Type 1 Diabetes and Periodontal Health

Association between Type 1 Diabetes Mellitus and Periodontal Diseases

Gingivitis and periodontitis are chronic inflammatory diseases that affect the supporting tissues of the teeth. Although induced by the presence of bacterial biofilms, other factor, such as tobacco smoking, drugs, and various systemic diseases, are known to influence their pathogenesis. Diabetes mellitus and periodontal diseases correspond to inflammatory diseases that have pathogenic mechanisms in common, with the involvement of pro-inflammatory mediators. A bidirectional relationship between type 2 diabetes and periodontitis has been documented in several studies. Significantly less studies have focused on the association between periodontal disease and type 1 diabetes. The aim of the study is to analyze the association between periodontal status and type 1 diabetes mellitus. The "Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines" was used and registered at PROSPERO. The search strategy included electronic databases from 2012 to 2021 and was performed by two independent reviewers. According to our results, we found one article about the risk of periodontal diseases in type 1 diabetes mellitus subjects; four about glycemic control; two about oral hygiene; and eight about pro-inflammatory cytokines. Most of the studies confirm the association between type 1 diabetes mellitus and periodontal diseases. The prevalence and severity of PD was higher in DM1 patients when compared to healthy subjects.

NEUTROPHIL ACTIVITIES IN ADOLESCENTS WITH TYPE I DIABETES MELLITUS DEPENDING ON PERIODONTAL STATE

OBJECTIVE

The aim: To estimate the neutrophil activities in adolescents with type 1 diabetes mellitus (T1DM) depending on periodontal state.

PATIENTS AND METHODS

Materials and methods: A total of 93 individuals aged 12-16 years, including 62 T1DM patients and 31 healthy (H) controls, were included. Both groups were categorized into subgroups depending on their periodontal state. Phagocytic activity of neutrophils (PAN) the index of neutrophil activation (INA), and the percent of formazan-active neutrophils were evaluated using the spontaneous and the induced nitroblue tetrazolium (sNBT and iNBT) tests into oral rinses.

RESULTS

Results: PAN was significantly higher in the healthy (H) controls with gingivitis compared with the individuals with gingival health (p < 0.0001). This parameter decreased significantly in the T1DM subjects, especially with periodontitis, compared with the H controls (p < 0.0001). The percent of formazan-active neutrophils and INA in the sNBT test increased in the T1DM patients with gingival health and continued to raise as periodontal state of adolescents with T1DM worsened (p<0.0001). The parameters of the iNBT test in the T1DM adolescents decreased with the periodontal disease development (p < 0.0001) that may demonstrate that superoxide production exhausts in diabetes, especially associated with periodontal disease.

CONCLUSION

Conclusions: The sNBT test in studied adolescents showed that both periodontal disease and T1DM increase the rate of activated neutrophils (p<0,05).

Influence of Chlorhexidine and Cetylpyridine on Periodontal Status and Indicators of Oxidative Stress in Patients with Type 1 Diabetes

Objective: One of the treatment goals in type 1 diabetes and periodontitis is to address chronic inflammation to prevent the development of neurovascular complications. The aim of this study was to assess the local anti-inflammatory effects of chlorhexidine digluconate and cetylpyridine chloride on periodontal status and indicators of oxidative stress in saliva in patients with type 1 diabetes. Materials and Methods: A total of 42 subjects aged 27 (interquartile range, IQR 22–35) years, with type 1 diabetes for a duration of 12 (IQR 9–18) years, and glycated hemoglobin 8.05 (IQR 7.1–9.4)% were included. Patients were examined twice—initially, and after 14 days of using toothpaste with chlorhexidine and cetylpyridine. Clinical examination of gingival tissues was performed. Certain oxidative stress markers (TP, TEAC, TBARS, AOPP) were measured in the saliva samples. Results: There were significant changes in clinical indicators of periodontal status before and after the application of the toothpaste (API before 0.35 (0.24–0.65) vs. API after 0.265 (0.18–0.39), p = 0.03; SBI before 0.07 (0.04–0.15) vs. SBI after 0.035 (0-0.06), p = 0.002; GI before 0.88 (0.46–1) vs. GI after 0.67 (0.25–1), p = 0.0008). The concentration of saliva TBARS decreased (p = 0.00005) and TEAC increased (p = 0.09). Conclusion: Proper oral hygiene supported by antibacterial chemicals may improve the periodontal status and reduce inflammation.

Interdisciplinary Approach for Oral Rehabilitation in a Young Type 1 Diabetes Patient

Introduction. The most frequent oral complications of diabetes are periodontal disease and caries. If left untreated, these may lead to tooth loss, with a significant psychological impact, especially in young patients. Case report. This case report presents a type 1 diabetes young female patient with periodontal disease, poor decay control and tooth loss, that create functional and esthetic issues. After consulting the diabetes specialist, an interdisciplinary dental treatment plan which comprise surgical, periodontal, endodontic and prosthetic rehabilitation was initiated. Long-term provisional computer-aided design and computer-aided manufacturing (CAD-CAM) fixed partial dentures were fabricated to stabilize the occlusion and to obtain in short term an optimal functional and esthetic rehabilitation. Conclusion. This case reveals a consistent collaboration between the prosthodontist, periodontist and endodontist, with an effective monitoring from the diabetes specialist, that conduct to a successful oral rehabilitation for a young female patient with type I diabetes.