 DOI: 10.1111/jcpe.12084] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 01/19/2023]
Abstract
CONTEXT The effect of periodontal therapy on diabetes outcomes has not been established. OBJECTIVE This update examines the effect of periodontal treatment on diabetes outcomes. DATA SOURCES Literature since October 2009 using MEDLINE. STUDY ELIGIBILITY CRITERIA Published RCTs including periodontal therapy for diabetic subjects, a metabolic outcome, an untreated control group, and follow-up of 3 months. DATA EXTRACTION Pre-defined data fields, including study quality indicators were used. DATA SYNTHESIS A search revealed 56 publications of which 9 met inclusion criteria. Mean change of HbA1c from baseline was compared across treatment groups. Pooled analysis was based on random effects models. RESULTS A meta-analysis indicated a mean treatment effect of -0.36% HbA1c (CI -0.54, -0.19) compared to no treatment after periodontal therapy (p < 0.0001). Heterogeneity tests revealed only minimal evidence of publication bias (I(2 ) = 9%). LIMITATIONS Small sample size and high risk of bias remain problematic for studies of this type. Periodontal therapy varied considerably. CONCLUSION The modest reduction in HbA1c observed as a result of periodontal therapy in subjects with type 2 diabetes is consistent with previous systematic reviews. Despite this finding, there is limited confidence in the conclusion due to a lack of multi-centre trials of sufficient sample size are lacking.
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Affiliation(s)
- Steven Engebretson
- Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY 10010, USA.
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152
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Engebretson S, Kocher T. Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta-analysis. J Periodontol 2016; 84:S153-69. [PMID: 23631575 DOI: 10.1902/jop.2013.1340017] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
CONTEXT The effect of periodontal therapy on diabetes outcomes has not been established. OBJECTIVE This update examines the effect of periodontal treatment on diabetes outcomes. DATA SOURCES Literature since October 2009 using MEDLINE. STUDY ELIGIBILITY CRITERIA Published RCTs including periodontal therapy for diabetic subjects, a metabolic outcome, an untreated control group, and follow-up of 3 months. DATA EXTRACTION Pre-defined data fields, including study quality indicators were used. DATA SYNTHESIS A search revealed 56 publications of which 9 met inclusion criteria. Mean change of HbA1c from baseline was compared across treatment groups. Pooled analysis was based on random effects models. RESULTS A meta-analysis indicated a mean treatment effect of _0.36% HbA1c (CI _0.54, _0.19) compared to no treatment after periodontal therapy (p < 0.0001). Heterogeneity tests revealed only minimal evidence of publication bias (I2 = 9%). LIMITATIONS Small sample size and high risk of bias remain problematic for studies of this type. Periodontal therapy varied considerably. CONCLUSION The modest reduction in HbA1c observed as a result of periodontal therapy in subjects with type 2 diabetes is consistent with previous systematic reviews. Despite this finding, there is limited confidence in the conclusion due to a lack of multi-centre trials of sufficient sample size are lacking.
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Affiliation(s)
- Steven Engebretson
- Department of Periodontology and Implant Dentistry, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA.
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153
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Elburki MS, Moore DD, Terezakis NG, Zhang Y, Lee HM, Johnson F, Golub LM. A novel chemically modified curcumin reduces inflammation-mediated connective tissue breakdown in a rat model of diabetes: periodontal and systemic effects. J Periodontal Res 2016; 52:186-200. [PMID: 27038334 DOI: 10.1111/jre.12381] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Periodontal disease is the most common chronic inflammatory disease known to mankind (and the major cause of tooth loss in the adult population) and has also been linked to various systemic diseases, particularly diabetes mellitus. Based on the literature linking periodontal disease with diabetes in a "bidirectional manner", the objectives of the current study were to determine: (i) the effect of a model of periodontitis, complicated by diabetes, on mechanisms of tissue breakdown including bone loss; and (ii) the response of the combination of this local and systemic phenotype to a novel pleiotropic matrix metalloproteinase inhibitor, chemically modified curcumin (CMC) 2.24. MATERIAL AND METHODS Diabetes was induced in adult male rats by intravenous injection of streptozotocin (nondiabetic rats served as controls), and Escherichia coli endotoxin (lipopolysaccharide) was repeatedly injected into the gingiva to induce periodontitis. CMC 2.24 was administered by oral gavage (30 mg/kg) daily; untreated diabetic rats received vehicle alone. After 3 wk of treatment, the rats were killed, and gingiva, jaws, tibia and skin were collected. The maxillary jaws and tibia were dissected and radiographed. The gingival tissues of each experimental group (n = 6 rats/group) were pooled, extracted, partially purified and, together with individual skin samples, analyzed for matrix metalloproteinase (MMP)-2 and MMP-9 by gelatin zymography; MMP-8 was analyzed in gingival and skin tissue extracts, and in serum, by western blotting. The levels of three bone-resorptive cytokines [interleukin (IL)-1β, IL-6 and tumor necrosis factor-α], were measured in gingival tissue extracts and serum by ELISA. RESULTS Systemic administration of CMC 2.24 to diabetic rats with endotoxin-induced periodontitis significantly inhibited alveolar bone loss and attenuated the severity of local and systemic inflammation. Moreover, this novel tri-ketonic phenylaminocarbonyl curcumin (CMC 2.24) appeared to reduce the pathologically excessive levels of inducible MMPs to near-normal levels, but appeared to have no significant effect on the constitutive MMPs required for physiologic connective tissue turnover. In addition to the beneficial effects on periodontal disease, induced both locally and systemically, CMC 2.24 also favorably affected extra-oral connective tissues, skin and skeletal bone. CONCLUSION This study supports our hypothesis that CMC 2.24 is a potential therapeutic pleiotropic MMP inhibitor, with both intracellular and extracellular effects, which reduces local and systemic inflammation and prevents hyperglycemia- and bacteria-induced connective tissue destruction.
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Affiliation(s)
- M S Elburki
- Department of Oral Biology and Pathology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.,Department of Periodontics, Faculty of Dentistry, Benghazi University, Benghazi, Libya
| | - D D Moore
- Department of Oral Biology and Pathology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA
| | - N G Terezakis
- Department of Oral Biology and Pathology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Y Zhang
- Department of Oral Biology and Pathology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA
| | - H-M Lee
- Department of Oral Biology and Pathology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA
| | - F Johnson
- Departments of Chemistry and Pharmacological Sciences, Stony Brook University, Stony Brook, NY, USA
| | - L M Golub
- Department of Oral Biology and Pathology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA
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154
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Rosedale MT, Strauss SM, Kaur N, Knight C, Malaspina D. Follow-up with primary care providers for elevated glycated haemoglobin identified at the dental visit. Int J Dent Hyg 2016; 15:e52-e60. [PMID: 27037977 DOI: 10.1111/idh.12214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study examined patient experiences after receiving elevated diabetes screening values using blood collected at a dental clinic. It explores patients' reactions to screening, whether or not they sought recommended medical follow-up, and facilitating factors and barriers to obtaining follow-up care. METHODS At the comprehensive care clinics at a large, urban College of Dentistry in the United States, haemoglobin A1C (HbA1C) values were obtained from 379 study participants who had not been previously diagnosed with diabetes. In all, 169 (44.6%) had elevated HbA1C values. We analysed quantitative and qualitative data concerning these patients' follow-up with primary care providers (PCPs). RESULTS We were able to contact 112 (66.3%) of the 169 study participants who had an elevated HbA1C reading. Of that group, 61 (54.5%) received recommended follow-up care from a PCP within 3 months, and an additional 28 (25.0%) said they intended to seek such care. Qualitative themes included the following: the screening letter - opportunity or burden, appreciation for the 3-month follow-up call and barriers to medical follow-up that included the following: lack of knowledge about diabetes, not understanding the importance of follow-up, busyness, financial concerns, fear and denial. CONCLUSIONS Quantitative and qualitative data demonstrate that dentists, dental hygienists and nurses are well poised to discover and translate new models of patient-centred, comprehensive care to patients with oral and systemic illness.
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Affiliation(s)
- M T Rosedale
- New York University College of Nursing and Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - S M Strauss
- New York University College of Nursing, New York, NY, USA
| | - N Kaur
- New York University College of Nursing, New York, NY, USA
| | - C Knight
- New York University College of Nursing, New York, NY, USA
| | - D Malaspina
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
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155
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Miklossy J, McGeer PL. Common mechanisms involved in Alzheimer's disease and type 2 diabetes: a key role of chronic bacterial infection and inflammation. Aging (Albany NY) 2016; 8:575-88. [PMID: 26961231 PMCID: PMC4925815 DOI: 10.18632/aging.100921] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 02/20/2016] [Indexed: 12/30/2022]
Abstract
Strong epidemiologic evidence and common molecular mechanisms support an association between Alzheimer's disease (AD) and type 2-diabetes. Local inflammation and amyloidosis occur in both diseases and are associated with periodontitis and various infectious agents. This article reviews the evidence for the presence of local inflammation and bacteria in type 2 diabetes and discusses host pathogen interactions in chronic inflammatory disorders. Chlamydophyla pneumoniae, Helicobacter pylori and spirochetes are demonstrated in association with dementia and brain lesions in AD and islet lesions in type 2 diabetes. The presence of pathogens in host tissues activates immune responses through Toll-like receptor signaling pathways. Evasion of pathogens from complement-mediated attack results in persistent infection, inflammation and amyloidosis. Amyloid beta and the pancreatic amyloid called amylin bind to lipid bilayers and produce Ca(2+) influx and bacteriolysis. Similarly to AD, accumulation of amylin deposits in type 2 diabetes may result from an innate immune response to chronic bacterial infections, which are known to be associated with amyloidosis. Further research based on an infectious origin of both AD and type 2 diabetes may lead to novel treatment strategies.
