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Santonocito S, Polizzi A, Marchetti E, Dalessandri D, Migliorati M, Lupi SM, Cicciù M, Isola G. Impact of Periodontitis on Glycemic Control and Metabolic Status in Diabetes Patients: Current Knowledge on Early Disease Markers and Therapeutic Perspectives. Mediators Inflamm 2022; 2022:4955277. [PMID: 35996409 PMCID: PMC9392618 DOI: 10.1155/2022/4955277] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Diabetes mellitus and periodontitis are two of the most common chronic diseases affecting the world's population, and they are intimately linked. For several years, in fact, it has been known that there is an interdependent relationship between the two diseases: Diabetes promotes the destruction of periodontal tissues, and periodontal disease negatively affects glycemic control. In relation to the control of dental plaque and oral dysbiosis responsible for periodontal disease, both nonsurgical and surgical therapy associated with proper home hygiene procedures have emerged as essential for good glycemic control. Moreover, several evidences suggest the essential role played by the control of periodontal disease in preventing the onset of the most common complications of diabetes: cardiovascular diseases, retinopathies, and other systemic diseases. The aim of this study is to update the current knowledge on the bi-univocal relationship between diabetes and periodontitis and the impact of therapy in the optimal management of these two disorders. From the information found in the literature, it has emerged that the correct treatment of periodontal disease in diabetic patients represents one of the main mechanisms and means currently established and valid to control periodontal disease and glucose metabolism and prevent the onset or development of diabetic complications.
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Affiliation(s)
- Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Enrico Marchetti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Domenico Dalessandri
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Migliorati
- Dental School, Department of Surgery, University of Genova, Italy
| | - Saturnino Marco Lupi
- Unit of Oral Surgery and Implantology, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Marco Cicciù
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy
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2
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Uğur Aydın Z, Koşumcu S, Ustaoğlu G, Bayrak S, Oruçoğlu H. Radiographic evaluation of the presence of pulp stone in aggressive periodontitis patients. ACTA ODONTOLOGICA TURCICA 2019. [DOI: 10.17214/gaziaot.427182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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3
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Romano F, Bongiovanni L, Bianco L, Di Scipio F, Yang Z, Sprio AE, Berta GN, Aimetti M. Biomarker levels in gingival crevicular fluid of generalized aggressive periodontitis patients after non-surgical periodontal treatment. Clin Oral Investig 2017; 22:1083-1092. [PMID: 28918557 DOI: 10.1007/s00784-017-2192-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to assess the effects of non-surgical periodontal treatment on gingival crevicular fluid (GCF) cytokines in patients with generalized aggressive periodontitis (GAgP), in relation to clinical parameters. MATERIALS AND METHODS Data were obtained from 16 GAgP patients and 15 periodontally healthy controls. Periodontal parameters and GCF biomarker levels were evaluated at baseline and repeated 3 and 6 months after treatment for GAgP subjects. Moderate and deep pocket sites were analyzed separately. The amount of interleukin (IL)-1β, IL-9, tumor necrosis factor (TNF)-α, platelet-derived growth factor (PDGF-bb), and vascular endothelial growth factor (VEGF) were measured using a highly specific and sensitive multiplex bead immunoassay. RESULTS At baseline, cytokine levels in the moderate and deep pocket sites of GAgP patients were higher than those of the healthy control sites. In GAgP group, periodontal treatment led to improvement in all examined clinical parameters and resulted in a statistically significant reduction in the total amounts of IL-1β, VEGF, and TNF-α, in comparison to baseline, already 3 months after therapy in both moderate and deep pocket sites and of PDGF-bb in deep sites (p < 0.01). At the concentration level, only IL-1β and VEGF were affected. CONCLUSION Non-surgical treatment of GAgP provided significant clinical benefits leading to a marked decrease in the GCF levels of some pro-inflammatory and pro-angiogenic cytokines, but not of IL-9 and PDGF-bb. CLINICAL RELEVANCE Although the periodontal therapy successfully decreased clinical signs of inflammation, the GCF levels of some inflammatory cytokines were still elevated.
