Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus

Factors behind change in knowledge after a mass media campaign targeting periodontitis

The aim of this study was to investigate changes in knowledge before and after a mass media campaign, in relation to social attributes, care system attributes and oral health aspects. The study was based on a questionnaire in a cohort design, sent out to 900 randomly sampled people aged 50-75 in Sweden. The response rate to the questionnaire before and after the campaign was 70% and 65% respectively. Sixty-four percent answered both questionnaires. Two questions addressed knowledge, while 10 questions aimed to measure social attributes, care system attributes and oral health aspects. Data were analysed for bivariate relations as to change in knowledge and social attributes, care system attributes and oral health aspects. Data were also analysed in multiple regression analysis with knowledge before, knowledge after and knowledge differences as dependent variables. The results showed that there were a number of independent variables with influence on the dependent variables. Of the social attributes, secondary education gave almost 10% (P < 0.001) better knowledge both before and after the campaign. Among care system attributes, high care utilization was related to knowledge both before and after the campaign. The most important factors for knowledge about periodontitis were education, care utilization and perceived importance of oral health. In conclusion, this study demonstrates that mass media might increase knowledge about periodontitis as a health promotion strategy.

Periodontal changes in children and adolescents with diabetes: a case-control study

OBJECTIVE

To evaluate the level of oral disease in children and adolescents with diabetes.

RESEARCH DESIGN AND METHODS

Dental caries and periodontal disease were clinically assessed in 182 children and adolescents (6-18 years of age) with diabetes and 160 nondiabetic control subjects.

RESULTS

There were no differences between case and control subjects with respect to dental caries. Children with diabetes had significantly higher plaque and gingival inflammation levels compared with control subjects. The number of teeth with evidence of attachment loss (the hallmark of periodontal disease) was significantly greater in children with diabetes (5.79 +/- 5.34 vs. 1.53 +/- 3.05 in control subjects, unadjusted P < 0.001). When controlling for age, sex, ethnicity, gingival bleeding, and frequency of dental visits, diabetes remained a highly significant correlate of periodontitis, especially in the 12- to 18-year-old subgroup. In the case group, BMI was significantly correlated with destruction of connective tissue attachment and bone, but duration of diabetes and mean HbA(1c) were not.

CONCLUSIONS

Our findings suggest that periodontal destruction can start very early in life in diabetes and becomes more prominent as children become adolescents. Programs designed to promote periodontal disease prevention and treatment should be provided to young patients with diabetes.

Strengthening the Prevention of Periodontal Disease: The WHO Approach

BACKGROUND

The aim of this paper is to provide an overview of the burden of periodontal disease in adult populations worldwide, to emphasize the essential risk factors common to periodontal disease and chronic diseases, to outline important new strategies for effective prevention of periodontal disease, and to inform about the role of the World Health Organization (WHO) in developing a national capacity for the prevention of disease.

METHODS

Information about periodontal health status as measured by the Community Periodontal Index system is stored in the WHO Global Oral Health Data Bank. Updated information concerning WHO standard age groups was used to describe the prevalence rates of signs of periodontal disease, i.e., gingival bleeding, periodontal pocketing, and loss of attachment.

RESULTS

Gingival bleeding is highly prevalent among adult populations in all regions of the world; advanced disease with deep periodontal pockets (> or =6 mm) affects approximately 10% to 15% of adults worldwide. The available evidence shows that important risk factors for periodontal disease relate to poor oral hygiene, tobacco use, excessive alcohol consumption, stress, and diabetes mellitus. Integrated preventive strategies based on the common risk factors approach are recommended for public health practice.

CONCLUSIONS

The vast majority of countries need to establish a surveillance system for measuring progress in the control of periodontal disease and promotion of oral health. WHO has designed approaches for the integration of oral disease prevention within the prevention of non-communicable chronic diseases, and global strategies are currently being implemented in all regions of the world.

Analytical epidemiology of periodontitis

AIMS

To review the literature related to the analytical epidemiology of periodontitis generated over the past decade. This review does not deal with descriptive epidemiologic studies of the prevalence, extent and severity of periodontitis with respect to global geography, but focuses exclusively on analytical epidemiology issues, including the challenges posed by the use of different case definitions across studies, current theories and models of disease progression, and risk factors associated with the onset and progression of periodontitis.

METHODS

Relevant publications in the English language were identified after Medline and PubMed database searches.

FINDINGS AND CONCLUSIONS

There is a conspicuous lack of uniformity in the definition of periodontitis used in epidemiologic studies, and findings from different research groups are not readily interpretable. There is a lack of studies that specifically address the distinction between factors responsible for the onset of periodontitis versus those affecting its progression. Colonization by specific bacteria at high levels, smoking, and poorly controlled diabetes have been established as risk factors for periodontitis, while a number of putative factors, including specific gene polymorphisms, have been identified in association studies. There is a clear need for longitudinal prospective studies that address hypotheses emerging from the cross-sectional data and include established risk factors as covariates along with new exposures of interest. Intervention studies, fulfilling the "targeting" step of the risk assessment process, are particularly warranted. Obvious candidates in this context are studies of the efficacy of elimination of specific bacterial species and of smoking cessation interventions as an alternative to the traditional broad anti-plaque approach in the prevention and control of periodontitis. Ideally, such studies should have a randomized-controlled trial design.

The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus

OBJECTIVES

The aim of the present study was to investigate the effect of improved periodontal health on metabolic control in type 2 diabetes mellitus (DM) patients.

MATERIAL AND METHODS

Fourty-four patients with type 2 DM were selected. Subjects were randomly assigned into two groups.

DATA COLLECTION

Plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment levels (CALs), gingival recession (GR) and bleeding on probing (BOP) were recorded at baseline at 1st and 3rd months. Fasting plasma glucose (FPG), 2-h post-prandial glucose (PPG), glycated haemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), HDL-cholesterol, LDL-cholesterol and microalbuminure were analysed at baseline, 3 months following the periodontal therapy. The treatment group received full-mouth scaling and root planing whereas the control group received no periodontal treatment.

RESULTS

A statistically significant effect could be demonstrated for PI, GI, PPD, CAL and BOP for the treatment group. HbA1c levels in the treatment group decreased significantly whereas the control group showed a slight but insignificant increase for this parameter.

CONCLUSIONS

The results of our study showed that non-surgical periodontal treatment is associated with improved glycaemic control in type 2 patients and could be undertaken along with the standard measures for the diabetic patient care.

