Periodontal disease, oral microbial flora and salivary antibacterial factors in diabetes mellitus type 1 patients

Interaction of Oral and Toothbrush Microbiota Affects Oral Cavity Health

Tooth brushing is necessary to maintain oral health. Little research has been carried out to explore microbial diversity in toothbrushes and to study the potential impact of these bacteria on human health. In the present study, 20 participants were enrolled, and the microbial diversity in their oral cavity and toothbrushes was investigated using high-throughput sequencing. Our results indicate that 1,136 and 976 operational taxonomic units (OTUs) were obtained from groups CB (samples from toothbrushes of participants using traditional Chinese medicinal toothpaste) and AB (samples from toothbrushes of those using antibacterial toothpaste), respectively. The pathogens Acinetobacter baumannii, Staphylococcus aureus, and Candida albicans were identified on toothbrushes. The presence of these pathogens increases the chance for the host to get infectious diseases, neurodegenerative diseases, cardiovascular diseases, and cancers. Moreover, our in vitro results indicate that traditional Chinese medicinal toothpaste and antibacterial toothpaste can not only inhibit the growth of pathogens but also markedly inhibit the growth of probiotics Lactobacillus salivarius and Streptococcus salivarius. Therefore, the inhibitory effect of toothpaste on probiotics, together with the existence of pathogens in toothbrushes, indicates a potential risk of tooth brushing for people in a sub-healthy state.

Clinical and microbial oral health status in children and adolescents with type 1 diabetes mellitus

OBJECTIVES

To study the oral health of young individuals with controlled and uncontrolled type 1 diabetes mellitus (T1DM) and compare the results with those for healthy counterparts.

MATERIALS AND METHODS

One-hundred and forty-four youngsters (6-15 years of age) were assigned, according to glycaemic control, to three study groups: (i) diabetic patients with poor glycaemic control [glycated haemoglobin (HbA1c ≥7.5%)] (n = 35); (ii) diabetic patients with good glycaemic control (HbA1c <7.5%) (n = 39); and (iii) healthy individuals (n = 70). Plaque, gingival inflammation, calculus and decayed, missing and filled surfaces (DMFS) indices were recorded. Salivary parameters were determined, and stimulated saliva was collected to allow detection and determination of the levels of oral Candida albicans and Streptococcus mutans by real-time polymerase chain reaction (PCR).

RESULTS

Significantly different amounts of plaque were found among the study groups (P = 0.024): youngsters with poor glycaemic control had significantly more plaque than youngsters in the other two groups. The gingival, calculus and DMFS indices were not significantly different among groups (P > 0.05). Candida albicans levels were not statistically significant different among groups, but the group with poor glycemic control showed an elevated frequency of detection. Streptococcus mutans was isolated from the oral cavity of 96 of the 144 individuals. A statistically significant difference in the level of S. mutans was found between the group with poor glycaemic control and the healthy control group (P = 0.032).

CONCLUSIONS

The results imply that youngsters with T1DM have a lower level of oral hygiene and are potentially at a higher risk of future oral disease, particularly when their metabolic disorder is uncontrolled. However, factors outside the oral cavity may also have a considerable impact on the initiation and progression of oral diseases.

A review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes

AIMS

To review the evidence for the molecular and cellular processes that may potentially link periodontal disease and diabetes. The pathogenic roles of cytokines and metabolic molecules (e.g. glucose, lipids) are explored and the role of periodontal bacteria is also addressed. Paradigms for bidirectional relationships between periodontitis and diabetes are discussed and opportunities for elaborating these models are considered.

METHODS

Database searches were performed using MeSH terms, keywords, and title words. Studies were evaluated and summarized in a narrative review.

RESULTS

Periodontal microbiota appears unaltered by diabetes and there is little evidence that it may influence glycaemic control. Small-scale clinical studies and experiments in animal models suggest that IL-1β, TNF-α, IL-6, OPG and RANKL may mediate periodontitis in diabetes. The AGE-RAGE axis is likely an important pathway of tissue destruction and impaired repair in diabetes-associated periodontitis. A role for locally activated pro-inflammatory factors in the periodontium, which subsequently impact on diabetes, remains speculative.

CONCLUSION

There is substantial information on potential mechanistic pathways which support a close association between diabetes and periodontitis, but there is a real need for longitudinal clinical studies using larger patient groups, integrated with studies of animal models and cells/tissues in vitro.