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Affiliation(s)
- Judith Miklossy
- International Alzheimer Research Centre, Prevention Alzheimer International Foundation, Martigny-Croix, Switzerland
| | - Patrick L. McGeer
- Kinsmen Laboratory of Neurological Research, The University of British Columbia, Vancouver, B.C, Canada
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156
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Fisher PD, Clemens J, Zach Hilt J, Puleo DA. Multifunctional poly(β-amino ester) hydrogel microparticles in periodontal in situ forming drug delivery systems. ACTA ACUST UNITED AC 2016; 11:025002. [PMID: 26947556 DOI: 10.1088/1748-6041/11/2/025002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In situ forming implants (ISIs) formed from poly(lactic-co-glycolic acid) (PLGA) have been commercialized for local drug delivery to treat periodontitis, but drug release from these bulk materials is typically subject to an initial burst. In addition, PLGA has inferior material properties for the dynamic mechanical environment of gingival tissue. In this work, poly(β-amino ester) (PBAE) hydrogel microparticles were incorporated into a PLGA matrix to provide several new functions: mechanical support, porosity, space-filling, and controlled co-delivery of antimicrobial and osteogenic drugs. First, the effects of PBAE microparticles on ISI architecture and material properties throughout degradation were investigated. Second, the influence of PBAE microparticles on drug release kinetics was quantified. Over a 15 d period, ISIs containing PBAE microparticles possessed greater porosity, ranging from 42-80%, compared to controls, which ranged from 24-54% (p < 0.001), and these ISIs also developed significantly greater accessible volume to simulated cell-sized spheres after 5 d or more of degradation (p < 0.001). PBAE-containing ISIs possessed a more uniform microarchitecture, which preserved mechanical resilience after cyclical loading (p < 0.001), and the materials swelled to fill the injected space, which significantly increased interfacial strength in an artificial periodontal pocket (p < 0.0001). PBAE microparticles eliminated the burst of freely-mixed simvastatin compared to 36% burst from controls (p < 0.0001), and high-dose doxycycline release was prolonged from 2 d to 7 d by pre-loading drug into the microparticles. PBAE-containing PLGA ISIs are more effective space-filling scaffolds and offer improved release kinetics compared to existing ISIs used to treat periodontitis.
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Affiliation(s)
- Paul D Fisher
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY 40506, USA
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157
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Pradeep A, Garg V, Raju A, Singh P. Adjunctive Local Delivery of Aloe Vera Gel in Patients With Type 2 Diabetes and Chronic Periodontitis: A Randomized, Controlled Clinical Trial. J Periodontol 2016; 87:268-74. [DOI: 10.1902/jop.2015.150161] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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158
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Kose O, Arabaci T, Kara A, Yemenoglu H, Kermen E, Kizildag A, Gedikli S, Ozkanlar S. Effects of Melatonin on Oxidative Stress Index and Alveolar Bone Loss in Diabetic Rats With Periodontitis. J Periodontol 2016; 87:e82-90. [PMID: 26832833 DOI: 10.1902/jop.2016.150541] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the effects of systemic melatonin treatment on serum oxidative stress index (OSI) and alveolar bone loss (ABL) in rats with diabetes mellitus (DM) and periodontitis. METHODS Seventy Sprague Dawley rats were divided into control, experimentally induced periodontitis (EP), DM, EP-DM, EP and melatonin treatment (EP-MEL), DM and melatonin treatment (DMMEL), and EP-DM-MEL groups. DM was induced by alloxan, after which periodontitis was induced by ligature for 4 weeks. After removal of the ligature, the rats in the melatonin groups (EP-MEL, DM-MEL, and EP-DM-MEL) were treated with a single dose of melatonin (10 mg/body weight) every day for 14 consecutive days. At the end of the study, all of the rats were euthanized, and intracardiac blood samples and mandible tissues were obtained for biochemical and histologic analyses. Serum levels of total oxidant status/total antioxidant status and OSI were measured. In addition, neutrophil and osteoclast densities and myeloperoxidase activities were determined in gingival tissue homogenates, and ABL was evaluated with histometric measurements. RESULTS Melatonin treatment significantly reduced fasting plasma glucose levels in the rats with DM. In addition, reduced OSI and ABL levels were detected in the EP-MEL and DM-MEL groups; the reductions in the EP-DM-MEL group were found to be more prominent. Melatonin also significantly decreased the increased myeloperoxidase activities and osteoclast and neutrophil densities in the EP, DM, and EP-DM groups. CONCLUSION It is revealed in this experimental study that melatonin significantly inhibited hyperglycemia-induced oxidative stress and ABL through antiDM and antioxidant effects in rats with DM and periodontitis.
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Affiliation(s)
- Oguz Kose
- Department of Periodontology, Faculty of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Taner Arabaci
- Department of Periodontology, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Adem Kara
- Department of Histology and Embryology, Faculty of Veterinary Medicine, Ataturk University
| | - Hatice Yemenoglu
- Department of Periodontology, Faculty of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Eda Kermen
- Department of Periodontology, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Alper Kizildag
- Department of Periodontology, Faculty of Dentistry, Pamukkale University, Denizli, Turkey
| | - Semin Gedikli
- Department of Histology and Embryology, Faculty of Veterinary Medicine, Ataturk University
| | - Seckin Ozkanlar
- Department of Biochemistry, Faculty of Veterinary Medicine, Ataturk University
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159
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Yang J, Zhang Q, Chen M, Wu WZ, Wang R, Liu CJ, Li B, Shi XL, Du HS, Tan HB. Association Between Helicobacter pylori Infection and Risk of Periodontal Diseases in Han Chinese: A Case-Control Study. Med Sci Monit 2016; 22:121-6. [PMID: 26753766 PMCID: PMC4716709 DOI: 10.12659/msm.894583] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background This study was performed to test the association between Helicobacter pylori (HP) and periodontal disease (PD). Material/Methods This was a case-control study in a comprehensive hospital, including all patients with newly diagnosed PD between 2012 and 2014 as cases and all patients without PD as controls, thorough periodontal examinations. Those who tested positive for HP were examined by means of polymerase chain reaction. Single and multivariate logistic regression was used to analyze the data using SPSS 19.0 software. Results This case-control study included 212 Han Chinese non-smoking adults. The results indicated that HP-positive status significantly increased the risk of PD (2.63 times higher (odds ratio [OR]=2.63; 95% confidence interval [CI]=1.48–4.67). After adjustment for age, sex, level of education, physical exercise, body mass index, and history of alcohol and diabetes mellitus, this association remained significantly (OR=2.82, 95% CI=1.55–5.13). Conclusions PD might be associated with HP infection in adults and HP infection may be a significant and independent risk factor for PD.
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Affiliation(s)
- Jing Yang
- Department of Infectious Disease, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
| | - Qiang Zhang
- The Key Laboratory of Cell Engineering in Guizhou Province, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Zunyi, Guizhou, China (mainland)
| | - Ming Chen
- Department of Nursing Education, School of Nursing, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
| | - Wu-zhou Wu
- Department of Osteological Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
| | - Rong Wang
- Department of Intensive Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
| | - Chang-jun Liu
- Department of Preventive Medicine, School of Public Administration, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
| | - Bei Li
- Department of Infectious Disease, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
| | - Xin-li Shi
- Department of Pathobiology and Immunology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China (mainland)
| | - Han-song Du
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Hua-bing Tan
- Department of Infectious Disease, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
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160
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Ummadisetty T, Chava VK, Bhumanapalli VRR. Diabetes and periodontitis: How well are the patients aware about an established relation? J Indian Soc Periodontol 2016; 20:472-475. [PMID: 28298834 PMCID: PMC5341327 DOI: 10.4103/0972-124x.184035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The study aimed to assess the levels of awareness about the mutual relationship between diabetes and periodontitis among high-risk age group of the general population and to assess the attitude of general physicians in suggesting diabetic patients to visit a dentist. MATERIALS AND METHODS A structured, closed-ended questionnaire either in English or in local language (Telugu) was distributed and collected from 203 patients who were willing to participate in the study attending the Department of Periodontics, Narayana Dental College & Hospital, Nellore, AP. Data were statistically analyzed and represented in percentages and number. RESULTS Only 49.8% of the sample population knew about the mutual relationship between diabetes and periodontitis and only 46% of the diabetic study population was suggested to visit a dentist by the physician. CONCLUSION There is an insufficient knowledge among the diabetic population regarding the mutual relationship. Only few physicians have suggested their diabetic patients to visit a dentist. As diabetic patients tend to visit a physician earlier than a dentist, it is their responsibility to educate and motivate their patients to seek dental treatment.
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Affiliation(s)
- Teja Ummadisetty
- Department of Periodontics, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Vijay Kumar Chava
- Department of Periodontics, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
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161
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Singhal S, Pradeep AR, Kanoriya D, Garg V. Human soluble receptor for advanced glycation end products and tumor necrosis factor-α as gingival crevicular fluid and serum markers of inflammation in chronic periodontitis and type 2 diabetes. J Oral Sci 2016; 58:547-553. [DOI: 10.2334/josnusd.16-0017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Sandeep Singhal
- Department of Periodontology, Government Dental College and Research Institute
| | - Avani R. Pradeep
- Department of Periodontology, Government Dental College and Research Institute
| | - Dharmendra Kanoriya
- Department of Periodontology, Government Dental College and Research Institute
| | - Vibhuti Garg
- Department of Periodontology, Government Dental College and Research Institute
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163
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Huang KC, Lai CH, Huang CF, Lu HK. A comprehensive periodontal treatment project: The periodontal status, compliance rates, and risk factors. J Dent Sci 2015; 11:182-188. [PMID: 30894969 PMCID: PMC6395145 DOI: 10.1016/j.jds.2015.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/20/2015] [Indexed: 11/13/2022] Open
Abstract
Background/purpose The comprehensive periodontal treatment project (CPTP) is being implemented in Taiwan since 2010. This retrospective study compared the periodontal status, compliance rates, and influence of risk factors for periodontal recurrence and tooth loss among groups of patients who accepted CPTP and conventional periodontal treatment (CPT). Materials and methods A total of 161 patients who received periodontal therapy were investigated and divided into compliant (n = 94) and noncompliant (n = 67) groups. Patients in the compliant group were further assigned to two subgroups: CPT with a postcard recall (PR) system (CPT + PR, n = 48) and CPTP with a PR system (CPTP + PR, n = 46). Demographic characteristics and periodontal parameters, including the probing pocket depth (PPD), bleeding on probing (BOP), and plaque control record (PCR), were collected for comparison between the subgroups. The risk factors for periodontal recurrence and tooth loss were statistically analyzed. Results The 161 patients were followed-up for a mean of 3.8 years. The patients in the CPTP + PR subgroup exhibited shallower PPD, less BOP, improved PCR, and fewer tooth loss. Age, smoking, PPD ≥7 mm, and PCR ≥30% were associated with periodontal recurrence, whereas age, diabetes, BOP ≥30%, and duration of the follow-up period were correlated with tooth loss. PR apparently increased the compliance rate of patients (27.3% vs. 77.7%). Conclusion CPTP with PR led to an optimal and stable periodontal status in patients. Compliant patients maintained a significantly improved periodontal status as compared with noncompliant patients.