The elderly at risk for periodontitis and systemic diseases

The increasing population of older subjects with dental care needs will become a major challenge to our society and its care providers. To manage the health care needs of the elderly, a coordination between medical and dental care providers will become necessary. From the dental perspective, it is important to develop skills in the risk assessment of older patients. Such risk assessment of older subjects should take an approach that is holistic and focused on the reduction of the infectious burden and the improvement of self-efficacy.

Expression of the receptor of advanced glycation end products in gingival tissues of type 2 diabetes patients with chronic periodontal disease: a study utilizing immunohistochemistry and RT-PCR

OBJECTIVES

Relationship between diabetes and periodontal disease is well established. It has been shown that advanced glycation end-products (AGEs) might exert noxious effects on gingival tissues through its receptor. Evidence for the role of receptors of AGE (RAGE) in periodontal disease was verified in a murine model for diabetes. However, the presence of RAGE in human gingival tissues has not been demonstrated previously. In this study we demonstrate the presence of RAGE in human periodontium in patients with chronic periodontitis with and without type 2 diabetes.

MATERIAL AND METHODS

Gingival biopsies from eight patients with both type 2 diabetes and chronic periodontitis and 14 healthy control subjects with chronic periodontitis were immunohistochemically stained for RAGE. Five samples from the study groups and four controls were subjected to reverse transcriptase coupled to polymerase chain reaction (RT-PCR) for quantitative determination of mRNA for RAGE.

RESULTS

On immunohistochemistry, positive staining for RAGE was seen in the endothelium and the basal and spinous layer of the inflamed gingival epithelium in both type 2 diabetes and non-diabetes tissue with no statistically significant difference between both groups. RT-PCR, however, showed a 50% increase in mRNA for RAGE in the gingiva of diabetic patients when compared with controls (p<0.05).

CONCLUSIONS

Although there was no change in the staining intensity for RAGE between both groups, the increase in the mRNA for RAGE in the type 2 diabetes gingival epithelium may indicate a possible involvement of this receptor in the periodontal destruction in type 2 diabetes.

Periodontal disease and mortality in type 2 diabetes

OBJECTIVE

Periodontal disease may contribute to the increased mortality associated with diabetes.

RESEARCH DESIGN AND METHODS

In a prospective longitudinal study of 628 subjects aged > or =35 years, we examined the effect of periodontal disease on overall and cardiovascular disease mortality in Pima Indians with type 2 diabetes. Periodontal abnormality was classified as no or mild, moderate, and severe, based on panoramic radiographs and clinical dental examinations.

RESULTS

During a median follow-up of 11 years (range 0.3-16), 204 subjects died. The age- and sex-adjusted death rates for all natural causes expressed as the number of deaths per 1,000 person-years of follow-up were 3.7 (95% CI 0.7-6.6) for no or mild periodontal disease, 19.6 (10.7-28.5) for moderate periodontal disease, and 28.4 (22.3-34.6) for severe periodontal disease. Periodontal disease predicted deaths from ischemic heart disease (IHD) (P trend = 0.04) and diabetic nephropathy (P trend < 0.01). Death rates from other causes were not associated with periodontal disease. After adjustment for age, sex, duration of diabetes, HbA1c, macroalbuminuria, BMI, serum cholesterol concentration, hypertension, electrocardiographic abnormalities, and current smoking in a proportional hazards model, subjects with severe periodontal disease had 3.2 times the risk (95% CI 1.1-9.3) of cardiorenal mortality (IHD and diabetic nephropathy combined) compared with the reference group (no or mild periodontal disease and moderate periodontal disease combined).

CONCLUSIONS

Periodontal disease is a strong predictor of mortality from IHD and diabetic nephropathy in Pima Indians with type 2 diabetes. The effect of periodontal disease is in addition to the effects of traditional risk factors for these diseases.

Gingival crevicular fluid levels of interleukin-1beta and glycemic control in patients with chronic periodontitis and type 2 diabetes

BACKGROUND

Patients with diabetes have increased incidence and severity of periodontal disease not accounted for by differences in the subgingival microbial infection. Poor glycemic control has been consistently associated with periodontal disease severity. Also, recent evidence suggests that hyperglycemia may induce inflammatory cytokine production. Few studies, however, have examined local biochemical measures of periodontal inflammation in patients with type 2 diabetes. The aim of this study was to determine whether glycemic control was related to gingival crevicular fluid (GCF) levels of interleukin-1beta (IL-1beta).

METHODS

GCF samples were collected from 45 patients with type 2 diabetes and untreated chronic periodontitis. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and attachment level (AL) were recorded at six sites per tooth. IL-1beta levels were determined from individual GCF samples by enzyme-linked immunoabsorbent assay (ELISA). Individual site and mean patient values were calculated. Glycated hemoglobin (HbA1c) levels were measured from anticoagulated whole blood using an automated affinity chromatography system. Serum glucose was also determined.

RESULTS

Clinical periodontal measures (PD, AL, BOP) and measures of glycemic control (HbA1c, random glucose) were significantly correlated with GCF IL-1beta. Patients with greater than 8% HbA1c had significantly higher mean GCF IL-1beta levels than patients with less than 8% HbA1c. In a multivariate model adjusting for age, gender, PD, AL, BOP, and PI, HbA1c and random glucose were independent predictors of high GCF IL-1beta.

CONCLUSIONS

Poor glycemic control is associated with elevated GCF IL-1beta. These data are consistent with the hypothesis that hyperglycemia contributes to an heightened inflammatory response, and suggests a mechanism to account for the association between poor glycemic control and periodontal destruction.

Anangu oral health: The status of the Indigenous population of the Anangu Pitjantjatjara lands

OBJECTIVE

To describe oral health in the Anangu Pitjantjatjaraku lands in South Australia and to compare with earlier surveys and national data.

DESIGN

Descriptive.

SETTING

Data were collected at the time of dental care service provision, according to World Health Organization protocols, at the request of the Nganampa Health Council on optical mark reader forms.

PARTICIPANTS

There were 356 Anangu adults and 317 children surveyed.

RESULTS

The mean number of teeth affected by dental caries in the deciduous dentition in young children, aged 5-6 years, was double (mean 3.20) that of the overall Australian child population aged 5-6 years (mean 1.44). In contrast to the decline in deciduous caries in Australian children generally, Anangu children aged 5-9 years had a 42% increase in the mean number of teeth affected since 1987. Adults experienced low levels of dental caries, but severe periodontal disease was more prevalent among diabetics (79%) compared with-non-diabetics (13.8%). Tooth loss was found more frequently among adults with diabetes (mean 5.51) than non-diabetics (mean 1.53).