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Affiliation(s)
- Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Via Nizza, 230 10126, Turin, Italy
| | - Loretta Bongiovanni
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Via Nizza, 230 10126, Turin, Italy
| | - Laura Bianco
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Via Nizza, 230 10126, Turin, Italy
| | - Federica Di Scipio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Zhiqian Yang
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Andrea Elio Sprio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Via Nizza, 230 10126, Turin, Italy.
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Sheibak N, Heidari Z, Mahmoudzadeh-Sagheb H. Quantitative Parameters of Interdental Gingiva in Chronic Periodontitis Patients with IFN-γ Gene Polymorphism. Prague Med Rep 2017; 118:37-48. [PMID: 28364573 DOI: 10.14712/23362936.2017.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Chronic periodontitis (CP), an infectious disease resulting in inflammation within the periodontal tissue, is the main cause of adult tooth loss. CP is a multi-factorial disorder and the interaction between multiple genetic and environmental factors results in the manifestation of this disease. Recent researches in periodontitis has focused on cytokine gene polymorphisms that play important role in periodontal inflammation, but few studies investigated histological change that occur during CP in the supporting tissue of teeth. The aims of this study were to investigate the association of IFN-γ +874 A/T polymorphisms and quantitative parameters of interdental gingiva in CP patients. The study samples were interdental gingiva biopsies from 60 individuals including 38 patients and 22 healthy subjects. After determination of IFN-γ +874 A/T gene polymorphism by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR), patients were divided in three subgroups: 10 AA, 18 AT and 10 TT. After slides preparation, quantitative parameters were estimated by Cavalieri's point-counting method. Statistical analyses were performed using Mann-Whitney and Kruskal-Wallis test to compare differences between groups. The volume density (Vv) of epithelium, connective tissue and its components were significantly different between the control and CP groups (P<0.05). Statistically significant differences in the Vv of collagenous and non-collagenous matrix of interdental gingiva between AA, AT and TT groups were found (P<0.05). Result of present study shows that IFN-γ +874 A/T is strongly associated with some quantitative parameters of connective tissue constituents of interdental papilla in CP patients.
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Affiliation(s)
- Nadia Sheibak
- Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zahra Heidari
- Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. .,Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Hamidreza Mahmoudzadeh-Sagheb
- Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.,Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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5
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Heidari Z, Mahmoudzadeh-Sagheb H, Hashemi M, Ansarimoghaddam S, Sheibak N. Estimation of volume density of interdental papilla components in patients with chronic periodontitis and interleukin-6 (-174G/C) gene polymorphisms. Dent Res J (Isfahan) 2016; 13:139-44. [PMID: 27076828 PMCID: PMC4810911 DOI: 10.4103/1735-3327.178199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The association between interleukin-6 (IL-6) (-174G/C) gene polymorphisms and level of tissue breakdown and periodontal disease progression is unknown. The present study investigated quantitative parameters of interdental papilla in chronic periodontitis (CP) patients with IL-6 (-174G/C) gene polymorphisms. Materials and Methods: Sixty gingival samples were studied. After determination of IL-6 (-174G/C) gene polymorphisms using a tetra-primer amplification refractory mutation system-polymerase chain reaction (T-ARMS-PCR) technique, 45 gingival tissue samples of CP patients (GG and GC+CC genotypes) were considered as case groups. Fifteen control samples were also collected from healthy individuals. After tissue processing, interdental gingival tissues were exhaustively sectioned into 4 μm-thick sections. Ten to thirteen sections were sampled by systematic uniform random sampling and stained with Masson trichrome, and the volume density (Vv) of the gingival components was estimated using Cavalier's point counting method. Statistical analysis was performed by Student t-test to compare differences between groups. The significance level was set at P < 0.05. Results: There were statistically significant differences in the Vv of epithelium, connective tissue, collagenous and non-collagenous matrix, and blood vessels between the control and CP groups (P < 0.0001). There were no statistically significant differences in the Vv of epithelium, connective tissue of gingiva, collagenous and non-collagenous matrix, and blood vessels among GG, GC, and CC genotypes in CP patients (P > 0.05). Conclusion: Results of the current study showed that there was no association between IL-6 (-174G/C) gene polymorphisms and quantitative parameters of interdental papilla in CP patients.