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Affiliation(s)
| | - Chao-Han Lai
- Periodontal Department, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Periodontal Clinic, Dental Department, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiung-Fang Huang
- Periodontal Department, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Periodontal Clinic, Dental Department, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsein-Kun Lu
- Periodontal Department, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Periodontal Clinic, Dental Department, Taipei Medical University Hospital, Taipei, Taiwan
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164
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Deppe H, Mücke T, Wagenpfeil S, Kesting M, Karl J, Noe S, Sculean A. Are selected IL-1 polymorphisms and selected subgingival microorganisms significantly associated to periodontitis in type 2 diabetes patients? a clinical study. BMC Oral Health 2015; 15:143. [PMID: 26576766 PMCID: PMC4650288 DOI: 10.1186/s12903-015-0132-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/06/2015] [Indexed: 02/06/2023] Open
Abstract
Background We evaluated the periodontal conditions in patients with type 2 diabetes mellitus compared to metabolically healthy controls, and determined whether periodontal interleukin genotypes and microorganisms differed between participants with and without type 2 diabetes mellitus. Methods From April 2011 to July 2012, we prospectively enrolled healthy controls and patients with type 2 diabetes mellitus. Evaluation included assessment of medical and periodontal findings. We also recorded the presence of several interleukin gene variants and specific microorganisms, both available through commercially available diagnostic kits. Statistical significance was tested by the chi-square test and student’s t-test. Results We enrolled 52 patients with type 2 diabetes mellitus and 52 healthy controls. Compared with controls, periodontal disease was significantly more severe in patients with type 2 diabetes mellitus for the following: plaque index, bleeding on probing, pocket probing depth, clinical attachment loss, severe periodontal destruction (i.e., clinical attachment loss ≥ 5 mm), and number of teeth. However, statistical analysis failed to detect significant differences with respect to the periodontal-related interleukin genotypes (p ≥ 0.58) or the selected oral microbiota (p ≥ 0.15). Conclusion Based on these results, it may be assumed that chronic periodontitis in patients with type 2 diabetes mellitus is most strongly associated with inadequate oral hygiene. Periodontal interleukin genotypes and differences in oral microbiota seem to play a subordinate role.
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Affiliation(s)
- Herbert Deppe
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, Homburg Saar, D-81675 Munich, Germany.
| | - Thomas Mücke
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, Homburg Saar, D-81675 Munich, Germany.
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, University of Saarland, Homburg Saar, Germany.
| | - Marco Kesting
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, Homburg Saar, D-81675 Munich, Germany.
| | - Julia Karl
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, Homburg Saar, D-81675 Munich, Germany.
| | - Sebastian Noe
- Department of Internal Medical Department II, Technical University of Munich, Klinikum rechts der Isar, Homburg Saar, Germany.
| | - Anton Sculean
- Department of Periodontology, University of Berne, Berne, Switzerland.
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165
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Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, Stevenson B, Furness S, Iheozor‐Ejiofor Z. Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev 2015; 2015:CD004714. [PMID: 26545069 PMCID: PMC6486035 DOI: 10.1002/14651858.cd004714.pub3] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Glycaemic control is a key issue in the care of people with diabetes mellitus (DM). Periodontal disease is the inflammation and destruction of the underlying supporting tissues of the teeth. Some studies have suggested a bidirectional relationship between glycaemic control and periodontal disease. This review updates the previous version published in 2010. OBJECTIVES The objective is to investigate the effect of periodontal therapy on glycaemic control in people with diabetes mellitus. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 31 December 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2014, Issue 11), MEDLINE via OVID (1946 to 31 December 2014), EMBASE via OVID (1980 to 31 December 2014), LILACS via BIREME (1982 to 31 December 2014), and CINAHL via EBSCO (1937 to 31 December 2014). ZETOC (1993 to 31 December 2014) and Web of Knowledge (1990 to 31 December 2014) were searched for conference proceedings. Additionally, two periodontology journals were handsearched for completeness, Annals of Periodontology (1996 to 2003) and Periodontology 2000 (1993 to 2003). We searched the US National Institutes of Health Trials Registry (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) of people with type 1 or type 2 DM (T1DM/T2DM) with a diagnosis of periodontitis. Interventions included periodontal treatments such as mechanical debridement, surgical treatment and antimicrobial therapy. Two broad comparisons were proposed:1. periodontal therapy versus no active intervention/usual care;2. periodontal therapy versus alternative periodontal therapy. DATA COLLECTION AND ANALYSIS For this review update, at least two review authors independently examined the titles and abstracts retrieved by the search, selected the included trials, extracted data from included trials and assessed included trials for risk of bias.Our primary outcome was blood glucose levels measured as glycated (glycosylated) haemoglobin assay (HbA1c).Our secondary outcomes included adverse effects, periodontal indices (bleeding on probing (BOP), clinical attachment level (CAL), gingival index (GI), plaque index (PI) and probing pocket depth (PPD)), cost implications and diabetic complications. MAIN RESULTS We included 35 studies (including seven from the previous version of the review), which included 2565 participants in total. All studies used a parallel RCT design, and 33 studies (94%) only targeted T2DM patients. There was variation between studies with regards to included age groups (ages 18 to 80), duration of follow-up (3 to 12 months), use of antidiabetic therapy, and included participants' baseline HbA1c levels (from 5.5% to 13.1%).We assessed 29 studies (83%) as being at high risk of bias, two studies (6%) as being at low risk of bias, and four studies (11%) as unclear. Thirty-four of the studies provided data suitable for analysis under one or both of the two comparisons.Comparison 1: low quality evidence from 14 studies (1499 participants) comparing periodontal therapy with no active intervention/usual care demonstrated that mean HbA1c was 0.29% lower (95% confidence interval (CI) 0.48% to 0.10% lower) 3 to 4 months post-treatment, and 0.02% lower after 6 months (five studies, 826 participants; 95% CI 0.20% lower to 0.16% higher).Comparison 2: 21 studies (920 participants) compared different periodontal therapies with each other. There was only very low quality evidence for the multiple head-to-head comparisons, the majority of which were unsuitable to be pooled, and provided no clear evidence of a benefit for one periodontal intervention over another. We were able to pool the specific comparison between scaling and root planing (SRP) plus antimicrobial versus SRP and there was no consistent evidence that the addition of antimicrobials to SRP was of any benefit to delivering SRP alone (mean HbA1c 0.00% lower: 12 studies, 450 participants; 95% CI 0.22% lower to 0.22% higher) at 3-4 months post-treatment, or after 6 months (mean HbA1c 0.04% lower: five studies, 206 patients; 95% CI 0.41% lower to 0.32% higher).Less than half of the studies measured adverse effects. The evidence was insufficient to conclude whether any of the treatments were associated with harm. No other patient-reported outcomes (e.g. quality of life) were measured by the included studies, and neither were cost implications or diabetic complications.Studies showed varying degrees of success with regards to achieving periodontal health, with some showing high levels of residual inflammation following treatment. Statistically significant improvements were shown for all periodontal indices (BOP, CAL, GI, PI and PPD) at 3-4 and 6 months in comparison 1; however, this was less clear for individual comparisons within the broad category of comparison 2. AUTHORS' CONCLUSIONS There is low quality evidence that the treatment of periodontal disease by SRP does improve glycaemic control in people with diabetes, with a mean percentage reduction in HbA1c of 0.29% at 3-4 months; however, there is insufficient evidence to demonstrate that this is maintained after 4 months.There was no evidence to support that one periodontal therapy was more effective than another in improving glycaemic control in people with diabetes mellitus.In clinical practice, ongoing professional periodontal treatment will be required to maintain clinical improvements beyond 6 months. Further research is required to determine whether adjunctive drug therapies should be used with periodontal treatment. Future RCTs should evaluate this, provide longer follow-up periods, and consider the inclusion of a third 'no treatment' control arm.Larger, well conducted and clearly reported studies are needed in order to understand the potential of periodontal treatment to improve glycaemic control among people with diabetes mellitus. In addition, it will be important in future studies that the intervention is effective in reducing periodontal inflammation and maintaining it at lowered levels throughout the period of observation.
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Affiliation(s)
- Terry C Simpson
- University of EdinburghEdinburgh Dental InstituteLauriston PlaceEdinburghScotlandUKEH3 8HA
| | - Jo C Weldon
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Ian Needleman
- UCL Eastman Dental InstituteUnit of Periodontology and International Centre for Evidence‐Based Oral Health256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Sarah H Wild
- Public Health Sciences, University of EdinburghCentre for Public Health and Primary Care ResearchTeviot PlaceEdinburghUKEH8 9AG
| | - David R Moles
- Peninsula Dental SchoolOral Health Services ResearchThe John Bull Building, Tamar Science Park, Research WayPlymouthUKPL6 8BU
| | - Brian Stevenson
- University of Dundee Dental Hospital and SchoolDepartment of Restorative DentistryPark PlaceDundeeTaysideUKDD1 4HN
| | - Susan Furness
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
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166
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Creanor S, Millward BA, Demaine A, Price L, Smith W, Brown N, Creanor SL. Patients' attitudes towards screening for diabetes and other medical conditions in the dental setting. Br Dent J 2015; 216:E2. [PMID: 24413142 DOI: 10.1038/sj.bdj.2013.1247] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2013] [Indexed: 01/09/2023]
Abstract
AIM To determine the attitudes of patients attending routine appointments at primary care dental clinics and general dental practices towards the possibility of chair-side screening for medical conditions, including diabetes, in the dental setting. METHODS A brief, anonymous, self-administered questionnaire distributed to adult patients (≥18 years) attending 2 primary care dental clinics and 16 general dental practices in South-West England. RESULTS One hundred and ninety-seven completed questionnaires were received from patients at primary care dental clinics and 429 from general dental practice patients. Overall, 87% of respondents thought that it was important or very important that dentists screened patients for medical conditions such as diabetes; 79% were very willing to let a dental team member carry out screening. The majority indicated willingness to be screened for various medical conditions during a visit to the dentist, with significantly higher proportions of respondents in the primary care clinics indicating willingness (hypertension: 83% vs 74%; heart disease: 77% vs 66%; diabetes 82% vs 72% [all p <0.02]). Nearly two thirds of primary care clinic respondents and over half of general practice patients indicated that they would be willing to discuss test results with the dental team. Overall, 61% had never knowingly been screened or tested for diabetes; 20% reported that they had been tested within the previous 12 months. CONCLUSION The majority of respondents supported the concept of medical screening in a dental setting and were willing both to have screening tests and discuss their results with the dental team. Patient acceptance is paramount for successful implementation of such screening programmes.