CONCLUSIONS

Oral health promotion strategies, in association with general health strategies, need to be developed to improve oral health in this remote Aboriginal population.

Oral disease burden in Northern Manhattan patients with diabetes mellitus

OBJECTIVES

We explored the association between diabetes mellitus and oral disease in a low-socioeconomic-status urban population.

METHODS

Dental records of 150 adults with diabetes and 150 nondiabetic controls from the dental clinic at Columbia University in Northern Manhattan matched by age and gender were studied.

RESULTS

There was a 50% increase in alveolar bone loss in diabetic patients compared with nondiabetic controls. Diabetes, increasing age, male gender, and use of tobacco products had a statistically significant effect on bone loss.

CONCLUSIONS

Our findings provide evidence that diabetes is an added risk for oral disease in this low-income, underserved population of Northern Manhattan. Oral disease prevention and treatment programs may need to be part of the standards of continuing care for patients with diabetes

Diabetes and oral tumors in Hungary: epidemiological correlations

OBJECTIVE

Numerous publications have already demonstrated that diabetes is a risk factor for the development of periodontal diseases and various inflammatory lesions in the oral mucosa. A possible correlation between diabetes and oral premalignancies and tumors was examined in this study, as no literature data are available concerning this problem.

RESEARCH DESIGN AND METHODS

Stomato-oncological screening was carried out on 200 diabetic patients in the medical departments; the control group included 280 adult dentistry outpatients. The lesions found were classified into three groups: inflammatory lesions, benign tumors, and precancerous lesions. A retrospective diabetes screening of 610 inpatients with histologically confirmed oral malignancies was also performed. The control group comprised 574 complaint- and tumor-free adults. Fasting blood glucose levels were determined in both groups, and the tumor location was registered in the cancer patients.

RESULTS

Benign tumors were found in 14.5% and precancerous lesions in 8% of diabetic patients. In the control group these values were significantly lower, at 6.4 and 3.2%, respectively (P>0.01). Earlier Hungarian screening studies indicated similar frequency of these lesions in the general population. The proportion of oral cavity lesions was higher among diabetic patients compared with that of the control patients. In the oral cancer patient group, diabetes was present in 14.6% and an elevated blood glucose level in 9.7%. These values are significantly higher than those for the tumor-free control group (P<0.01). The gingival and labial tumor location was significantly more frequent among diabetic cancer patients than in the nondiabetic group (P<0.01). The combination of diabetes and smoking means a higher risk for oral precancerous lesions and malignancies.

CONCLUSIONS

Diabetes may be a risk factor for oral premalignancies and tumors.

Periodontal disease and diabetes mellitus

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

Role of smoking and HbA1c level in periodontitis among insulin-dependent diabetic patients

OBJECTIVES

The aim was to analyse the role of smoking and HbA1c level in attachment loss (AL) and probing depths (PDs) among insulin-dependent diabetic patients. MATERIAL AND-METHODS: The study subjects were selected from a group of 149 insulin-dependent diabetic patients and included 64 patients (39 men and 25 women) aged 30 years or older. Data were obtained from patient records and by clinical examination. The outcome variables were the number of sites with AL and PDs of 5-9 mm. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated using Poisson regression models. RR was adjusted for the number of teeth, dental calculus and age.

RESULTS

RR for AL among the smokers was 4.15 (95% CI: 2.30-7.63) and that for PD among the smokers was 7.96 (95% CI: 4.91-13.19). HbA1c was not related to AL or PD. Among smokers with HbA1c > 8.5, RR for AL was 12.34 (95% CI: 4.14-39.35), but RR was not elevated for PD.

CONCLUSIONS

It can be concluded that the poor metabolic control together with smoking is extremely detrimental for AL.

Blood Test Values and Community Periodontal Index Scores in Medical Checkup Recipients

BACKGROUND

We examined the blood test values of people who received general medical checkups and their Community Periodontal Index (CPI) score.

METHODS

A total of 7,452 persons (5,742 males and 1,710 females), who had general medical and dental checkups, were the subjects of the study. Many were people who worked for companies in and around Nagoya and their family members, ranging in age from 16 to 80 years. The blood test in our study consisted of 37 items used in general blood tests. Partial-mouth recordings were used to measure CPI scores. The highest CPI score for each subject was used for analysis. Odds ratios and confidence interval values were obtained using the Mantel-Haenszel method to analyze the results.

RESULTS

CPI scores of 3 and 4 were related to the test values of high-density-lipoprotein cholesterol, serum iron, white blood cell count, fasting blood sugar, glycosylated hemoglobin A1, glycosylated hemoglobin A1c, and C-reactive protein.

CONCLUSION

Blood test values tended to show correlations with CPI scores, more clearly seen in males than in females.

Oral disorders and chronic systemic diseases in very old adults living in institutions

This study evaluated whether oral disorders were associated with chronic systemic diseases in 532 Canadian adults who are old and very old and living in institutions. A brief oral examination documented tooth retention, caries, and periodontal and gingival health. Medical records provided information about chronic systemic conditions. A history of stroke was associated with a higher experience of caries, a higher ratio of decayed-to-present teeth, and more gingival and periodontal problems. Participants with high blood pressure, osteoporosis, or diabetes were more likely to be edentulous or to have fewer teeth than participants who did not have these conditions. Participants who had arthritis retained more teeth with age. Participants who had more diseases also tended to have poorer gingival or periodontal conditions, fewer teeth, and higher risk of edentulousness. The associations between systemic diseases and more severe oral disorders may be direct or may be mediated by underlying factors such as health behaviors.

Associations of Periodontal Status with General Health Conditions and Serum Antibody Titers forPorphyromonas gingivalisandActinobacillus actinomycetemcomitans

BACKGROUND

The purpose of the present study was to evaluate associations of periodontal status with general health conditions and with serum antibody titers for Porphyromonas gingivalis (Pg) and Actinobacillus actinomycetemcomitans (Aa) in a Japanese population.

