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Trullenque-Eriksson A, Tomasi C, Eeg-Olofsson K, Berglundh T, Petzold M, Derks J. Periodontitis in patients with diabetes and its association with diabetes-related complications. A register-based cohort study. BMJ Open 2024; 14:e087557. [PMID: 38964804 PMCID: PMC11227830 DOI: 10.1136/bmjopen-2024-087557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/14/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVE To evaluate the association between type 1 diabetes (T1D)/type 2 diabetes (T2D) and periodontitis and assess the influence of periodontitis on diabetes-related complications. DESIGN Observational study; longitudinal analysis of register data. SETTING Swedish primary care centres, hospitals and dental clinics reporting to nationwide healthcare registers (2010-2020). PARTICIPANTS 28 801 individuals with T1D (13 022 women; mean age 42 years) and 57 839 individuals without diabetes (non-T1D; 26 271 women; mean age 43 years). 251 645 individuals with T2D (110 627 women; mean age 61 years) and 539 805 individuals without diabetes (non-T2D; 235 533 women; mean age 60 years). Diabetes and non-diabetes groups were matched for age, gender and county of residence. MAIN OUTCOME MEASURES Prevalent periodontitis, diabetes-related complications (retinopathy, albuminuria, stroke and ischaemic heart disease) and mortality. RESULTS Periodontitis was more common among T2D (22%) than non-T2D (17%). Differences were larger in younger age groups (adjusted RR at age 30-39 years 1.92; 95% CI 1.81 to 2.03) and exacerbated by poor glycaemic control. Periodontitis prevalence was 13% in T1D and 11% in non-T1D; only the subgroup with poor glycaemic control was at higher risk for periodontitis. Periodontitis was associated with a higher incidence of retinopathy (T1D: HR 1.08, 95% CI 1.02 to 1.14; T2D: HR 1.08, 95% CI 1.06 to 1.10) and albuminuria (T1D: HR 1.14, 95% CI 1.06 to 1.23; T2D: HR 1.09, 95% CI 1.07 to 1.11). Periodontitis was not associated with a higher risk for stroke, cardiovascular disease or higher mortality in T1D/T2D. CONCLUSIONS The association between T2D and periodontitis was strong and exacerbated by poor glycaemic control. For T1D, the association to periodontitis was limited to subgroups with poor glycaemic control. Periodontitis contributed to an increased risk for retinopathy and albuminuria in T1D and T2D.
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Affiliation(s)
- Anna Trullenque-Eriksson
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lu L, Zhao D, Li C, Sun Y, Geng F, Zhang S, Li W, Wang S, Pan Y. The role of periodontitis in the development of atherosclerotic cardiovascular disease in participants with the components of metabolic syndrome: a systematic review and meta-analysis. Clin Oral Investig 2024; 28:339. [PMID: 38801482 DOI: 10.1007/s00784-024-05731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/18/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES Prevention of atherosclerotic cardiovascular disease (ASCVD) is important in individuals with metabolic syndrome components (MetS), and periodontitis may play an important role in this process. This study aims to evaluate the association between periodontitis and ASCVD in participants with the components of MetS, including obesity, dysglycemia, hypertension, and dyslipidemia. MATERIALS AND METHODS This study conducted followed the MOOSE reporting guidelines and the PRISMA 2020 guidelines. EMBASE, MEDLINE, Web of Science, Cochrane Library, PubMed and OpenGrey were searched for observational studies about the linkage of periodontitis to ASCVD in people with MetS components up to April 9, 2023. Cohort, case-control and cross-sectional studies were included after study selection. Quality evaluation was carried out using the original and modified Newcastle-Ottawa Scale as appropriate. Random-effects model was employed for meta-analysis. RESULTS Nineteen studies were finally included in the quality analysis, and all of them were assessed as moderate to high quality. Meta-analyses among fifteen studies revealed that the participants with periodontitis were more likely to develop ASCVD in those who have dysglycemia (RR = 1.25, 95% CI = 1.13-1.37; p < 0.05), obesity (RR = 1.13, 95% CI = 1.02-1.24; p < 0.05), dyslipidemia (RR = 1.36, 95% CI = 1.13-1.65; p < 0.05), or hypertension (1.20, 95% CI = 1.05-1.36; p < 0.05). CONCLUSIONS Periodontitis promotes the development of ASCVD in participants with one MetS component (obesity, dysglycemia, hypertension or dyslipidemia). CLINICAL RELEVANCE In people with MetS components, periodontitis may contribute to the ASCVD incidence.