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Affiliation(s)
- S Creanor
- Centre for Medical Statistics and Bioinformatics, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - B A Millward
- Plymouth Diabetes Centre, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, UK
| | - A Demaine
- Peninsula Medical School, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - L Price
- Research Design Service South West, ITTC Building, Tamar Science Park, Plymouth, UK
| | - W Smith
- Peninsula Dental Social Enterprise CIC, Plymouth, UK
| | - N Brown
- Peninsula Dental Social Enterprise CIC, Plymouth, UK
| | - S L Creanor
- Peninsula Dental School, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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167
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Liu H, Yin W. Reducing Dental Plaque and Gingivitis With 0.6% Cortex Ilicis Rotundae Toothpaste: A Randomized, Double-Masked Clinical Trial. J Periodontol 2015; 87:327-33. [PMID: 26469809 DOI: 10.1902/jop.2015.150414] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cortex Ilicis Rotundae has antioxidant and anti-inflammatory properties. Few studies have evaluated the effects of toothpastes containing Cortex Ilicis Rotundae. This study evaluates the antiplaque and antigingivitis effects of a test toothpaste containing 0.6% Cortex Ilicis Rotundae extract in a calcium carbonate base compared with a control toothpaste without any active ingredient. METHODS One hundred adults with a mean plaque index (PI) ≥ 1.5 and a mean gingival index (GI) ≥ 1.0 were enrolled in this randomized, double-masked, placebo-controlled clinical trial. They were assigned randomly to use a test toothpaste or a control toothpaste. At baseline, 6 weeks, and 12 weeks, they received examinations of oral hard and soft tissues, using Löe-Silness GI for gingivitis and the Turesky modification of the Quigley-Hein PI for PI. Adverse events were monitored. RESULTS When the study was completed, the test group reported lower mean GI than the control group (1.13 ± 0.22 versus 1.30 ± 0.23; P = 0.001) and lower mean PI than the control group (2.53 ± 0.5 versus 2.93 ± 0.44; P < 0.001). Compared to the baseline, the test group had reductions in GI and PI of 14.39% and 17.86%, respectively (both P < 0.001); the control group had reductions in GI and PI of 3.7% and 3.93%, respectively (both P < 0.001). No adverse events were reported during the course of the study. CONCLUSION The toothpaste containing 0.6% Cortex Ilicis Rotundae was effective in reducing dental plaque and gingivitis after 12 weeks of use compared with a negative control toothpaste.
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Affiliation(s)
- Hongchun Liu
- Department of Preventive Dentistry, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University
| | - Wei Yin
- Department of Preventive Dentistry, West China College of Stomatology, Sichuan University, Chengdu, China
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168
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Han K, Nam GE, Kim DH, Park JB, Ko Y, Roh YK, Cho KH, Park YG. Association of Periodontitis With Urinary Albumin Excretion in Korean Adults With Diabetes: The 2012 Korea National Health and Nutrition Examination Survey. Medicine (Baltimore) 2015; 94:e1839. [PMID: 26496329 PMCID: PMC4620835 DOI: 10.1097/md.0000000000001839] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Albuminuria and periodontitis are both commonly associated with systemic inflammation. However, the association between urinary albumin excretion (UAE) and periodontitis in patients with type 2 diabetes has not been fully investigated. This study aimed to investigate the association between UAE and periodontitis in Korean adults with type 2 diabetes.This study performed a cross-sectional analysis and used hierarchical multivariable logistic regression analysis models. Data from the 2012 Korean National Health and Nutrition Examination Survey were analyzed. A total of 547 patients, with type 2 diabetes without renal impairment, were included in this study. UAE was assessed using the urinary albumin to creatinine ratio (UACR). A community periodontal index greater than or equal to code 3 was used to define periodontitis.The risk of periodontitis tended to increase as UACR increased even after adjustment for potential confounders (P for trend in the odds ratios = 0.05 in model 1; 0.02 in model 2; and 0.01 in model 3). In a subgroup analysis, the prevalence of periodontitis was significantly higher in the patients with albuminuria (UACR >30 mg/g) than in those without albuminuria among patients younger than 65 years (P = 0.03), those with newly diagnosed diabetes (P = 0.04), or those without obesity (P = .04).UAE was positively associated with the risk of periodontitis in Korean adults with type 2 diabetes. In the patients who were younger, were newly diagnosed with diabetes, or had normal body mass index, individuals with albuminuria were more likely to have a higher prevalence of periodontitis. Early identification of periodontitis may be helpful in Korean diabetic adults with increased UAE.
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Affiliation(s)
- Kyungdo Han
- From the Department of Biostatistics, College of Medicine, The Catholic University of Korea (KH, YGP), Department of Family Medicine, Korea University Hospital, College of Medicine, Korea University (GEN, DHK, KHC), Department of Periodontics, College of Medicine, The Catholic University of Korea (J-BP, YK); and Department of Family Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea (YKR)
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169
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Ling MR, Chapple ILC, Matthews JB. Peripheral blood neutrophil cytokine hyper-reactivity in chronic periodontitis. Innate Immun 2015; 21:714-25. [PMID: 26055820 DOI: 10.1177/1753425915589387] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/07/2015] [Indexed: 12/20/2022] Open
Abstract
Pro-inflammatory cytokine release (IL-8, IL-6, TNF-α, IL-1β) by peripheral blood neutrophils, isolated from periodontitis patients (before/after therapy) and matched controls, was determined after 18 h culture in the presence/absence of Escherichia coli LPS, opsonised Staphylococcus aureus, heat-killed Fusobacterium nucleatum and Porphyromonas gingivalis. All cultures demonstrated differences in the amounts of each cytokine detected (P < 0.0001), with a clear release pattern (IL-8 > IL-6 > TNF-α = IL-1β). Median cytokine release from unstimulated patient neutrophils was consistently, but non-significantly, higher than from control cells. Stimulated cytokine release from untreated patient neutrophils was also consistently higher than from control cells. This hyper-reactivity was significant for all tested cytokines when data for all stimuli were combined (P < 0.016). In terms of individual stimuli, significant hyper-reactivity was detected with LPS (IL-8), F. nucleatum (IL-8, TNF-α), opsonised S. aureus (IL-8, TNF-α, IL-1β) and P. gingivalis (IL-8, IL-1β). Cytokine production by patient neutrophils did not reduce following successful non-surgical periodontal therapy and, except for responses to F. nucleatum, the cytokine hyper-reactivity detected pre-therapy was retained. These data demonstrate that chronic periodontitis is characterised by neutrophils that constitutively exhibit cytokine hyper-reactivity, the effects of which could modulate local and systemic inflammatory-immune responses and influence the risk and severity of periodontitis-associated systemic inflammatory diseases.
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Affiliation(s)
- Martin R Ling
- Periodontal Research Group and MRC Centre for Immune Regulation, College of Medical and Dental Sciences, The University of Birmingham, St Chad's Queensway, Birmingham B4 6NN, UK
| | - Iain L C Chapple
- Periodontal Research Group and MRC Centre for Immune Regulation, College of Medical and Dental Sciences, The University of Birmingham, St Chad's Queensway, Birmingham B4 6NN, UK
| | - John B Matthews
- Periodontal Research Group and MRC Centre for Immune Regulation, College of Medical and Dental Sciences, The University of Birmingham, St Chad's Queensway, Birmingham B4 6NN, UK
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170
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Artese HPC, Foz AM, Rabelo MDS, Gomes GH, Orlandi M, Suvan J, D’Aiuto F, Romito GA. Periodontal therapy and systemic inflammation in type 2 diabetes mellitus: a meta-analysis. PLoS One 2015; 10:e0128344. [PMID: 26010492 PMCID: PMC4444100 DOI: 10.1371/journal.pone.0128344] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 04/26/2015] [Indexed: 02/07/2023] Open
Abstract
AIM The aim of this systematic review was to assess the effect of periodontal therapy (PT) on serum levels of inflammatory markers in people with type 2 diabetes mellitus (T2DM). METHODS OF STUDY SELECTION A literature search was carried out using MEDLINE via Pubmed, EMBASE, LILACS and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Randomized-controlled trials (RCTs) and controlled clinical trials (CCTs) evaluating the effect of PT on systemic inflammatory markers were deemed eligible. Case series (CS), reports and pilot trials were excluded. Study quality was assessed using the Cochrane Collaboration's risk assessment tool. Meta-analysis was carried out using random effect methods. RESULTS The search strategy identified 3,164 potential studies of which 61 were assessed for eligibility and 9 (6 RCTs and 3 CCTs) were included in this systematic review. Three RCTs were classified by the authors as being at low risk of bias and three were "unclear" and classified as uncertain risk of bias. All CCTs were considered to be at a high risk of bias. The meta-analysis showed a statistically significant mean difference (MD) for TNF- α (-1.33 pg/ml, 95% CI: -2.10; -0.56, p<0.001) and CRP (-1.28 mg/l, 95% CI: -2.07; - 0.48, p<0.001) favoring periodontal intervention versus control. CONCLUSION The results of this meta-analysis support the hypothesis that PT reduces serum levels of TNF- α and CRP in T2DM individuals. The decrease of inflammatory burden has important implications for metabolic control and can, in part, explain the mechanisms linking periodontitis and increased risk for complications in people with T2DM.
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Affiliation(s)
- Hilana Paula Carillo Artese
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Adriana Moura Foz
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Mariana de Sousa Rabelo
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Giovane Hisse Gomes
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Marco Orlandi
- Unit of Periodontology, UCL Eastman Dental Institute, London, United Kingdom
| | - Jean Suvan
- Unit of Periodontology, UCL Eastman Dental Institute, London, United Kingdom
| | - Francesco D’Aiuto
- Unit of Periodontology, UCL Eastman Dental Institute, London, United Kingdom
| | - Giuseppe Alexandre Romito
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Mohamed HG, Idris SB, Mustafa M, Ahmed MF, Åstrøm AN, Mustafa K, Ibrahim SO. Impact of Chronic Periodontitis on Levels of Glucoregulatory Biomarkers in Gingival Crevicular Fluid of Adults with and without Type 2 Diabetes. PLoS One 2015; 10:e0127660. [PMID: 25993052 PMCID: PMC4438982 DOI: 10.1371/journal.pone.0127660] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/17/2015] [Indexed: 12/23/2022] Open
Abstract
The relationship between diabetes and periodontal disease is bidirectional, but information about the effect of chronic periodontitis on the levels of the glucoregulatory biomarkers locally in gingival crevicular fluid (GCF) is limited. The aim of this study was to compare the levels of 10 glucoregulatory biomarkers in GCF, firstly in subjects with type 2 diabetes (T2DM) presenting with and without chronic periodontitis and secondly, in subjects without diabetes, with and without chronic periodontitis. The material comprised a total of 152 subjects, stratified as: 54 with T2DM and chronic periodontitis (G1), 24 with T2DM (G2), 30 with chronic periodontitis (G3) and 44 without T2DM or periodontitis (G4). The levels of the biomarkers were measured using multiplex biometric immunoassays. Periodontal pocket depths were recorded in mm. Subsets G1 and G2 and subsets G3 and G4 were compared independently. Among T2DM subjects, GIP, GLP-1 and glucagon were significantly up-regulated in G1 compared to G2. Moreover, there were no statistical differences between the two groups regarding C-peptide, insulin, ghrelin, leptin and PAI-1. Comparisons among individuals without T2DM revealed significantly lower amounts of C-peptide and ghrelin in G3 than in G4. The number of sites with pocket depth ≥ 4mm correlated negatively with C-peptide (Spearman’s correlation co-efficient: -0.240, P < 0.01) and positively with GIP and visfatin (Spearman’s correlation co-efficient: 0.255 and 0.241, respectively, P < 0.01). The results demonstrate that chronic periodontitis adversely influences the GCF levels of glucoregulatory biomarkers, as it is associated with disturbed levels of biomarkers related to the onset of T2DM and its medical complications.