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Affiliation(s)
- Zahra Heidari
- Research Center for Infectious Diseases and Tropical Medicine, Iran; Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamidreza Mahmoudzadeh-Sagheb
- Research Center for Infectious Diseases and Tropical Medicine, Iran; Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Hashemi
- Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences and Health Services, Zahedan, Iran
| | - Somayeh Ansarimoghaddam
- Department of Periodontology, School of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Nadia Sheibak
- Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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6
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Penmetsa GS, Baddam S, Manyam R, Dwarakanath CD. Comparison of the number of gingival blood vessels between type 2 diabetes mellitus and chronic periodontitis patients: An immunohistological study. J Indian Soc Periodontol 2015; 19:164-8. [PMID: 26015666 PMCID: PMC4439625 DOI: 10.4103/0972-124x.152105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 12/08/2014] [Indexed: 12/11/2022] Open
Abstract
Background: The relationship between diabetes and periodontitis has been studied for more than 50 years and is generally agreed that the periodontal disease is more prevalent in diabetic patients compared to nondiabetics. Vascular changes like increased thickness of basement membrane in small vessels has been reported in diabetic patients, but the quantity of blood vessels in gingiva of diabetic patients has not been discussed much. The aim of this study was to compare the number of blood vessels in gingiva between chronic periodontitis (CP) patients, CP with diabetes (type 2), and normal healthy gingiva. Materials and Methods: The study included 75 patients, divided into three groups of 25 patients each-Group I with healthy periodontium (HP), Group II with CP, and Group III with CP with diabetes mellitus (CPDM). Gingival biopsies were obtained from the subjects undergoing crown lengthening procedure for Group I, and in patients with CP and in CPDM biopsies were collected from teeth undergoing extraction. Sections were prepared for immune histochemical staining with CD34. Results: Difference was observed in the average number of blood vessels when compared between HP, CP, and CPDM groups. Statistical significant difference was observed when the HP and CP groups and HP and CPDM groups were compared. Conclusion: The results of the study indicated that the number of blood vessels in gingival connective tissue is significantly higher in CP and CPDM patients.
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Affiliation(s)
- Gautami Subhadra Penmetsa
- Department of Periodontics, Vishnu Dental College, Vishnupur, Bhimavaram, West Godavari, Andhra Pradesh, India
| | - Satyanarayana Baddam
- Department of Periodontics, Vishnu Dental College, Vishnupur, Bhimavaram, West Godavari, Andhra Pradesh, India
| | - Ravikanth Manyam
- Department of Oral Pathology, Vishnu Dental College, Vishnupur, Bhimavaram, West Godavari, Andhra Pradesh, India
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7
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Local and systemic immune responses in gingivitis and periodontitis. Open Med (Wars) 2014. [DOI: 10.2478/s11536-013-0328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
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8
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Heidari Z, Mahmoudzadeh-Sagheb H, Hashemi M, Rigi-Ladiz MA. Quantitative Analysis of Interdental Gingiva in Patients With Chronic Periodontitis and Transforming Growth Factor-β1 29C/T Gene Polymorphisms. J Periodontol 2014; 85:281-9. [DOI: 10.1902/jop.2013.130087] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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9
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Kasprzak A, Surdacka A, Tomczak M, Konkol M. Role of high endothelial postcapillary venules and selected adhesion molecules in periodontal diseases: a review. J Periodontal Res 2012; 48:1-21. [PMID: 22582923 DOI: 10.1111/j.1600-0765.2012.01492.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Periodontitis is accompanied by the proliferation of small blood vessels in the gingival lamina propria. Specialized postcapillary venules, termed periodontal high endothelial-like venules, are also present, and demonstrate morphological and functional traits similar to those of high endothelial venules (HEVs) in lymphatic organs. The suggested role of HEVs in the pathogenesis of chronic periodontitis involves participation in leukocyte transendothelial migration and therefore proinflammatory effects appear. Recent observations suggest that chronic periodontitis is an independent risk factor for systemic vascular disease and may result in stimulation of the synthesis of acute phase protein by cytokines released by periodontal high endothelial cells (HECs). However, tissue expression of HEV-linked adhesion molecules has not been evaluated in the gingiva of patients with chronic periodontitis. This is significant in relation to potential therapy targeting expression of the adhesion molecules. In this review, current knowledge of HEV structure and the related expression of four surface adhesion molecules of HECs [CD34, platelet endothelial cell adhesion molecule 1, endoglin and intercellular adhesion molecule 1 (ICAM-1)], involved in the key steps of the adhesion cascade in periodontal diseases, are discussed. Most studies on the expression of adhesion molecules in the development and progression of periodontal diseases pertain to ICAM-1 (CD54). Studies by the authors demonstrated quantitatively similar expression of three of four selected surface markers in gingival HEVs of patients with chronic periodontitis and in HEVs of reactive lymph nodes, confirming morphological and functional similarity of HEVs in pathologically altered tissues with those in lymphoid tissues.