Periodontitis: oral complication of diabetes

Periodontitis is a common, chronic, inflammatory disease in which the supporting apparatus of the teeth is gradually destroyed, resulting in tooth mobility and tooth loss. Susceptibility to periodontitis is increased approximately three-fold in people with diabetes. Hyperglycemia leads to exacerbated tissue destruction and the clinical signs of periodontitis. There is evidence to support a two-way relationship between periodontitis and diabetes; not only does diabetes increase the risk for periodontitis, but periodontitis is associated with compromised glycemic control. Cooperation between health care teams would benefit the treatment of patients with diabetes and periodontitis.

Oropharyngeal flora in patients admitted to the medical intensive care unit: clinical factors and acid suppressive therapy

Acid suppression therapy in critically ill patients significantly reduces the incidence of stress ulceration and gastrointestinal (GI) bleeding; however, recent studies suggest that proton pump inhibitors (PPIs) increase the risk of pneumonia. We wanted to test the hypothesis that acid suppressive therapy promotes alteration in the bacterial flora in the GI tract and leads to colonization of the upper airway tract with pathogenic species, potentially forming the biological basis for the observed increased incidence of pneumonia in these patients. This was a prospective observational study on patients (adults 18 years or older) admitted to the medical intensive care unit (MICU) at a tertiary care centre. Exclusion criteria included all patients with a diagnosis of pneumonia at admission, with infection in the upper airway, or with a history of significant dysphagia. Oropharyngeal cultures were obtained on day 1 and days 3 or 4 of admission. We collected data on demographics, clinical information, and severity of the underlying disease using APACHE II scores. There were 110 patients enrolled in the study. The mean age was 49±16 years, 50 were women, and the mean APACHE II score was 9.8 ± 6.5. Twenty per cent of the patients had used a PPI in the month preceding admission. The first oropharyngeal specimen was available in 110 cases; a second specimen at 72-96 h was available in 68 cases. Seventy-five per cent of the patients admitted to the MICU had abnormal flora. In multivariate logistic regression, diabetes mellitus and PPI use were associated with abnormal oral flora on admission. Chronic renal failure and a higher body mass index reduced the frequency of abnormal oral flora on admission. Most critically ill patients admitted to our MICU have abnormal oral flora. Patients with diabetes and a history of recent PPI use are more likely to have abnormal oral flora on admission.

Skeletal maturation in obese patients

INTRODUCTION

The objective of this study was to compare skeletal maturation in obese patients and in subjects of normal weight to evaluate the best timing for orthopedic and orthodontic treatment. The null hypothesis was that obese and normal-weight patients show similar degrees of skeletal maturation.

METHODS

The sample for this retrospective study consisted of 50 white patients (28 boys, 22 girls) whose x-rays (hand-wrist and lateral cephalometric radiographs) were already available. The test group included 25 obese patients (11 girls, 14 boys; average age, 9.8 ± 2.11 years), and the control group included 25 subjects of normal weight (11 girls, 14 boys; average age, 9.9 ± 2.5 years). Skeletal maturation was determined by using the carpal analysis method and the cervical vertebral maturation method.

RESULTS

According to the carpal analysis, there was a significant difference between skeletal and chronologic ages between the test group (11.8 ± 11.4 months) and the control group (-2.9 ± 3.1 months). Furthermore, the obese subjects exhibited a significantly higher mean cervical vertebral maturation score (2.8 ± 0.7) than did the control subjects (2 ± 0.6) (P <0.05).

CONCLUSIONS

Compared with the normal-weight subjects, the obese subjects showed a higher mean discrepancy between skeletal and chronologic ages according to the carpal analysis and had a significantly higher cervical vertebral maturation score. Thus, to account for the growth in obese patients with skeletal discrepancies, it might be necessary to perform examinations and dentofacial and orthopedic treatments earlier than in normal-weight subjects.

Associations between periodontal disease and selected risk factors of early complications among youth with type 1 and type 2 diabetes: a pilot study

BACKGROUND

Most studies evaluating the relation between periodontal disease and diabetes in children have not considered diabetes type.

OBJECTIVE

To evaluate the relationship between periodontal damage and risk factors of diabetes complications among youth by diabetes type in a pilot study.

SUBJECTS

155 participants (126 with type 1 diabetes; 29 with type 2 diabetes) from the SEARCH for Diabetes in Youth study in South Carolina who were <20 yr of age at diagnosis.

METHODS

Cross-sectional analysis of periodontal damage (bone loss ≥3 mm on ≥1 permanent tooth site on pre-existing bitewing radiographs) and diabetes type assigned by the provider at diagnosis.