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Affiliation(s)
- Hasaan G. Mohamed
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
- * E-mail:
| | - Shaza B. Idris
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Manal Mustafa
- Oral Health Competence Center in Western Norway, Hordaland, Bergen, Norway
| | | | - Anne N. Åstrøm
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Kamal Mustafa
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Salah O. Ibrahim
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Olczak-Kowalczyk D, Pyrżak B, Dąbkowska M, Pańczyk-Tomaszewska M, Miszkurka G, Rogozińska I, Swoboda-Kopeć E, Gozdowski D, Kalińska A, Piróg A, Mizerska-Wasiak M, Roszkowska-Blaim M. Candida spp. and gingivitis in children with nephrotic syndrome or type 1 diabetes. BMC Oral Health 2015; 15:57. [PMID: 25952029 PMCID: PMC4425863 DOI: 10.1186/s12903-015-0042-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/28/2015] [Indexed: 01/12/2023] Open
Abstract
Background Diabetes and Nephrotic syndrome (NS) promote plaque-related gingivitis and yeast-like fungal infections. The study assesses the impact of Candida spp. and general disease- or treatment-related factors on plaque-related gingivitis severity in children and adolescents with Nephrotic syndrome /diabetes. Methods Body mass index (BMI), BMI standard deviation score, and oral cavity (Plaque Index – PLI, Gingival Index – GI, mucosa status, presence and Candida enzymatic activity) were assessed in 96 patients (32 with NS: 30- immunosuppressive treatment, 35 - type 1 diabetes, and 29 generally healthy), aged; 3–18 years. Laboratory included cholesterol and triglyceride measurements; in diabetic subjects– glycated haemoglobin, in NS: total protein, albumin, creatinine, haemoglobin, haematocrit, white cell count, urinary protein excretion. Medical records supplied information on disease duration and treatment. A statistical analysis was performed; Kendall Tau coefficient, chi-square test, t-test, and multiple regression analysis ( P < 0.05). Results Candida spp. often occurred in healthy patients, but oral candidiasis was found only in the NS and diabetes groups (9.37% and 11.43%). Gingivitis occurred more frequently in patients with NS/diabetes. Gingivitis severity was correlated with PLI, age, and yeast enzyme activity in NS – to with immunosuppressive treatment with >1 drug, drug doses, treatment duration, lipid disorders, and BMI; in diabetes, with blood glucose and glycated haemoglobin >8%. Conclusion Poor hygiene control is the main cause of gingivitis. Gingivitis severity is most likely related to age, lipid disorders and increase in body mass. Candida spp., in uncompensated diabetes and in those using immunosuppressive treatment, might intensify plaque-related gingivitis.
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Affiliation(s)
- Dorota Olczak-Kowalczyk
- Department of Paediatric Dentistry, Medical University of Warsaw, 18 Miodowa St, 00-246, Warszawa, Poland.
| | - Beata Pyrżak
- Department of Paediatric Endocrinology, Medical University of Warsaw, Warszawa, Poland.
| | - Maria Dąbkowska
- Department of Dental Medical Microbiology, Medical University of Warsaw, Warszawa, Poland.
| | | | - Grażyna Miszkurka
- Department of Paediatric Endocrinology, Medical University of Warsaw, Warszawa, Poland.
| | - Izabela Rogozińska
- Department of Paediatric Endocrinology, Medical University of Warsaw, Warszawa, Poland.
| | - Ewa Swoboda-Kopeć
- Department of Dental Medical Microbiology, Medical University of Warsaw, Warszawa, Poland.
| | - Dariusz Gozdowski
- Department of Experimental Statistics and Bioinformatics, Warsaw University of Life Sciences, Warsaw, Poland.
| | - Angelika Kalińska
- Department of Paediatric Dentistry, Medical University of Warsaw, 18 Miodowa St, 00-246, Warszawa, Poland.
| | - Anna Piróg
- Department of Paediatric Dentistry, Medical University of Warsaw, 18 Miodowa St, 00-246, Warszawa, Poland.
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Abstract
The oral health is influenced by systemic health, and one of the most common chronic diseases encountered in dental practice is diabetes mellitus. Diabetes can worsen oral infections and vice versa. In the literature, periodontitis and diabetes in the young to middle-aged adults have been the most widely researched area. Understanding the patho-physiology, clinical manifestations and management of different types of orofacial diseases in diabetic patients are important to the diabetologist and the dentist for the optimal care of patients with these diseases. This review explores the inter-link between diabetes and oral health.
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174
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Koneru S, Tanikonda R. Reliability of gingival blood sample to screen diabetes in dental hospital. Int J Prev Med 2015; 6:23. [PMID: 25830012 PMCID: PMC4378031 DOI: 10.4103/2008-7802.153538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 12/24/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Early detection and treatment of diabetes mellitus may reduce the burden of diabetes and its complications. Screening of undiagnosed diabetes with gingival blood sample in patients attending to the dental hospital and to check the reliability with standard method. METHODS Five hundred and fifty new patients age ranged from 30 to 50 years were randomly selected. Of 550 patients examined, gingival blood samples of 454 patients were collected from bleeding site and analyzed with self-monitoring device. Blood glucose values were recorded. In addition, all the patients were advised for the second visit with overnight fasting for fasting Blood glucose assessment. Among them, 442 patients returned for fasting blood glucose assessment in laboratory with blood glucose analyzer. RESULTS In the total of 454 patients gingival blood glucose assessment with self-monitoring device, 64 patients showed ≥200 mg/dL, which indicates diabetes, and the other 390 patients showed ≤200 mg/dL, which indicates patients are not diabetic. Whereas, the results of the laboratory blood glucose analysis, 24 (5.43%) patients showed ≥126 mg/dL, 36 (8.14%) patients showed 100-125 mg/dL and the other 382 patients are not diabetic. Comparison of blood glucose measurements by two methods showed sensitivity 96.66% and specificity 99.47%. CONCLUSIONS The results of the present study showed blood obtained from periodontal pocket probing is a reliable sample to screen diabetes in periodontal disease population. Early diagnosis of diabetes in the dental hospitals can help improve the patient's oral health and overall health status by helping patients avoid or reduce complications from diabetes.
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Affiliation(s)
- Suneetha Koneru
- Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Rambabu Tanikonda
- Department Conservative Dentistry and Endodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
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175
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Chiu SYH, Lai H, Yen AMF, Fann JCY, Chen LS, Chen HH. Temporal sequence of the bidirectional relationship between hyperglycemia and periodontal disease: a community-based study of 5,885 Taiwanese aged 35-44 years (KCIS No. 32). Acta Diabetol 2015; 52:123-31. [PMID: 24990094 DOI: 10.1007/s00592-014-0612-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/10/2014] [Indexed: 11/26/2022]
Abstract
The relationship between hyperglycemia (including diabetes) and periodontal disease (PD) has been noted previously, but its temporal sequence in the same study based on a population-based study has been barely addressed. Our study sought to clarify temporal bidirectional relationships between both diseases among Taiwanese aged 35-44 years. A prospective follow-up cohort study was designed by following over time the two normal cohorts (PD-free or hyperglycemia-free) derived from 5,885 subjects aged 35-44 years who were periodically attending a screening program. We ascertained both incident cases of PD (defined by Community Periodontal Index score ≧ 3) and hyperglycemia [fasting plasma glucose (FPG) ≧100 mg/dL] or type 2 diabetes (FPG ≧ 126 mg/dL) with 5-year follow-up. Cox proportional hazards regression model was used to assess the effect of PD on hyperglycemia and vice versa with adjustment for other confounding factors. Participants with PD presented a 33 % increase in their risk of incident hyperglycemia (including diabetes) [adjusted hazard ratio (aHR) = 1.33 (95 % CI 1.09-1.63)] after controlling for potential confounding factors. Conversely, prediabetes and type 2 diabetes mellitus led to a significant elevated risk for PD [aHR = 1.25 (95 % CI 1.00-1.57) and aHR = 1.95 (95 % CI 1.22-3.13)] after adjustment for other confounding factors. In conclusion, a significant bidirectional relationships was found between hyperglycemia and PD, suggesting that both diseases may share common latent traits and pathways that are worthy of being further elucidated by continuing a long-term follow-up of this cohort.
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Affiliation(s)
- Sherry Yueh-Hsia Chiu
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan
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176
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Grudyanov AI, Tkacheva ON, Avraamova TV, Khvatova NT. [The relationship between inflammatory periodontal diseases and cardiovascular diseases]. STOMATOLOGIIA 2015; 94:50-55. [PMID: 26331175 DOI: 10.17116/stomat201594350-55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Estimated the relationship between inflammatory periodontal diseases and the risk of developing cardiovascular disease. Installed combined effect of periodontitis and cardiovascular disease.