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Affiliation(s)
- A Kasprzak
- Department of Histology and Embryology, Poznan University of Medical Sciences, Poznań, Poland.
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10
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Roy S, Trudeau K, Roy S, Behl Y, Dhar S, Chronopoulos A. New Insights into Hyperglycemia-induced Molecular Changes in Microvascular Cells. J Dent Res 2009; 89:116-27. [DOI: 10.1177/0022034509355765] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Hyperglycemia is the most prevalent characteristic of diabetes and plays a central role in mediating adverse effects on vascular cells during the progression of diabetic vascular complications. In diabetic microangiopathy, hyperglycemia induces biochemical and molecular changes in microvascular cells that ultimately progress to retinal, renal, and neural complications and extends to other complications, including advanced periodontal disease. In this review, we describe changes involving basement membrane thickening, tissue remodeling, gap junctions, inflammation, cytokines, and transcription factors, and their effects on the pathogenesis of diabetic microvascular complications. The majority of the changes described relate to retinal microangiopathy, since ultrastructural, structural, and biochemical alterations have been well-characterized in this tissue.
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Affiliation(s)
- S. Roy
- Departments of Medicine and Ophthalmology, Boston University School of Medicine, and
- Department of Periodontology and Oral Biology, Boston University School of Dental Medicine, Boston University, 650 Albany Street, Boston, MA 02118, USA
| | - K. Trudeau
- Departments of Medicine and Ophthalmology, Boston University School of Medicine, and
- Department of Periodontology and Oral Biology, Boston University School of Dental Medicine, Boston University, 650 Albany Street, Boston, MA 02118, USA
| | - S. Roy
- Departments of Medicine and Ophthalmology, Boston University School of Medicine, and
- Department of Periodontology and Oral Biology, Boston University School of Dental Medicine, Boston University, 650 Albany Street, Boston, MA 02118, USA
| | - Y. Behl
- Departments of Medicine and Ophthalmology, Boston University School of Medicine, and
- Department of Periodontology and Oral Biology, Boston University School of Dental Medicine, Boston University, 650 Albany Street, Boston, MA 02118, USA
| | - S. Dhar
- Departments of Medicine and Ophthalmology, Boston University School of Medicine, and
- Department of Periodontology and Oral Biology, Boston University School of Dental Medicine, Boston University, 650 Albany Street, Boston, MA 02118, USA
| | - A. Chronopoulos
- Departments of Medicine and Ophthalmology, Boston University School of Medicine, and
- Department of Periodontology and Oral Biology, Boston University School of Dental Medicine, Boston University, 650 Albany Street, Boston, MA 02118, USA
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11
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Aspriello SD, Zizzi A, Lucarini G, Rubini C, Faloia E, Boscaro M, Tirabassi G, Piemontese M. Vascular Endothelial Growth Factor and Microvessel Density in Periodontitis Patients With and Without Diabetes. J Periodontol 2009; 80:1783-9. [DOI: 10.1902/jop.2009.090239] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Sakallioğlu EE, Aliyev E, Lütfioğlu M, Yavuz U, Açikgöz G. Vascular endothelial growth factor (VEGF) levels of gingiva and gingival crevicular fluid in diabetic and systemically healthy periodontitis patients. Clin Oral Investig 2007; 11:115-20. [PMID: 17279364 DOI: 10.1007/s00784-006-0097-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 12/29/2006] [Indexed: 10/23/2022]
Abstract