METHODS

Subjects (1,314) aged 40 years or older were recruited for the study. Their periodontal status was evaluated using the community periodontal index of treatment needs (CPITN). Records from general health examinations were used for the present analyses, including data on age, gender, body mass index, systolic and diastolic blood pressure (SBP/DBP); levels of serum alkaline phosphatase, total cholesterol, high-density lipoprotein cholesterol, triglyceride, fasting blood glucose, and C-reactive protein (CRP); counts of white blood cells (WBC) and platelets; smoking habit; and electrocardiogram recordings. Serum IgG antibody titers for Pg fimbrial antigens (IgG.Pg.Fim.), Pg whole-cell antigens (IgG.Pg.whol.), and Aa whole-cell antigens (IgG.Aa.whol.) were determined using enzyme-linked immunosorbent assay. The subjects were divided, according to their maximum CPITN codes, into four periodontal groups: max.CPITN-0/1/2, -3, -4, or -MS (missing sextant).

RESULTS

Multivariable logistic regression analyses revealed significant associations of the max.CPITN-4 subjects who were males (odds ratio, OR: 2.03) or smokers (OR: 1.73), or who had high diastolic blood pressure (OR: 1.27), high WBC (OR: 1.24), high serum CRP level (OR: 2.39) and high serum IgG.Pg.Fim. (OR: 1.17), IgG.Pg.whol. (OR:1.54), and IgG.Aa.whol. (OR: 1.19) titers.

CONCLUSION

Significant associations between periodontal status and several health conditions were found in the adult population examined, including gender, smoking habit, diastolic blood pressure, white blood cell counts, C-reactive protein, and serum IgG antibodies to P. gingivalis fimbriae, IgG P. gingivalis whole cell, and IgG A. actinomycetemcomitans whole cell titers.

Association Between Interleukin-1 Genotype and Periodontal Disease in a Diabetic Population

BACKGROUND

Recently, it has become evident that for many common chronic diseases, modifying factors amplify disease mechanisms to make the clinical condition more severe. The aims of this report were 1) to investigate the prevalence of periodontitis in a diabetic population, 2) to evaluate the association of periodontitis with metabolic control, and 3) to evaluate periodontitis in diabetics with different interleukin (IL)-1 genotypes.

METHODS

One hundred diabetic patients were screened. Type and duration of diabetes, level of control (glycosylated hemoglobin), and demographic data were recorded. Periodontal disease was defined as two or more teeth with clinical attachment loss (CAL) > or = 5 mm. Poorly controlled diabetes was defined as glycosylated hemoglobin values > 8%. Finger-stick blood samples were collected and analyzed for genotyping of IL-1A (+4845), IL-1B (+3954), IL-1B (-511), and IL-1RN (+2018) polymorphisms.

RESULTS

Among the diabetic patients in the study, 66% showed periodontal destruction, and 43% of those could be characterized as severe. The prevalence of severe attachment loss increased with decreasing control of diabetes. Only the IL-1B (-511) genotype was found to be associated with periodontal disease in the African American patients (P<0.05). The frequency of allele 1 was 0.77 in periodontitis affected versus 0.33 in healthy African American diabetics. A borderline significant association between IL-1B (+3954) and periodontal disease also was noted in Caribbean periodontal patients (P=0.06); however, the allele 2 frequency in this population was only 10%.

CONCLUSIONS

These data confirm the high prevalence and severity of periodontitis in the diabetic population, and support the association between poor glycemic control and periodontal disease. The low prevalence of some of the IL-1 gene polymorphisms in the ethnic groups included in this study limits the validity of conclusions on genotype associations with clinical findings, but there was a trend suggesting that allele 1 at IL-1B (-511) and IL-1B (+3954) was overrepresented among diabetics with periodontal disease.

Oral infections and systemic diseases

An association between periodontal infection and CVD has been revealed in some epidemiologic studies, whereas other studies were unable to demonstrate such an association. A link between the two diseases may be explained by shared established or nonestablished risk factors. Future studies with extended control of confounding factors and intervention studies may add to the understanding of a possible relationship between the diseases. In some cases, IE is caused by dental plaque bacteria. Several studies are suggestive of oral bacteria causing respiratory infection. The pathogenesis and course of a number of other diseases including DM and rheumatoid arthritis have been associated wish periodontitis, but more research is necessary to elucidate possible pathogenic interactions.

Serum IgG to heat shock proteins and Porphyromonas gingivalis antigens in diabetic patients with periodontitis

BACKGROUND

Past studies have reported a correlation between the presence and severity of periodontitis and serum antibody titers to species-specific antigens of Porphyromonas gingivalis or to cross-reactive antigens, such as lipopolysaccharide (LPS) and heat shock proteins (HSP), shared between P. gingivalis and other bacteria. Our recent study of periodontal treatment outcome in insulin-dependent (type 1) diabetes mellitus patients with severe periodontitis (IDDMI/periodontitis) resulted in two key findings: 1. serum glutamic acid decarboxylase autoantibody (GAD65 Ab) levels were significantly associated with periodontal pocket depth change (PDC) and 2. serum IgG titers to P. gingivalis cells were positively associated with GAD65 Ab level in seropositive (GAD65 Ab +) patients. We have therefore hypothesized that profiles of serum autoantibody levels and IgG titers, to P. gingivalis-specific antigens may be useful in assessing risk for refractory periodontitis in such patients.

AIM

To determine whether PDC resulting from non-surgical periodontal treatment can be predicted using profiles of baseline IgG titers to P. gingivalis-specific antigens, human HSP, and GAD65.

METHODS

PDC was assessed two months after non-surgical periodontal treatment of 7 GAD65 Ab + and 11 GAD65 AbIDDM/periodontitis patients. Pretreatment titers to GAD65, recombinant human heat shock proteins (HSP90, HSP70, and HSP60), and various P. gingivalis antigens were measured using radioligand precipitation or enzyme-linked immunosorbent (ELISA) assays and compared to the same measurements for 154 recent-onset IDDM patients and 46 non-diabetic controls.

RESULTS

Median titers (ELISA units) to HSP90 and HSP70 were significantly higher than non-diabetic controls for GAD65 Ab + (p degrees = 0.002) and GAD65 Ab- (p = 0.034) IDDM/periodontitis patients, respectively. Multivariate regression analysis indicated significant partial correlation of PDC with log-transformed titers to HSP90 (r = - 0.62, p = 0.008), HSP70 (r = + 0.62, p = 0.009), GAD65 (r = - 0.60, p = 0.01) and P. gingivalis LPS (r = - 0.5 1, p = 0.04). Furthermore, hierarchical clustering of baseline profiles of log-transformed HSP90, HSP70, and GAD65 Ab titers sorted patients into two distinct clusters with significantly different median PDC (1.45 min, n = 10 vs. 0.65 min, n = 8; p = 0.016, Mann-Whitney).