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Affiliation(s)
- A I Grudyanov
- Central Research Institute of Stomatology and Maxillofacial Surgery, Moscow
| | - O N Tkacheva
- State Research Center for Preventive Medicine, Moscow
| | - T V Avraamova
- Central Research Institute of Stomatology and Maxillofacial Surgery, Moscow; State Research Center for Preventive Medicine, Moscow
| | - N T Khvatova
- State Research Center for Preventive Medicine, Moscow
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177
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Oppermann RV, Haas AN, Rösing CK, Susin C. Epidemiology of periodontal diseases in adults from Latin America. Periodontol 2000 2014; 67:13-33. [DOI: 10.1111/prd.12061] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2014] [Indexed: 01/22/2023]
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178
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Bizenjima T, Seshima F, Ishizuka Y, Takeuchi T, Kinumatsu T, Saito A. Fibroblast growth factor-2 promotes healing of surgically created periodontal defects in rats with early, streptozotocin-induced diabetes via increasing cell proliferation and regulating angiogenesis. J Clin Periodontol 2014; 42:62-71. [PMID: 25361403 DOI: 10.1111/jcpe.12324] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the effects of fibroblast growth factor (FGF)-2 on the healing of surgical periodontal defects in rats with early, streptozotocin-induced diabetes. MATERIALS AND METHODS Fifty Wistar rats were assigned to streptozotocin-induced diabetes or non-diabetes group. Periodontal defects were surgically created at maxillary first molars. Defects were treated with hydroxypropyl cellulose (HPC) or FGF-2 with HPC. Defect fill was evaluated by microcomputed tomography. Histological and immunohistochemical analyses were performed. RESULTS Compared to vehicle alone, FGF-2 treatment yielded significantly greater bone volume and trabecular thickness in diabetes group. Diabetes group displayed reduced new bone formation and significantly longer epithelial down-growth compared to non-diabetes group. In diabetes group, FGF-2 treatment increased PCNA-positive cells and new bone formation after 2 weeks and suppressed epithelial down-growth, but new cementum formation was minimal even after 4 weeks. In diabetes group, overexpression of vascular endothelial growth factor was evident in cells within connective tissue, and no significant enhancement was observed by FGF-2 treatment. FGF-2 increased the expression of α-smooth muscle actin in diabetes group. CONCLUSIONS Treatment of surgical periodontal defects in diabetic rats with the single application of FGF-2 provided beneficial effects primarily on new bone formation via increasing cell proliferation and regulating angiogenesis.
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179
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Lee MCI. [Oxidative stress and periodontal disease--periodontal disease as a life-related disease and vascular disease]. Nihon Yakurigaku Zasshi 2014; 144:281-286. [PMID: 25492364 DOI: 10.1254/fpj.144.281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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180
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Strauss SM, Rosedale M, Pesce MA, Juterbock C, Kaur N, DePaola J, Goetz D, Wolff MS, Malaspina D, Danoff A. Point-of-Care HbA1c Testing with the A1cNow Test Kit in General Practice Dental Clinics: A Pilot Study Involving Its Accuracy and Practical Issues in Its Use. POINT OF CARE 2014; 13:142-147. [PMID: 25593546 PMCID: PMC4290166 DOI: 10.1097/poc.0000000000000039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
With millions of at-risk people undiagnosed with pre-diabetes and diabetes, there is a need to identify alternate screening sites for out-of-range glucose values. We examined practical issues and accuracy (relative to High Performance Liquid Chromatography testing in a laboratory) in the use of the A1cNow point of care device for this screening in general practice dental clinics at a large University-based Dental College. Health care professionals obtained evaluable readings for only 70% of the subjects, even after two attempts, and its use according to manufacturer's instructions was often challenging in the busy environment of the dental clinic. At thresholds for pre-diabetes and diabetes established by the American Diabetes Association, sensitivities of the A1cNow kit relative to the HPLC method were 91.9% and 100%, respectively. However, specificities for pre-diabetes and diabetes were 66.7% and 82.4%, respectively, indicating many false positive results. A better strategy for diabetes screening may involve a laboratory-based analysis approach that is patient- and provider-friendly, with minimal burden to the dental team.
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Affiliation(s)
| | - Mary Rosedale
- College of Nursing, New York University, New York, New York, USA
| | - Michael A. Pesce
- Center for Advanced Laboratory Medicine, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | | | - Navjot Kaur
- College of Nursing, New York University, New York, New York, USA
| | - Joe DePaola
- College of Nursing, New York University, New York, New York, USA
| | - Deborah Goetz
- New York University Langone Medical Center, New York, New York, USA
| | - Mark S. Wolff
- College of Dentistry, New York University, New York, New York, USA
| | | | - Ann Danoff
- New York University Langone Medical Center, New York, New York, USA
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181
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Garcia D, Tarima S, Okunseri C. Periodontitis and glycemic control in diabetes: NHANES 2009 to 2012. J Periodontol 2014; 86:499-506. [PMID: 25427615 DOI: 10.1902/jop.2014.140364] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study examines the association between periodontitis, diabetes (DM), and glycemic control. METHODS National Health and Nutrition Examination Survey data for 2009 to 2012 were analyzed. Periodontitis status of each participant was assessed using the full-mouth periodontal examination protocol, classified using the Centers for Disease Control and Prevention and the American Academy of Periodontology surveillance case definition for total periodontitis. Self-reported DM status was defined as yes or no. Glycemic control was assessed using glycohemoglobin data at cutoff points of 7.0%, 7.5%, 8.0%, 8.5%, and 9.0%. Descriptive statistics and logistic regression analyses were performed, and all analyses were adjusted for the survey design. RESULTS Overall, 7,042 adults ≥30 years old with complete data were included in the study. The mean glycohemoglobin levels for individuals with and without periodontitis were 5.9% and 5.6%, respectively, and increased to 7.4% and 7.0% for participants with DM. The majority of participants with and without periodontitis were aged 50 to 64 and 35 to 49 years (37.4% versus 44.5%), respectively. In the bivariate analysis, several demographic factors were significantly associated with having periodontitis, including self-reported DM status and glycemic control. In the multivariate analysis, demographic factors, glycohemoglobin cutoff values of 8.0%, 8.5%, and 9.0%, and mean glycohemoglobin level remained significant, but self-reported DM status was not. CONCLUSION This study demonstrates that glycohemoglobin and demographic factors are significantly associated with periodontitis, but not self-reported status.
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Affiliation(s)
- Dina Garcia
- Institute for Health & Society, Medical College of Wisconsin, Milwaukee, WI
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182
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Corbi SCT, Bastos AS, Orrico SRP, Secolin R, Dos Santos RA, Takahashi CS, Scarel-Caminaga RM. Elevated micronucleus frequency in patients with type 2 diabetes, dyslipidemia and periodontitis. Mutagenesis 2014; 29:433-9. [DOI: 10.1093/mutage/geu043] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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183
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Abstract
Oral pathologic abnormality is common and can be potentially serious. There are many diseases of the mouth that medical personnel must be able to diagnose and initiate management. The most prevalent lesions can be categorized as infectious, inflammatory, and common benign and malignant lesions. This article discusses prevalence, cause, diagnosis, and management of lesions such as stomatitis, candidiasis, caries, oral cancers, and bony tori.
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Affiliation(s)
- Hugh Silk
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA.
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184
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Bascones-Martínez A, Muñoz-Corcuera M, Bascones-Ilundain J. [Diabetes and periodontitis: A bidirectional relationship]. Med Clin (Barc) 2014; 145:31-5. [PMID: 25192582 DOI: 10.1016/j.medcli.2014.07.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 07/05/2014] [Accepted: 07/07/2014] [Indexed: 02/07/2023]
Abstract
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, a defect in insulin action or a combination of both. Periodontitis is now considered a chronic localized infection of the oral cavity that can trigger inflammatory host immune responses at local and systemic levels, and can also be a source of bacteremia. It is now known that periodontitis has an influence on the pathogenesis of certain systemic diseases. The biological relationship between diabetes and periodontal disease is well documented. In the mid-90s sufficient scientific support for the association between diabetes and periodontitis was published, and periodontitis was designated as the sixth complication of diabetes. There have been studies that show an improvement in both clinical and immunological parameters of periodontitis and glycemic control in long-term diabetes after treatment of periodontal disease. In addition, scientific evidence confirms that poorer glycemic control contributes to a worse periodontal condition. The interplay between the 2 conditions highlights the importance of the need for a good communication between the internist and dentist about diabetic patients, considering always the possibility that the 2 diseases may be occurring simultaneously in order to ensure an early diagnosis of both.
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Affiliation(s)
- Antonio Bascones-Martínez
- Departamento de Medicina y Cirugía Bucofacial, Facultad de Odontología, Universidad Complutense de Madrid, Madrid, España.
| | - Marta Muñoz-Corcuera
- Departamento de Medicina y Cirugía Bucofacial, Facultad de Odontología, Universidad Complutense de Madrid, Madrid, España
| | - Jaime Bascones-Ilundain
- Departamento de Odontología Conservadora, Facultad de Odontología, Universidad Complutense de Madrid, Madrid, España
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185
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Chee B, Park B, Bartold PM. Periodontitis and type II diabetes: a two-way relationship. INT J EVID-BASED HEA 2014; 11:317-29. [PMID: 24298927 DOI: 10.1111/1744-1609.12038] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
For many years an association between diabetes and periodontitis has been suspected. In more recent times this relationship has been suggested to be bidirectional with each condition being able to influence the other. In this review the two-way relationship between diabetes and periodontitis is considered. For this narrative review a very broad search strategy of the literature was developed using both EMBASE and MEDLINE (via PubMed) databases. The reference lists from the selected papers were also scanned, and this provided an additional source of papers for inclusion and further assessment. The data available suggest that diabetes is a risk as well as a modifying factor for periodontitis. Individuals with diabetes are more likely to have periodontitis and with increased severity when diabetes is uncontrolled/poorly controlled. Possible mechanisms of how diabetes affects periodontitis include adipokine-mediated inflammation, neutrophil dysfunction, uncoupling of bone and advanced glycation end-products-receptor for advanced glycation end-products interaction. Evidence is accruing to support how periodontitis can affect diabetes and complications associated with diabetes. There is some evidence demonstrating that periodontal therapy can result in a moderate improvement in glycaemic control. Available evidence indicates that diabetes and peridontitis are intricately interrelated and that each condition has the capacity to influence clinical features of each other.
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Affiliation(s)
- Brian Chee
- Department of Dentistry, University of Adelaide, Adelaide, South Australia, Australia
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186
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Levine RS. Obesity, diabetes and periodontitis--a triangular relationship? Br Dent J 2014; 215:35-9. [PMID: 23846063 DOI: 10.1038/sj.bdj.2013.627] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2013] [Indexed: 12/13/2022]
Abstract
The global rise of obesity, both adult and childhood, has been paralleled by a rise in type 2 diabetes, a trend predicted to continue for at least the next two decades. The combined effect will create a burden of direct and co-morbidities that will strain the physical and financial resources of all countries. While it is accepted that both type 1 and type 2 diabetes are major risk factors for the development and progression of periodontal disease, there is growing evidence that obesity is both an indirect risk factor because it affects glycaemic control and a direct risk factor because secretion of pro-inflammatory agents by adipose tissue modifies the periodontal reaction to the plaque biofilm. Recent research suggests that periodontitis may adversely affect glycaemic control, which can be improved by periodontal treatment with reduced risk of diabetic co-morbidity, thereby creating a two-way relationship. Furthermore it appears possible that periodontitis may stimulate inflammatory change in adipose tissue, creating a triangular self-generating cycle of morbidity linking obesity, diabetes and periodontal disease. Dentists should recognise these interlinked risk factors and consider including an assessment of glycaemic control and adiposity, possibly by waist-to-hip ratio, when periodontitis is diagnosed and in collaboration with medical practitioners provide treatment to help reduce the development of systemic disease.