It has been demonstrated that diabetes mellitus (DM) may have an inductive effect on the vascular endothelial growth factor (VEGF) levels of periodontium during periodontal disease. The aim of this study is to confirm this phenomenon, investigating whether it is also valid for diabetic periodontitis patients under good metabolic control. Sixteen type II DM patients, all with a glycosylated hemoglobin (HbA1c) value less than 7 (test), and 15 systemically healthy (control) chronic periodontitis patients were included in the study. The VEGF concentrations in the gingival supernatants and gingival crevicular fluid (GCF) samples of the study groups were measured by enzyme-linked immunosorbent assay. The data were analyzed by Student's t test in statistical means. The VEGF levels were significantly higher in the gingival supernatants of the test group (55.89 +/- 8.11 pg/ml) than that of the control group (24.81 +/- 2.04 pg/ml; p < 0.01). However, there was no statistically significant difference in the VEGF levels of GCF between the study groups (38.96 +/- 4.89 pg/ml in the test and 32.20 +/- 4.02 pg/ml in the control group; p > 0.05). Our study confirms that DM affects the VEGF levels of periodontal soft tissues in periodontal disease, and our results also suggest that this effect may not be influenced by the metabolic control of DM.
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Affiliation(s)
- Elif Eser Sakallioğlu
- Department of Periodontology, Faculty of Dentistry, Ondokuz Mayis University, Kurupelit, Samsun 55139, Turkey.
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13
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Abstract
Dental caries is the result of microbial activities that induce the progressive localised destruction of teeth. Without treatment, this eventually results in infection of the dental pulp and surrounding periapical tissues. Although the bacteria responsible for caries initiation and early caries progression have been extensively studied, the microbiology of dentine caries reportedly shows considerable diversity and the associated microflora has not yet been fully identified. A search of the literature shows that few studies have analysed the microbiology of deep caries or examined the relationship between this microflora and the histopathology of chronic pulpitis in symptomatic teeth. The majority of the studies investigating the microbiology of carious dentine have used traditional culture methodology that has been reported to be fraught with difficulties and to underestimate the microbial populations. However, recent work using new technology in the form of Polymerase Chain Reaction (PCR) has shown potential by enhancing the identification and quantification of bacteria from complex environments. Application of this technology to carious dentine has identified an environment dominated by anaerobic organisms and containing significant numbers of Gram-negative bacteria that have been strongly implicated in endodontic infections subsequent to carious pulpitis. Examination of the histopathology of pulp sections from teeth extracted as a result of carious pulpitis showed pulpal reactions ranging from minimal inflammation to marked inflammatory infiltration of the pulp tissue. Of interest, were hard and soft tissue pathologic changes noted in the pulp tissues resulting from the combined effects of the carious microorganisms and the host tissue response. Improved knowledge of the microbial species associated with pulpitis could create the potential for development of diagnostic tools and restorative materials with appropriate antimicrobial properties.
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Affiliation(s)
- F Elizabeth Martin
- Faculty of Dentistry, University of Sydney, Westmead Centre for Oral Health, Westmead Hospital, Wentworthville, NSW, 2145, Australia.