CONCLUSION

Pretreatment profiles of serum antibody titers to HSP90, HSP70, GAD65, and P. gingivalis LPS may be useful for predicting which patients with IDDM/periodontitis will have a poor response to non-surgical periodontal therapy.

Dentists, diabetes and periodontitis

This review updates the relationship between diabetes mellitus and periodontitis. A checklist has been included to assist the general dental practitioner identify individuals with undiagnosed diabetes. The literature indicates a similar incidence of periodontitis exists between well-controlled diabetics and non-diabetics. However, a greater incidence and severity of periodontitis is observed in both Type 1 and 2 long-term diabetics with poor metabolic control. There is an undeniable link between diabetes mellitus and periodontitis with complex interactions occurring between these diseases. A critical review of the literature fails to support the notion that periodontal therapy has a beneficial effect on the long-term control of diabetes. We have explored the associations between periodontitis and diabetes in the hope of providing the general dental practitioner with the knowledge to support the diabetic patient with the best possible dental care and advice.

Oral self-care among adults with diabetes in Finland

OBJECTIVES

The importance of maintenance and promotion of periodontal health is emphasized among people with diabetes because of their high risk for periodontal diseases. Our aim was to evaluate oral health behavior and its determinants among adults with diabetes in Finland.

METHODS

The population of the questionnaire study consisted of 420 systematically selected adults with diabetes, who were members of a national diabetes register. The response rate was 80%. Questions focused on self-treatment, -prevention, and -diagnosis of oral diseases, utilization of dental services, and knowledge and attitudes toward oral health among adult people with diabetes. Oral self-care was evaluated in the framework of the New Century model of oral health promotion.

RESULTS

The proportion of edentulous subjects was 23%, and these were excluded from further analysis. Self-reported twice-a-day brushing among dentate participants was significantly more common among women and the highly educated, but was less common compared with earlier studies among Finnish adults. A quarter of those surveyed reported never cleaning interdental surfaces, with the number of daily cleaners being nearly equal (27%). Age 40 years or over and recent treatment by a private dentist were significant predictors for daily interdental cleaning. The proportion of those who had attended a dental appointment within the last year was 63%, and the main reason for the last dental visit was an emergency among almost one-fifth of those surveyed.

CONCLUSIONS

A need exists for further promotion of oral self-care among adults with diabetes. Support by dental and other health care professionals involved in diabetes care should be encouraged.

Aspectos relevantes da interface entre diabetes mellitus e infecção

O diabetes mellitus (DM) é uma doença de alta prevalência nas sociedades modernas, na maioria das vezes com tratamento inadequado ou ausente. Apesar de geralmente considerado como fator de risco independente para ocorrência e gravidade de infecções em geral, o DM não apresenta evidência clínica forte de sua relação com infecção. Observa-se, porém, uma maior ocorrência de certas infecções em pacientes com DM, com curso menos favorável para algumas delas. Há também tipos de infecção quase exclusivos de pacientes com DM. Experimentalmente, observa-se depressão da atividade dos neutrófilos, menor eficiência da imunidade celular, alteração dos sistemas antioxidantes e menor produção de interleucinas. Com relação às infecções comuns, as que envolvem o trato respiratório não têm comprovadamente maior gravidade em pacientes com DM, exceção feita ao pneumococo - por isso a recomendação para sua vacinação contra S. pneumoniae e influenza. Quanto ao trato urinário, há maior ocorrência de bacteriúria assintomática em mulheres com DM, com maiores índices de pielonefrite, necrose papilar, abscesso perinéfrico, pielonefrite xantogranulomatosa, e cistite e pielonefrite gangrenosas. Periodontite e infecções de partes moles são também mais comuns no DM. Cada tipo de infecção é associado a germes típicos, e seu conhecimento é fundamental para um tratamento inicial adequado. As infecções quase exclusivas de pacientes com DM incluem otite externa maligna, mucormicose rinocerebral, colecistite gangrenosa e o somatório de alterações que caracterizam o pé diabético. O conhecimento destas infecções assume maior importância por requererem freqüentemente uma abordagem multidisciplinar, envolvendo endocrinologistas, infectologistas, cirurgiões vasculares e nefrologistas, dentre outros.

Infectious complications of dental and periodontal diseases in the elderly population

Retention of teeth into advanced age makes caries and periodontitis lifelong concerns. Dental caries occurs when acidic metabolites of oral streptococci dissolve enamel and dentin. Dissolution progresses to cavitation and, if untreated, to bacterial invasion of dental pulp, whereby oral bacteria access the bloodstream. Oral organisms have been linked to infections of the endocardium, meninges, mediastinum, vertebrae, hepatobiliary system, and prosthetic joints. Periodontitis is a pathogen-specific, lytic inflammatory reaction to dental plaque that degrades the tooth attachment. Periodontal disease is more severe and less readily controlled in people with diabetes; impaired glycemic control may exacerbate host response. Aspiration of oropharyngeal (including periodontal) pathogens is the dominant cause of nursing home-acquired pneumonia; factors reflecting poor oral health strongly correlate with increased risk of developing aspiration pneumonia. Bloodborne periodontopathic organisms may play a role in atherosclerosis. Daily oral hygiene practice and receipt of regular dental care are cost-effective means for minimizing morbidity of oral infections and their nonoral sequelae.

Comparative evaluation of adjunctive oral irrigation in diabetics

AIM

The purpose of this study was to assess the response of diabetics to scaling and root planing treatment and subgingival oral irrigation as adjunctive therapy.

METHOD

A total of 52 type 1 and 2 diabetics (mean age 51.3+/-14) with adult periodontitis were randomized to two groups. Treatment included ultrasonic scaling and scaling and root planing in both groups (control and test) plus subgingival water irrigation 2x daily for the test group. Assessments were made prior to and at 6 and 12 weeks after treatment. Parameters measured were modified gingival index (MGI), probing pocket depth (PPD), plaque index (PI), clinical attachment level (CAL), and bleeding on probing (BOP). Systemic measurement of Reactive Oxygen Species (ROS) generation, cytokines (TNF-alpha, IL-1beta, IL-10, and PGE2), and glycated hemoglobin (HbA1C).

RESULTS

After treatment, analysis of data showed that both groups had clinical and systemic improvement. The test group had a statistically significant reduction for MGI, PI, and BOP compared to controls (p<0.03) at 12 weeks and for ROS generation at 12 weeks (p<0.012). Unlike controls, systemic analysis of cytokines showed a statistically significant reduction from baseline for IL-1beta at 6 weeks and PGE2 at 6 and 12 weeks (p<0.05) within test group.