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Affiliation(s)
- R S Levine
- Department of Oral Surgery, Leeds Dental Institute and Academic Unit of Obstetrics, Gynaecology and Paediatrics, University of Leeds, UK.
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187
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Mauri-Obradors E, Jané-Salas E, Sabater-Recolons MDM, Vinas M, López-López J. Effect of nonsurgical periodontal treatment on glycosylated hemoglobin in diabetic patients: a systematic review. Odontology 2014; 103:301-13. [PMID: 25062756 DOI: 10.1007/s10266-014-0165-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 05/25/2014] [Indexed: 12/12/2022]
Abstract
This review was designed to determine whether non-surgical periodontal treatment is able to reduce serum glycosylated hemoglobin (HbA1c) levels in patients with diabetes mellitus (DM). Several previous reports showed that scaling and root planning (SRP) improve periodontal status in patients with DM, but whether it also improves metabolic control of the disease is unclear. A systematic review was conducted according to the recommendations of the Cochrane Collaboration and PRISMA. A literature search was conducted in October 2012 using three libraries (Cochrane, Web of Knowledge, and Scopus) and the keywords "periodontal disease" and "diabetes mellitus." Only 21 of the articles met the inclusion criteria for this review. A total of 1,454 patients were thus included in this study to evaluate whether periodontal treatment improved serum HbA1c levels. Both the methodological quality and the risk of bias of each study were taken into account using the Jadad scale. Only ten of the included studies had an acceptable-good score of 3-5. Fourteen of the studies reported a significant decrease in serum HbA1c levels (p < 0.05) after periodontal treatment. The remaining seven studies failed to find a significant decrease in serum HbA1c. The findings of this review suggest that the published literature is insufficient and inconclusive to clearly support periodontal treatment as a means to improve serum HbA1c levels in patients with type 1 DM. It also demonstrates the need for homogeneous studies, with larger samples and longer follow-up periods, to properly address this question.
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Affiliation(s)
- Elisabet Mauri-Obradors
- School of Dentistry, Department of Stomatology, University Campus of Bellvitge, University of Barcelona, Pabellón de Gobierno, 2º planta, O8907 L' Hospitalet de Llobregat, Barcelona, Spain.
| | - Enric Jané-Salas
- School of Dentistry, Department of Stomatology, University Campus of Bellvitge, University of Barcelona, Pabellón de Gobierno, 2º planta, O8907 L' Hospitalet de Llobregat, Barcelona, Spain.
| | - Maria del Mar Sabater-Recolons
- School of Dentistry, Department of Stomatology, University Campus of Bellvitge, University of Barcelona, Pabellón de Gobierno, 2º planta, O8907 L' Hospitalet de Llobregat, Barcelona, Spain.
| | - Miguel Vinas
- Department Pathology and Experimental Therapeutics, University Campus of Bellvitge, University of Barcelona and IDIBELL, Barcelona, Spain.
| | - José López-López
- School of Dentistry, Department of Stomatology, University Campus of Bellvitge, University of Barcelona, Pabellón de Gobierno, 2º planta, O8907 L' Hospitalet de Llobregat, Barcelona, Spain.
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188
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Zhang Q, Li Z, Wang C, Shen T, Yang Y, Chotivichien S, Wang L. Prevalence and predictors for periodontitis among adults in China, 2010. Glob Health Action 2014; 7:24503. [PMID: 25008055 PMCID: PMC4090366 DOI: 10.3402/gha.v7.24503] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/25/2014] [Accepted: 06/01/2014] [Indexed: 01/12/2023] Open
Abstract
Background Although the interrelationship between poor oral health and chronic diseases is well established, few related studies are available in China. In this study, the prevalence of severe periodontitis and its association with chronic diseases among adults in China have been explored. Design During China's 2010 Chronic Disease and Risk Factor Surveillance (CCDRFS) survey among adults aged 18 and older, 3 out of 162 surveillance points and the entire sample from each point (600×3=1,800 subjects) were selected as pilot study sites in which oral examination was performed. Basic demographic information, chronic diseases status, and results of oral examination were collected from 2010 CCDRFS data. A standard oral examination was conducted by trained staff. Periodontitis was defined as moderate (4–5 mm pockets) or severe (≥6 mm pockets). Chronic disease status was determined by using standard methods and criteria. Multivariate logistic analysis was used to identify the independent association of various factors with severe periodontitis. Results Of 1,800 subjects, 1,728 subjects (96%) provided complete information. The prevalence of severe periodontitis was 1.9% (32/1,728) (95% CI=1.2–2.5). In multivariate model, participants with diabetes were 2.4 times (OR=2.4, 95% CI=1.1–5.6) more likely to have severe periodontitis. Being male was significantly associated with severe periodontitis (OR=3.5, 95% CI=1.6–7.7). Living in a rural area was related to an increased chance of having severe periodontitis (OR=2.1, 95% CI=1.0– 4.9). Attainment of at least 6 years of education was inversely associated with severe periodontitis (OR=0.3, 95% CI=0.1–0.8). Conclusions According to this pilot project, prevalence of severe periodontitis was low. Control measures should be particularly emphasized for high-risk groups such as less educated people (<6 years of education), people living in rural areas, men, and diabetes patients. Population-based studies, including oral examination by trained staff, are feasible and should be done in order to understand the burden of periodontitis and to provide an effective response to this key oral health issue.
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Affiliation(s)
- Qi Zhang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhixin Li
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chunxiao Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tao Shen
- Chinese Field Epidemiology Training Program (CFETP), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yang Yang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Saipin Chotivichien
- Bureau of Nutrition, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China;
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189
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The potential oral health impact of cost barriers to dental care: findings from a Canadian population-based study. BMC Oral Health 2014; 14:78. [PMID: 24962622 PMCID: PMC4079168 DOI: 10.1186/1472-6831-14-78] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 06/11/2014] [Indexed: 12/22/2022] Open
Abstract
Background Prior to the 2007/09 Canadian Health Measures Survey, there was no nationally representative clinical data on the oral health of Canadians experiencing cost barriers to dental care. The aim of this study was to determine the oral health status and dental treatment needs of Canadians reporting cost barriers to dental care. Methods A secondary data analysis of the 2007/09 Canadian Health Measures Survey was undertaken using a sample of 5,586 Canadians aged 6 to 79. Chi square tests were conducted to test the association between reporting cost barriers to care and oral health outcomes. Logistic regressions were conducted to identify predictors of reporting cost barriers. Results Individuals who reported cost barriers to dental care had poorer oral health and more treatment needs compared to their counterparts. Conclusions Avoiding dental care and/or foregoing recommended treatment because of cost may contribute to poor oral health. This study substantiates the potential likelihood of progressive dental problems caused by an inability to treat existing conditions due to financial barriers.
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190
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Ansai T, Awano S, Soh I. Problems and future approaches for assessment of periodontal disease. Front Public Health 2014; 2:54. [PMID: 24904917 PMCID: PMC4035603 DOI: 10.3389/fpubh.2014.00054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 05/10/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Toshihiro Ansai
- Division of Community Oral Health Development, Kyushu Dental University , Kitakyushu , Japan
| | - Shuji Awano
- Division of Community Oral Health Development, Kyushu Dental University , Kitakyushu , Japan
| | - Inho Soh
- Division of Community Oral Health Development, Kyushu Dental University , Kitakyushu , Japan
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191
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Arora N, Papapanou PN, Rosenbaum M, Jacobs DR, Desvarieux M, Demmer RT. Periodontal infection, impaired fasting glucose and impaired glucose tolerance: results from the Continuous National Health and Nutrition Examination Survey 2009-2010. J Clin Periodontol 2014; 41:643-52. [PMID: 24708451 DOI: 10.1111/jcpe.12258] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 02/06/2023]
Abstract
AIM We investigated the relationship between periodontal disease, a clinical manifestation of periodontal infection, and pre-diabetes. METHODS The National Health and Nutrition Examination Survey, 2009-2010 enrolled 1165 diabetes-free adults (51% female) aged 30-80 years (mean ± SD=50 ± 14) who received a full-mouth periodontal examination and an oral glucose tolerance test. Participants were classified as having none/mild, moderate or severe periodontitis and also according to mean probing depth ≥ 2.19 mm or attachment loss ≥ 1.78 mm, (respective 75th percentiles). Pre-diabetes was defined according to ADA criteria as either: (i) impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). In multivariable logistic regression models, the odds of IFG and IGT were regressed on levels of periodontitis category. RESULTS The odds ratios and 95% confidence intervals for having IGT among participants with moderate or severe periodontitis, relative to participants with none/mild periodontitis were 1.07 [0.50, 2.25] and 1.93 [1.18, 3.17], p = 0.02. The ORs for having IFG were 1.14 [0.74, 1.77] and 1.12 [0.58, 2.18], p = 0.84. PD ≥ 75 th percentile was related to a 105% increase in the odds of IGT: OR [95% CI] = 2.05 [1.24, 3.39], p = 0.005. CONCLUSIONS Periodontal infection was positively associated with prevalent impaired glucose tolerance in a cross-sectional study among a nationally representative sample.
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Affiliation(s)
- Nidhi Arora
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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192
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Kocyigit I, Yucel HE, Cakmak O, Dogruel F, Durukan DB, Korkar H, Unal A, Sipahioglu MH, Oymak O, Gurgan CA, Tokgoz B. An ignored cause of inflammation in patients undergoing continuous ambulatory peritoneal dialysis: periodontal problems. Int Urol Nephrol 2014; 46:2021-8. [PMID: 24756531 DOI: 10.1007/s11255-014-0716-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/08/2014] [Indexed: 11/25/2022]
Abstract
AIM We aimed to assess whether there is a significant relation between periodontal health status and inflammation in uremic patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and also to reveal the efficiency of periodontal treatment in patients with various degrees of periodontal problems. PATIENTS AND METHODS Overall, 68 patients undergoing CAPD were included in the study. Clinical indices and measurements were obtained at baseline and panoramic radiographies were used for the diagnosis. According to the baseline values, patients were stratified into four groups according to the severity of periodontal problems as follows: healthy/gingivitis, slight-to-moderate, and severe periodontitis. A control examination was performed 3 months after the periodontal treatment for only 43 patients. Clinical and laboratory parameters before and after treatment were compared. RESULTS The frequency of periodontal disease was found to be high in uremic patients on CAPD. The frequency and severity of periodontitis was also found to be significantly (p < 0.01) higher in patients with high sensitive C-reactive protein levels and longer duration of peritoneal dialysis (p < 0.01). In addition, the periodontitis rate was found to be higher in patients with cardiovascular disease (p < 0.05) and diabetes mellitus (p < 0.01). CONCLUSION A meticulous periodontal examination should be a routine part of management of the uremic patients on CAPD because periodontal disease could be one of the hidden sources of unexplained inflammatory status.