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Zoellner H, Chapple CC, Hunter N. Microvasculature in gingivitis and chronic periodontitis: disruption of vascular networks with protracted inflammation. Microsc Res Tech 2002; 56:15-31. [PMID: 11810703 DOI: 10.1002/jemt.10009] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Gingivitis occurring when bacterial plaque accumulates in the gingival crevice provides a convenient and interesting model for chronic inflammation in humans. In some patients, gingivitis progresses to the destructive lesion of periodontitis, involving the formation of periodontal pockets. The basis for pocket formation and progression is not as yet clear, although neutrophilic polymorphonuclear leukocytes (PMN) appear to play a protective role. Vascular changes appear to either facilitate or inhibit PMN function with the effect of either protecting from, or stimulating, periodontitis. Contrary to most circumstances, high endothelial cells in periodontitis are involved with PMN rather than lymphocyte emigration. Expansion of the microvasculature through increased vascular diameter and tortuosity as well as the development of high endothelial cells appears to protect from periodontitis by increasing the supply of both plasma defense factors and PMN to the tissues. Vascular changes that may oppose this and promote periodontitis are the formation of perivascular hyaline material and accumulation of basement membrane rests. The inadequate tissue turnover that accumulation of these vascular products represents can be argued as a vascular response to a chronic inflammation that has failed to eliminate the irritant. It is suggested that these vascular changes may account for the highly localized and burst-like pattern of pocket formation in periodontitis. Finally, it is possible that the recent observation that periodontitis is an independent risk factor for systemic vascular disease may reflect stimulation of acute phase protein synthesis by cytokines released by periodontal high endothelial cells.
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Affiliation(s)
- Hans Zoellner
- Department of Oral Medicine and Oral Pathology, University of Sydney, Westmead Hospital Dental Clinical School, Westmead Hospital, Sydney, NSW 2145, Australia.
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15
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Ye P, Chapple CC, Kumar RK, Hunter N. Expression patterns of E-cadherin, involucrin, and connexin gap junction proteins in the lining epithelia of inflamed gingiva. J Pathol 2000; 192:58-66. [PMID: 10951401 DOI: 10.1002/1096-9896(2000)9999:9999<::aid-path673>3.0.co;2-t] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The structural integrity and functional differentiation of the lining epithelium were studied in relation to inflammatory changes associated with destructive periodontitis. In the different regions of lining epithelia from clinically healthy gingiva and periodontitis, comparisons were made of the expression patterns of E-cadherin, which is critical in intercellular adhesion; of proteins associated with gap junction communication channels; and of involucrin, which is a key marker of differentiation in stratified epithelia. Filamentous actin (F-actin), which is important in cell structural integrity, attachment, and migration, was also examined. Semiquantitative immunohistochemical analysis revealed that in both clinically healthy gingiva and lesions of advanced periodontitis, expression patterns of E-cadherin, involucrin, and connexins 26 and 43 were similar, with a statistically significant reduction in staining intensity from the external oral epithelium, through the gingival sulcus, to the junctional epithelium or pocket epithelium, respectively. Furthermore, there was a striking reduction in staining for E-cadherin, involucrin, and both connexins in the pathological lining epithelium of the periodontal pocket. These changes were associated with marked alterations of filamentous actin expression, collectively indicating profound perturbation of the epithelial structure. The data reported support the concept that the ability of the pathological lining epithelium to function as an effective barrier against the ingress of microbial products into the tissues is severely compromised.
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Affiliation(s)
- P Ye
- Institute of Dental Research, United Dental Hospital, Sydney, NSW, Australia
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16
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Abstract
Macrophage populations in 22 biopsies of untreated advanced periodontitis were compared with those in 26 biopsies of clinically healthy (minimally inflamed) gingival tissue. The immunohistochemical investigation used high specificity monoclonal antibodies, including a pan-macrophage marker and probes for acute inflammatory, resident histiocytic, and reparative phenotypes. Macrophage expression of the functional activation markers MHC class II, basic fibroblast growth factor (bFGF), acid phosphatase (AP), and tartrate-resistant acid phosphatase (TRAP) was also examined. The study showed that advanced periodontitis and minimally inflamed tissues displayed similar distribution patterns and numbers for the macrophage phenotypic markers: there were, however, regionally-specific differences in the populations. In the advanced periodontitis lesion, there was little evidence of macrophage activation for the expression of HLA-DR, bFGF, and TRAP, although strong expression of HLA-DR and bFGF was observed in association with blood vessels. Macrophages expressing AP showed a distinct regional distribution; this, however, was not associated with foci of degenerate plasma cells. The apparent failure of recruitment and activation of macrophages may in part be both a cause and a consequence of the pathological features of this disease.
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Affiliation(s)
- C C Chapple
- Institute of Dental Research, Surry Hills, NSW, Australia.
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