CONCLUSION

These results suggest that scaling and root planing and adjunctive therapy may be of value in establishing a healthy periodontium in diabetics.

Assessment of periodontal treatment needs among adults with diabetes in Finland

OBJECTIVES

People with diabetes have a high risk for periodontal disease, which can be considered one of the complications of diabetes. We evaluated periodontal treatment needs using the Community Periodontal Index of Treatment Needs (CPITN) in relation to diabetes-related factors and oral hygiene.

DESIGN

The sample consisted of 120 dentate diabetics, all of whom were regular patients at the Salo Regional Hospital Diabetes Clinic. The nurses, who interviewed the patients, collected data on duration and type of diabetes, complications, and HbA1c level. Clinical periodontal examination included identification of visible plaque, the presence of calculus and use of the CPITN.

RESULTS

The CPITN score 3 was the most prevalent. According to the logistic regression model, poor metabolic control was significantly related to pathologic pockets. No significant association was found between diabetes-related factors and the highest individual CPITN score of 4, which was, in turn, significantly associated with extensive calculus.

CONCLUSIONS

Excessive periodontal treatment needs found, indicate that current dental care may be insufficient in adults with diabetes. Oral health among high-risk groups, especially those with poor metabolic control, should be promoted by collaboration between dental and health care professionals involved in diabetes care.

Treatment outcome for IDDM patients in relation to glutamic acid decarboxylase autoantibodies and serum IgG to periodontal pathogens

BACKGROUND

Patients with insulin-dependent diabetes mellitus (IDDM) have elevated risk for periodontitis (PD) relative to subjects without diabetes. Whether refractory PD in IDDM patients is related to autoimmunity as indicated by serum glutamic acid decarboxylase autoantibody GAD Ab levels or to host bacterial immunity as reflected by serum antibody titers to periodontal pathogens is unknown.

AIMS

To determine if non-surgical periodontal treatment outcome differs between GAD Ab-seropositive and -seronegative IDDM patients by assessing the following parameters: (1) pretreatment serum levels of GAD Ab, (2) pretreatment serum IgG titers to key periodontal pathogens, and (3) changes in periodontal pocket probing depth (PDC) after treatment.

METHODS

Before and two months after periodontal treatment of 11 GAD Ab-seronegative and 7 -seropositive subjects, PDC was assessed and serum GAD Ab and IgG to Porphyromonas gingivalis (Pg), Bacteroides forsythus (BJ), and Actinobacillus actinomycetemcomitans (Aa) were studied using established radioligand precipitation and enzyme-linked immunosorbent assays, respectively.

RESULTS

The PDC decrease was significantly better for GAD Ab-seronegative subjects than for seropositive subjects (median 1.4 mm+/-0.5 s.d. versus 0.5 mm+/-0.3 s.d., p<0.03, Mann-Whitney). GAD Ab levels and PDC were positively correlated (r=+0.71, p<0.05) for sero-positive subjects but were neutral (r=-0.07) for seronegative subjects. Serum IgG to Pg and GAD Ab levels were positively associated (r2=0.42) in seropositive subjects. Logistic regression analysis confirmed that GAD Ab status was the primary discriminator for PDC (p<0.04).

CONCLUSION

Detection of elevated GAD Ab levels in combination with elevated IgG titers to Pg before treatment is indicative of IDDM patients with refractory PD.

Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective

This review evaluates evidence for a bidirectional relationship between diabetes and periodontal diseases. A comprehensive Medline search of the post-1960 English language literature was employed to identify primary research reports of relationships between diabetes and periodontal diseases. Reports included in the review on the adverse effects of diabetes on periodontal health (DM-->PD) were restricted to those comparing periodontal health in subjects with and without diabetes. Review of adverse affects of periodontal infection on glycemic control included reports of periodontal treatment studies and follow-up observational studies in which changes in glycemic control could be assessed. Observational studies reporting DM-->PD provided consistent evidence of greater prevalence, severity, extent, or progression of at least one manifestation of periodontal diseases in the large majority of reports (supportive evidence in 44/48 total reviewed; 37/41 cross-sectional and 7/7 cohort). Additionally, there were no studies reviewed with superior design features to refute this association. Treatment studies provided direct evidence to support periodontal infection having an adverse, yet modifiable, effect on glycemic control. However, not all investigations reported an improvement in glycemic control after periodontal treatment. Additional evidence to support the effect of severe periodontitis on increased risk for poorer glycemic control comes from 2 follow-up observational studies. The evidence reviewed supports viewing the relationship between diabetes and periodontal diseases as bidirectional. Further rigorous, systematic study is warranted to establish that treating periodontal infections can be influential in contributing to glycemic control management and possibly to the reduction of the burden of complications of diabetes mellitus.

Periodontitis and diabetes interrelationships: role of inflammation

Diabetes mellitus is a systemic disease with several major complications affecting both the quality and length of life. One of these complications is periodontal disease (periodontitis). Periodontitis is much more than a localized oral infection. Recent data indicate that periodontitis may cause changes in systemic physiology. The interrelationships between periodontitis and diabetes provide an example of systemic disease predisposing to oral infection, and once that infection is established, the oral infection exacerbates systemic disease. In this case, it may also be possible for the oral infection to predispose to systemic disease. In order to understand the cellular/molecular mechanisms responsible for such a cyclical association, one must identify common physiological changes associated with diabetes and periodontitis that produce a synergy when the conditions coexist. A potential mechanistic link involves the broad axis of inflammation, specifically immune cell phenotype, serum lipid levels, and tissue homeostasis. Diabetes-induced changes in immune cell function produce an inflammatory immune cell phenotype (upregulation of proinflammatory cytokines from monocytes/polymorphonuclear leukocytes and downregulation of growth factors from macrophages). This predisposes to chronic inflammation, progressive tissue breakdown, and diminished tissue repair capacity. Periodontal tissues frequently manifest these changes because they are constantly wounded by substances emanating from bacterial biofilms. Diabetic patients are prone to elevated low density lipoprotein cholesterol and triglycerides (LDL/TRG) even when blood glucose levels are well controlled. This is significant, as recent studies demonstrate that hyperlipidemia may be one of the factors associated with diabetes-induced immune cell alterations. Recent human studies have established a relationship between high serum lipid levels and periodontitis. Some evidence now suggests that periodontitis itself may lead to elevated LDL/TRG. Periodontitis-induced bacteremia/endotoxemia has been shown to cause elevations of serum proinflammatory cytokines such as interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha), which have been demonstrated to produce alterations in lipid metabolism leading to hyperlipidemia. Within this context, periodontitis may contribute to elevated proinflammatory cytokines/serum lipids and potentially to systemic disease arising from chronic hyperlipidemia and/or increased inflammatory mediators. These cytokines can produce an insulin resistance syndrome similar to that observed in diabetes and initiate destruction of pancreatic beta cells leading to development of diabetes. Thus, there is potential for periodontitis to exacerbate diabetes-induced hyperlipidemia, immune cell alterations, and diminished tissue repair capacity. It may also be possible for chronic periodontitis to induce diabetes.