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Affiliation(s)
- Ismail Kocyigit
- Department of Nephrology, Erciyes University Medical Faculty, 38039, Kayseri, Turkey,
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A survey of the perception of comprehensiveness among dentists in a large Brazilian city. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:4249-61. [PMID: 24743842 PMCID: PMC4025042 DOI: 10.3390/ijerph110404249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/10/2014] [Accepted: 04/11/2014] [Indexed: 12/03/2022]
Abstract
Objectives: To quantitatively identify the perception of dentists regarding comprehensiveness and its domains of “patient welcoming”, “bonding” and “quality of care” in primary dental care settings of a large Brazilian city. Methods: A questionnaire was administered to all dentists comprising the primary health care service to Belo Horizonte with tenured jobs and 40 work hours per week, totalling a population of 207 professionals. The response rate was 90.34%. A pilot test was conducted with 44 dentists working in primary care for at least two years and who did not participate in the main study. Descriptive statistical analysis involved calculating proportions. No confidence intervals were calculated because this was a census study. Results: In most items (79.0%), professionals’ perceptions about the comprehensiveness were overwhelmingly positive. When we stratified the analysis by domain and checked those items about which dentists had a less favourable perception, 22.7% were in the patient welcoming domain, 25.0% were in the bonding domain and 12.5% were in quality of care. Conclusions: Comprehensiveness, as an approach in health care practice, needs to be enhanced, and there is evidence that these dentists are aware of its importance.
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Ota M, Seshima F, Okubo N, Kinumatsu T, Tomita S, Okubo T, Saito A. A collaborative approach to care for patients with periodontitis and diabetes. THE BULLETIN OF TOKYO DENTAL COLLEGE 2014; 54:51-7. [PMID: 23614953 DOI: 10.2209/tdcpublication.54.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As periodontal disease and diabetes mellitus (DM) have bidirectional interactions, an effective approach to periodontal treatment for patients with diabetes in the clinical setting is essential. This paper reports an effort in collaborative care for patients with periodontitis and diabetes between dental and medical professionals, and provides a preliminary evaluation regarding the clinical outcomes. We have introduced a clinical pathway program at our institution applicable to patients with periodontitis and DM. Physicians and dentists utilize the clinical pathway to share medical and dental information in order to provide the optimal care for each patient. So far, this clinical pathway has been applied to the treatment of 50 patients. We analyzed clinical outcomes in 10 patients with the chief complaint of periodontal problems who had also been diagnosed with type 2 DM. After initial periodontal therapy and diabetes care, a significant improvement in the mean value of glycated hemoglobin and fasting plasma glucose was observed, accompanied by clinical resolution of periodontal parameters. Within the limitations of the present study, the results suggest that collaborative care between periodontists and physicians based on the clinical pathway is effective in glycemic control of patients with periodontitis and type 2 DM. This indicates the need for closer collaboration between medical and dental professionals in improving the management of these diseases.
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Affiliation(s)
- Mikio Ota
- Department of Periodontology, Tokyo Dental College, Masago, Mihama-ku, Chiba, Japan.
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195
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Movva LR, Ho DK, Corbet EF, Leung WK. Type-2 diabetes mellitus, metabolic control, serum inflammatory factors, lifestyle, and periodontal status. J Dent Sci 2014. [DOI: 10.1016/j.jds.2013.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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196
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Soboku K, Kikuchi T, Fujita S, Takeda H, Naruse K, Matsubara T, Noguchi T. Altered Gene Expression in Gingival Tissues and Enhanced Bone Loss in Rats With Diabetes With Experimental Periodontitis. J Periodontol 2014; 85:455-64. [DOI: 10.1902/jop.2013.120705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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197
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Resistin: a potential biomarker for periodontitis influenced diabetes mellitus and diabetes induced periodontitis. DISEASE MARKERS 2014; 2014:930206. [PMID: 24692844 PMCID: PMC3944905 DOI: 10.1155/2014/930206] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/01/2013] [Accepted: 11/12/2013] [Indexed: 11/28/2022]
Abstract
Biomarkers are highly specific and sensitive indicators of disease activity. Resistin is a recently discovered adipocytokine, having a potent biomarker quality. Initially resistin was thought to be produced by adipocytes alone; however, emerging evidence suggests that it is also produced in abundance by various cells of the immunoinflammatory system, indicating its role in various chronic inflammatory diseases. Data suggests that resistin plays a role in obesity, insulin resistance, cardiovascular diseases, and periodontitis. Resistin derived its name from the original observation that it induced insulin resistance (resist-in: resist insulin) in mice and is downregulated in mature murine adipocytes cultured in the presence of insulin sensitizing drugs like thiazolidinediones. It is well recognized that obesity, is associated with insulin resistance and diabetes. A three-way relationship has been established between diabetes, obesity and periodontitis. Recent evidence also suggests an association between obesity and increased risk for periodontitis. Our previous research showed incremental elevation of resistin with periodontal disease activity and a reduced level of resistin, after periodontal therapy. Thus resistin would be one of the molecular links connecting obesity, periodontitis, and diabetes and may serve as a marker that links periodontal disease with other systemic diseases. A Medline/PubMed search was carried out for keywords “Diabetes Mellitus,” “Periodontitis,” and “Resistin,” and all relevant research papers from 1990 in English were shortlisted and finalized based on their importance. This review provides an insight into the biological action of resistin and its possible role in periodontitis influenced diabetes mellitus and diabetes induced periodontitis.
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198
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Effect of nonsurgical periodontal therapy (with or without oral doxycycline delivery) on glycemic status and clinical periodontal parameters in patients with prediabetes: a short-term longitudinal randomized case-control study. Clin Oral Investig 2014; 18:1963-8. [PMID: 24449228 DOI: 10.1007/s00784-014-1185-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/06/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of the present short-term longitudinal randomized case-control study was to assess the effect of nonsurgical periodontal therapy (NSPT) (with and without oral doxycycline delivery) on glycemic status and clinical periodontal parameters in patients with prediabetes. MATERIAL AND METHODS Sixty-six patients with prediabetes and periodontal disease were included. Characteristics of the study cohort (age, gender, socioeconomic status [SES] education status, duration of prediabetes, and type of treatment adopted for prediabetes management) were recorded. Patients were randomly divided into two groups (33 patients/group). In group 1, scaling and root planing (SRP) was performed, and in group-2, patients underwent SRP and oral doxycycline (100 mg) administration once daily for 15 days. In each group, the following parameters were investigated at baseline and after 3 months: (a) fasting blood glucose level (FBGL), (b) hemoglobin A1c (HbA1c), and (c) periodontal parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD], and clinical attachment loss [AL]). Statistical analysis was performed using Student's t test. RESULTS There was no significant difference in age, gender, SES, education status, and duration and treatment of prediabetes among individuals in groups 1 and 2. Three months post-NSPT, FBGL and HbA1c were significantly reduced among patients in group 1 (P < 0.05) and group 2 (P < 0.05) compared to baseline. Three months post-NSPT, PI (P < 0.05), BOP (P < 0.05), and PD (P < 0.05) were significantly reduced among patients in group 1 (P < 0.05) and group 2 (P < 0.05) compared to baseline. There was no difference in clinical AL between the groups after 3 months of NSPT. CONCLUSION NSPT (with and without oral doxycycline delivery) reduces hyperglycemia and periodontal inflammation in patients with prediabetes.
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199
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Jung YS, Shin MH, Kweon SS, Lee YH, Kim OJ, Kim YJ, Chung HJ, Kim OS. Periodontal disease associated with blood glucose levels in urban Koreans aged 50 years and older: the Dong-gu study. Gerodontology 2014; 32:267-73. [PMID: 24428748 DOI: 10.1111/ger.12107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the association of periodontal disease and the number of teeth present with the risk of prediabetes and diabetes as well as with blood glucose and HbA1c levels in adult Koreans. BACKGROUND The relationship between periodontal disease and diabetes has not been fully elucidated. MATERIALS AND METHODS Cross-sectional data from 5535 participants aged ≥50 years were obtained from 2008 to 2010. Periodontal status was measured as pocket depth (PD), clinical attachment loss (CAL) and bleeding on probing (BOP) recorded. The percentage of sites with a PD ≥4 mm, CAL ≥4 mm (CAL4) and BOP (BOP%) were recorded. Participants were divided into three groups according to PD4, CAL4 and BOP% measurements. Number of teeth present was divided into four groups. Participants were classified as normoglycaemic, prediabetic or diabetic based on HbA1c and fasting glucose levels. RESULTS After full adjustment, the highest tertile of CAL4 (OR: 1.47, 95% CI: 1.18-2.02, p < 0.001), PD4 (OR: 1.58, 95% CI: 1.26-1.97, p < 0.001) and BOP% (OR: 1.37, 95% CI: 1.07-1.75, p = 0.012) had significantly increased odds of diabetes. The number of teeth present was inversely related to diabetes (p < 0.001) and prediabetes (p = 0.032) risk. Periodontal disease severity was positively associated with HbA1c and glucose levels. The number of teeth present was positively associated with HbA1c, but not glucose, levels. CONCLUSION Periodontal disease and the number of teeth present are associated with an increased risk of diabetes and increased blood glucose and HbA1c levels in Koreans aged ≥50 years.
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Affiliation(s)
- Young-Suk Jung
- Department of Periodontology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, South Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea.,Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine, Wonkwang University College of Medicine, Iksan, South Korea
| | - Ok-Joon Kim
- Department of Oral Pathology, School of Dentistry, Dental Science Institute, Chonnam National University, Gwangju, South Korea
| | - Young-Joon Kim
- Department of Periodontology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, South Korea
| | - Hyun-Ju Chung
- Department of Periodontology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, South Korea
| | - Ok-Su Kim
- Department of Periodontology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, South Korea
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Sahril N, Aris T, Mohd Asari AS, Yaw SL, Saleh NC, Omar MA, Teh CH, Abdul Muttalib K, Idzwan MF, Low LL, Junid NZ, Ismail F, Ismail NA, Abu Talib N. Oral health seeking behaviour among Malaysians with type II diabetes. ACTA ACUST UNITED AC 2014. [DOI: 10.7243/2055-7205-1-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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