RESULTS

Periodontal damage was observed in 52 individuals (34%) overall, but was more common in type 2 (16/29, 55%) vs. type 1 diabetes (37/126, 29%). Among youth with type 2 diabetes, those with periodontal damage had lower fasting c-peptide (2.3 vs. 3.4 ng/mL, p-value=0.01), and higher triglyceride levels (171.8 vs. 87.2, p-value=0.01) than those without periodontal damage after adjustment for age, sex, race, education level, family income, duration of diabetes, diabetes control, time between study visit and date of radiograph, tooth brushing, and visits to the dentist. Blood pressure, waist circumference, LDL cholesterol and A1c were not associated with periodontal damage.

CONCLUSIONS

The associations between periodontal disease and risk factors for diabetes complications differ by diabetes type. Periodontal damage is associated with impaired beta cell function and metabolic syndrome components in type 2 but not type 1 diabetes. These findings need to be confirmed in larger, prospective studies.

Periodontal condition in diabetics in Belgrade

Background/Aim. Diabetes mellitus (DM) as a complex metabolic disease influences functioning of numerous organs. Therefore, frequent diabetic complication is chronic periodontitis. The aim of the study was to investigate the influence of various risk factors, like age, sex, duration of DM, oral hygiene, on oral manifestations of diabetes. Methods. The group of diabetics included 52 adult patients, 18-79-year of age, both sexes (33 females, 19 males) out of which 35 patients were with diabetes mellitus type I and 17 with type II. Mean age of the patients was 54.6 years and the mean duration of diabetes was 11.1 years. The controls consited of 67 volunteers from the city of Belgrade, 19-24-year of age, both sexes (47 females, 20 males) with no paradonthopathy and non-systemic diseases. Estimation of periodontal status of the patients was performed by measuring dental plaque index, gingival index and periodontal pockets' depth. Results. The results suggest an increased incidence and severity of periodontitis in diabetic patients. It was established that duration of diabetes, patients' age and bad oral hygiene had a negative influence on status of remained teeth in diabetics, while the sex had no influence on parameters monitored. Conclusion. Indices of oral hygiene level and periodontal status (dental plaque index, gingival index and periodontal pockets' depth) were significantly worsened in patients with diabetes. Negative influence on remained teeth had patients' age (>50 years), duration of diabetes (> 20 years) and bad oral hygiene. About half of the patients had a total or partial bridge suggesting that periodontitis is significant complication of diabetes mellitus.

Gingival condition of women with gestational diabetes on a Greek island

The purpose of this study was to investigate the condition of gingival tissues in women who had gestational diabetes mellitus. The study group consisted of 64 women with gestational diabetes and the control group of 88 healthy pregnant women. The plaque index and gingival index and their relationship to a series of variables (socio-demographic, diet, oral hygiene, oral condition) were evaluated. Clinical evaluations were carried out between 34 and 36 weeks of pregnancy. The women with gestational diabetes had a higher mean plaque index and higher mean gingival index than the healthy pregnant women (p = 0.048 and p = 0.029, respectively). Linear regression analysis showed an association between gingival index and plaque index (p < 0.001). Gestational diabetes was not significantly related to gingivitis when other factors that differed between the two groups were taken into account. The results of the study suggest that gingival inflammation seems to be more prevalent in women with gestational diabetes compared to healthy pregnant women, while the plaque accumulation remains the main cause of gingival inflammation.

Reduction in incidence of methicillin-resistant Staphylococcus aureus (MRSA) after radical surgery for head and neck cancer

This study investigated factors associated with the onset of methicillin-resistant Staphylococcus aureus (MRSA) infection among patients with head and neck cancer who underwent radical reconstructive surgery. The study group consisted of 103 patients who underwent radical reconstructive surgery between January 1994 to December 2002. They were divided into two groups with respect to the date of surgery: Group I (from January 1994 to December 1997) and Group II (from January 1998 to December 2002). The use of third-generation cephalosporins and imipenem as postoperative antibiotics was restricted after 1998 (Group II). A significantly lower incidence of MRSA was found in Group II than for Group I (p = 0.0069, chi2 test). The following factors were identified as being associated with the onset of MRSA infection: long surgical duration (p < 0.035, Wilcoxon signed-rank test), large hemorrhage (p < 0.049, Wilcoxon signed-rank test), and use of third-generation cephalosporins or imipenem (p < 0.004, chi2 test). MRSA infection was found more often in the surgically reconstructed tongue and floor of the mouth. The use of antibiotics such as vancomycin, wound irrigation, curettage and sequestrectomy were effective in eradicating the infection. MRSA, when it occurred in the maxilla, was mostly limited to colonization.