Treatment of periodontal disease and control of diabetes: an assessment of the evidence and need for future research

Evidence points to an increased cytokine response in type 2 diabetes, especially the proinflammatory cytokines interleukin (IL)-1 beta, IL-6, and tumor necrosis factor (TNF)-alpha. Genetics, age, and, nutrition are important signals for this increased response and as reported more recently, infections and inflammation. Persistent elevation of IL-1 beta, IL-6, and TNF-alpha in the diabetic state have an effect on the liver, stimulate the release of acute-phase proteins, produce the characteristic dysregulation of lipid metabolism associated with type 2 diabetes, and have effects on pancreatic beta cells as well. In addition, TNF-alpha, a potent inhibitor of the tyrosine kinase activity of the insulin receptor, has been implicated as an etiologic factor for insulin resistance. Collectively, the evidence supports a role for cytokine elevation in the pathophysiology and metabolic abnormalities associated with diabetes. Periodontitis is an infection that is twice as prevalent in diabetic individuals compared to non-diabetics. Porphyromonas gingivalis, one of the microorganisms responsible for this infection, is able to invade endothelial cells and is a potent signal for monocyte and macrophage activation. Thus, once established in the diabetic host, this chronic infection complicates diabetes control and increases the occurrence and severity of microvascular and macrovascular complications. Unlike treatment of acute infections, modalities of treatment for chronic infections are a matter of debate. Evidence indicates that mechanical removal of subgingival infection does not result in complete elimination of periodontal infection and consequently there is no effect on diabetes control measured as reduction in glycated hemoglobin. On the other hand, studies incorporating systemic antibiotics as adjuncts to mechanical debridement result in a reduction of P. gingivalis to nondetectable levels and a concomitant reduction in glycated hemoglobin, independent of the hypoglycemic effects of diabetes drugs or insulin. The evidence supports the notion that treatment of chronic periodontal infection is essential in the diabetic patient. Assessment of infection status in diabetic patients is fundamental for appropriate treatment decisions.

Potential risk of serious oral infections in the diabetic patient: a clinical report

Diabetes has many manifestations, including increased vulnerability to bacterial and fungal infections, that may be of concern to the dental profession. Oral candidosis and other opportunistic fungal infections may be early, nonspecific signs of uncontrolled diabetes. Rhinocerebral involvement often extends to the paranasal sinuses, pharynx, palate, orbit, and brain, causing severe tissue destruction and necrosis. This clinical report describes a young woman with diabetes who developed mucormycosis of the maxilla. Tissue destruction resulted in loss of the entire premaxilla, the anterior half of the hard palate, and all maxillary teeth except for the right and left second molars. An interim clear acrylic resin prosthesis was fabricated to restore facial contours and speech and to allow mastication. This prosthesis subsequently was duplicated, and teeth were added for improved lip support, esthetics, and mastication.

Periodontal disease in pregnancy complicated by type 1 diabetes mellitus

BACKGROUND

Systemic disease and hormonal changes have been implicated as complicating factors for periodontal disease. Diabetes has been identified as a risk factor for periodontal disease, and diabetics can experience periodontal destruction at an earlier age than non-diabetic individuals. Increased hormone levels during pregnancy can contribute to increased gingival inflammation. The purpose of this study was to examine the association of type 1 diabetes mellitus (DM) on the periodontal status of pregnant women.

METHODS

Thirty-three (13 diabetic and 20 non-diabetic) subjects, 20 to 39 weeks gestation, participated in this study. The mean age of the diabetics and non-diabetics was 28.5 +/- 7.1 (SD) and 27.0 +/- 7.3 years, respectively. The following parameters were assessed at Ramfjord's reference teeth: plaque index (PI), gingival inflammation (GI), probing depth (PD), gingival margin (GM) location, and clinical attachment level (CAL).

RESULTS

Diabetic subjects had significantly (P<0.001) higher PI (1.48 +/- 0.69) and GI (1.77 +/- 0.44) scores than non-diabetics (PI = 0.63 +/- 0.38; GI = 0.93 +/- 0.48). Mean PD for diabetics (2.95 +/- 0.69 mm) was significantly different (P<0.024) from that of non-diabetics (2.44 +/- 0.32 mm). Although mean GM location was coronal to the cemento-enamel junction (CEJ) in both groups, gingival margins were at a more apical position (P<0.001) in the diabetics (-0.20 +/- 1.24 mm) compared to non-diabetics (-1.76 +/- 0.53 mm). Mean CAL values also varied significantly (P<0.001) between diabetics (2.60 +/- 1.54 mm) and non-diabetics (0.68 +/- 0.65 mm). Significant differences were seen for GI (P<0.001), PD (P=0.005), GM location (P<0.001), and CAL (P<0.001) when assessing the effect of diabetes and controlling for plaque. When assessing the effect of plaque and controlling for diabetes, the only significant difference was GI (P=0.001).

CONCLUSIONS

The results of this study demonstrate that periodontal inflammation and destruction are increased in pregnant diabetics as compared to non-diabetic pregnant patients. These findings may have implications for diabetic control and, hence, maternal and fetal outcomes in pregnant diabetic patients.

Impact of oral diseases on systemic health in the elderly: diabetes mellitus and aspiration pneumonia

Evidence is increasing that oral health has important impacts on systemic health. This paper presents data from the third National Health and Nutrition Examination Survey (NHANES III) describing the prevalence of dental caries and periodontal diseases in the older adult population. It then evaluates published reports and presents data from clinical and epidemiologic studies on relationships among oral health status, chronic oral infections (of which caries and periodontitis predominate), and certain systemic diseases, specifically focusing on type 2 diabetes and aspiration pneumonia. Both of these diseases increase in occurrence and impact in older age groups. The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults. Our review found clinical and epidemiologic evidence to support considering periodontal infection a risk factor for poor glycemic control in type 2 diabetes; however, there is limited representation of older adults in reports of this relationship. For aspiration pneumonia, several lines of evidence support oral health status as an important etiologic factor. Additional clinical studies designed specifically to evaluate the effects of treating periodontal infection on glycemic control and improving oral health status in reducing the risk of aspiration pneumonia are warranted. Although further establishing causal relationships among a set of increasingly more frequently demonstrated associations is indicated, there is evidence to support recommending oral care regimens in protocols for managing type 2 diabetes and preventing aspiration pneumonia.

