The oxygen utilization and glucose oxidation rate of gingival tissue from non-diabetic and diabetic patients

Assessment of the hemodynamic profile in periodontal tissues of diabetic subjects with periodontitis by optical spectroscopy

BACKGROUND AND OBJECTIVE

The influence of diabetes mellitus (DM) on the hemodynamics of periodontal tissues has not been assessed previously. The primary objective of this study was to validate optical spectroscopy as a periodontal diagnostic tool for subjects with type 2 DM and chronic periodontitis.

MATERIAL AND METHODS

Using a portable optical near-infrared spectrometer, optical spectra were obtained from healthy (n = 127), gingivitis (n = 115), and periodontitis (n = 109) sites of 65 subjects with type 2 DM and chronic periodontitis. Healthy (n = 65) sites of 15 nondiabetic subjects without periodontitis were used as controls. A modified Beer-Lambert unmixing model that incorporates a nonparametric scattering-loss function was used to determine the relative contribution of deoxygenated hemoglobin and oxygenated hemoglobin (HbO2 ) to the overall spectrum. The balance between tissue oxygen delivery and oxygen utilization in periodontal tissues was assessed.

RESULTS

In diabetic subjects, tissue oxygen saturation and HbO2 concentration were significantly decreased in the periodontitis sites (p < 0.01) compared with the healthy and gingivitis sites. Furthermore, tissue oxygenation in healthy sites of control subjects was significantly higher than that in sites of diabetic subjects (p < 0.01).

CONCLUSION

In summary, the results of this study suggest that optical spectroscopy can monitor the hemodynamic profile in diabetic subjects with chronic periodontitis. Furthermore, healthy sites of diabetic subjects presented lower tissue oxygenation than did those of nondiabetic subjects.

Diabetes and periodontal disease

Diabetes mellitus is a systemic disease characterized by increased blood glucose levels and abnormalities of lipid metabolism due to absence or decreased level of insulin. It affects all the body organs and their functions either directly or indirectly. Every dentist should have a basic understanding of the etiopathogenesis, oral and systemic manifestations of this disease. The periodontal diseases are a consequence of extension of the gingival inflammation into the underlying supporting structures of the periodontium, initiated by the presence of plaque and its products on the surfaces of the teeth and the adjoining structures. The progression of periodontal disease is influenced by variety of factors like microorganisms, host response, systemic background, and genetic makeup of the host. Amongst them, diabetes mellitus tops the list. Diabetes and periodontitis influence the clinical outcome of each other and control of both influences the clinical improvement of each.

Some suspected periodontopathogens and serum antibody response in adult long-duration insulin-dependent diabetics

The subgingival microflora and serum antibody response were examined in long-duration insulin-dependent diabetics and age- and sex-matched non-diabetics. The material consisted of 9 diabetics aged 40-49 years and 19 aged 50-59 years, 13 non-diabetics aged 40-49 years and 21 aged 50-59 years. The bacterial species studied (Actinobacillus actinomycetemcomitans, Campylobacter rectus, Capnocytophaga spp, Eikenella corrodens, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia) were recovered in diabetics as well as in non-diabetics. Significantly more diabetics in both age groups harboured P. gingivalis compared to non-diabetics. Prevalence of P. gingivalis was associated with deepened periodontal pockets among non-diabetics but not among diabetics. In diabetics and non-diabetics, the serum antibody titres for most antigens were similar.

Diabetes--a risk factor for periodontitis in adults?

With the increasing number of diabetics in an aging population and controversial research reports on the relationship of diabetes to periodontitis, clarification of diabetes as a risk factor for periodontitis would be helpful. This review notes variations in type, metabolic control, and duration of diabetes and highlights the results of studies that have considered these variations. Diabetics who maintained reasonably good metabolic control had not lost more teeth or experienced more periodontal attachment loss than non-diabetics, although they had more periodontal pockets. Poorly-controlled diabetics with extensive calculus on their teeth had more periodontitis and tooth loss than well-controlled diabetics or non-diabetics. Long-duration diabetics were also at greater risk for periodontitis. Mechanisms by which diabetes may contribute to periodontitis include vascular changes, neutrophil dysfunction, altered collagen synthesis, and genetic predisposition. Minimizing plaque and calculus in the oral cavity through careful self-care and regular professional care is important to reduce the risk of periodontitis in diabetics.

Microbiological and immunological studies of adult periodontitis in patients with noninsulin-dependent diabetes mellitus

The subgingival microflora and serum antibody response was examined in periodontitis patients with noninsulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), and normal glucose tolerance (NGT). The predominant cultivable microflora was determined for subgingival plaque sampled from two deep periodontal pockets in each of eight adult periodontitis patients with NIDDM. Indirect immunofluorescence for Bacteroides intermedius, Bacteroides gingivalis, and Haemophilus actinomycetemcomitans was used to examine these same samples as well as 186 additional subgingival plaque samples from 47 patients with moderate to severe generalized periodontitis including 25 subjects with NIDDM, six subjects with IGT, and 16 subjects with NGT. Serum antibody levels to 13 microorganisms including seven oral bacterial species and one nonoral control species were measured by enzyme-linked immunosorbent assays (ELISA) in 377 subjects including 84 normal subjects without periodontal disease, 112 normal subjects with periodontitis, 19 periodontally normal subjects with IGT, 65 periodontitis patients with IGT, 15 periodontally normal subjects with NIDDM, and 82 periodontitis patients with NIDDM. Three hundred eighty-two bacterial isolates were recovered from the eight patients. B. intermedius was the most frequently isolated microorganism constituting 16% of the total isolates followed by Wolinella recta and B. gingivalis, which each accounted for 13% of the total. Streptococcus sanguis was the most prevalent microorganism, which was found in 75% of the sites. Subgingival plaque samples examined by immunofluorescence demonstrate a high prevalence of black-pigmented Bacteroides and suggest that the proportion of B. gingivalis but not B. intermedius is higher in NIDDM with periodontitis than in other groups.(ABSTRACT TRUNCATED AT 250 WORDS)

The development of an altered gingival crevicular microflora in the alloxan-diabetic rat

The microflora of the rat gingival crevice were examined at various time intervals after inducing experimental diabetes. A variety of Gram-positive and Gram-negative cocci and short rods were isolated from the normal rat crevice. Within a week after alloxan administration, Leptotrichia buccalis was detected for the first time. Other features in the diabetic animals included an increased frequency of isolation of Proteus spp., Lactobacillus spp. and decrease of Escherichia coli. Occasionally, a decrease was also observed in Bacteroides spp. and Streptococcus spp. No difference was observed between diabetic and non-diabetic animals in the isolation of Selonomonas, Campylobacter, Bifidobacterium and Actinomyces. Plaque accumulation was markedly increased in the diabetic rats. It was concluded that the change in gingival microflora resulted from diabetes-induced alterations in the sulcular environment (such as increased substrate levels, e.g. glucose and urea, and decreased oxygen) and that the microbiological changes preceded the depending of the periodontal pocket.