Clinical and radiological improvement of periodontal disease in patients with type 2 diabetes mellitus treated with alendronate: a randomized, placebo-controlled trial

BACKGROUND

Alendronate (ALN) is an aminobisphosphonate commonly used for osteoporosis in postmenopausal women. We studied the effect of ALN on bone loss prevention in type 2 diabetes mellitus patients with periodontal disease.

METHODS

In a controlled double-blind, randomized study we evaluated prospectively diabetic patients paired by gender and years since diagnosis for 6 months. The study included 40 patients (20 men and 20 women), 50 to 60 years old, with more than 5 years since diagnosis of diabetes and established periodontitis. They were randomly allocated to alendronate (10 mg/daily) or placebo treatment for 6 months. The endpoints of treatment were: the distance between the alveolar bone border and the cemento-enamel-junction (CEJ) evaluated by means of digital radiographic imaging, a biochemical marker of bone resorption (urine N-telopeptide) (Ntx), and periodontal parameters. Metabolic control was assessed at baseline and after 6 months.

RESULTS

Baseline and 6-month glycated hemoglobin levels were similar in both groups. Alendronate induced a significant decrease in NTx at 6 months (P = 0.006). Periodontal parameters improved in both groups. However, they were significantly better for the ALN treated group. Alveolar bone border-CEJ distance increased in the placebo, but decreased in the ALN group (P = 0.0003).

CONCLUSIONS

In type-2 diabetic patients, alendronate induced more improvement in alveolar bone crest height than control therapy. No differences in urinary N-telopeptide or glycated hemoglobin were observed in this short-term randomized controlled pilot trial.

Focus on primary care: periodontal disease: implications for women's health

A definite relationship is emerging between periodontal infections and systemic conditions. The objective of this review is to address this relationship as it pertains to cardiovascular disease and diabetes mellitus. Furthermore, because recent reports link the presence of periodontal disease to preterm delivery, the possible relationship between the development and progression of periodontal disease and certain hormonal states in women such as puberty, oral contraceptive use, menopause, and pregnancy will also be discussed. Although the current literature suggests a strong association between periodontal disease and a number of the discussed systemic conditions, causality can only be established with prospective studies. Intervention studies are needed to address how treatment effects the incidence and/or severity of periodontal disease-related systemic illness.

Relationship of blood glucose level to community periodontal index of treatment needs and body mass index in a permanent Israeli military population

BACKGROUND

The goal of this study was to find a possible link between blood glucose levels and periodontal disease.

METHODS

In a prospective study the dental health of 10,590 military service men and women was examined. The relationships of periodontal condition, expressed as CPITN index, and blood glucose levels were tested. The effect of gender, body mass index (BMI), and smoking was also evaluated.

RESULTS

Blood glucose levels were significantly and positively associated with severe periodontal disease, men, and higher BMI. Smoking did not affect blood glucose levels.

CONCLUSIONS

Blood glucose levels might be associated with severe periodontal disease.

Metabolic diseases and their possible link to risk indicators of periodontitis

BACKGROUND

During the last few years, risk assessment has become one of the main topics of periodontal research. Therefore, the aim of this study was to determine whether a predisposition to metabolic disorders such as diabetes mellitus (in the absence of diagnosed diabetic disease) or hyperlipidemia may be risk indicators for periodontitis.

METHODS

One hundred patients ranging in age from 40 to 70 years were examined. The patients were classified as having impaired glucose tolerance (IGT) but no manifest diabetes (56 patients), hyperlipidemia (17 patients, HL), or normal metabolic status (27 control patients). Probing depth (PD), attachment level (AL), plaque index (PI), and gingival bleeding on probing (BOP) were recorded. Serum antibody titers (SAT) to A. actinomycetemcomitans (A.a.), P. intermedia (P.i.), and P. gingivalis (P.g.) were determined by enzyme-linked immunosorbent assay (ELISA). Pooled subgingival plaque samples were analyzed using indirect immunofluorescence to detect the same organisms. In addition, respiratory burst activity of peripheral polymorphonuclear leukocytes (PMN) was evaluated by chemiluminescence (CL).

RESULTS

No significant differences were observed between the IGT group and normal controls in the following parameters: 1) percentage of sites exhibiting BOP; 2) mean PI; 3) mean PD and AL; 4) percentage of periodontal microorganisms; and 5) increased SAT. The IGT probands exhibited a significantly higher mean serum level of triglycerides, as well as higher formyl-methionyl-leucyl-phenylalanine (FMLP)-stimulated PMN chemiluminescence than the control group. Patients with hyperlipidemia (HL) showed a significantly higher number of sextants with increased PD (73.4%) than the control group (50.6%). Similar results were obtained when comparing the percentage of all sites with increased PD (HL = 16.7%, control 12.3%). The mean FMLP-stimulated CL in patients with hyperlipidemia was significantly higher than the control group. When looking at all patients, there was a small but statistically significant correlation between PD and lipid levels. In addition, a significant correlation was observed between lipid serum levels and the FMLP-stimulated chemiluminescence.

CONCLUSIONS

These findings suggest that abnormal glucose tolerance, which is a predisposing factor for diabetes mellitus, does not appear to be a risk indicator for periodontal disease. On the other hand, impaired lipid metabolism does seem to be a risk indicator for periodontitis.

Diabetes and periodontal diseases. Committee on Research, Science and Therapy. American Academy of Periodontology

This position paper on diabetes mellitus was prepared by the Research, Science and Therapy Committee of The American Academy of Periodontology. It is intended to: 1) update members of the dental profession on the diagnosis and medical management of patients with diabetes mellitus; 2) summarize current knowledge on the relation between diabetes mellitus and periodontal diseases; 3) provide an overview of factors in diabetic patients relevant to understanding the pathogenesis of periodontal diseases in these subjects; 4) outline special considerations associated with treatment of periodontal diseases in diabetic patients; and 5) discuss possible approaches to the management of diabetic emergencies in the dental office.