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Affiliation(s)
- Lijie Lu
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Shenyang, China
- Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Dan Zhao
- Department of Implant Dentistry, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Chen Li
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Shenyang, China
- Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Yangyang Sun
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Shenyang, China
- Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Fengxue Geng
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Shenyang, China
- Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Shuwei Zhang
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Shenyang, China
- Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Weiqi Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Sichuan University, Chengdu, China
| | - Songlin Wang
- Salivary Gland Disease Center, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Laboratory of Oral Health and Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China.
| | - Yaping Pan
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Shenyang, China.
- Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China.
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Ansari Moghadam S, Abbaszade H, Sartipi M, Ansari Moghadam A. Evaluating the association between gingival crevicular blood glucose levels and finger capillary blood glucose levels according to periodontal status. Eur J Med Res 2024; 29:86. [PMID: 38291508 PMCID: PMC10826020 DOI: 10.1186/s40001-023-01611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/21/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the association between gingival crevicular blood glucose levels (GCBG) and finger capillary blood glucose levels (FCBG) according to the periodontal status of patients. MATERIALS AND METHODS In this case-control study, 80 patients were divided into 4 groups according to their periodontal status. In these patients, an area of the maxillary gingiva with the highest probing depth was selected for blood sampling. Blood glucose obtained from this area and the right fingertip was measured with a glucometer. Data were analyzed using ANOVA and Pearson correlation coefficient with a significance threshold of 0.05. RESULTS The groups studied were matched in regard to their sex and age (P > 0.05). The average FCBG and GCBG were not significantly different according to periodontal status (P > 0.05). The correlation between the FCBG and the GCBG showed a significant positive correlation in the total number of participants (P < 0.05, r = 0.531). CONCLUSION The study observed a positive association between GCBG and FCBG. However, the relationship with periodontal status appeared to be relatively weak. Further research may be needed to determine the potential efficacy of GCBG in diabetes screening during periodontal examinations. CLINICAL RELEVANCE Most patients with diabetes do not have proper periodontal health, so it may be helpful to screen for diabetes during periodontal examinations.
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Affiliation(s)
- Somaye Ansari Moghadam
- Department of Periodontology, Oral and Dental Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hanie Abbaszade
- Oral and Dental Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohadeseh Sartipi
- Sri Rajiv Gandhi College of Dental Science & Hospital, Rajiv Gandhi University of Health Sciences, Bangalore, India.
| | - Alireza Ansari Moghadam
- Department of Health, Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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4
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Upadhyaya JD, Mutalik VS. Oral Lesions Associated with Systemic Disease. Oral Maxillofac Surg Clin North Am 2023; 35:227-236. [PMID: 36805901 DOI: 10.1016/j.coms.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Oral manifestations may be the first sign of a systemic disease, or represent lesions associated with an established or recurrent disease. Oral health care providers are often the first to recognize these signs. Some lesions have characteristic features that allow for early detection and intervention. On the contrary, clinical manifestations may be diverse and require a comprehensive evaluation to establish a definitive diagnosis. This article reviews the oral manifestations of select systemic diseases to help clinicians develop a differential diagnosis that leads to early diagnosis and timely intervention.
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Affiliation(s)
- Jasbir D Upadhyaya
- Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, 2800 College Avenue, Building 285, Alton, IL 62002, USA.
| | - Vimi Sunil Mutalik
- Department of Dental Diagnostic and Surgical Sciences, University of Manitoba Dr. Gerald Niznick College of Dentistry, 780 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W2, Canada
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Böhme Kristensen C, Ide M, Forbes A, Asimakopoulou K. Psychologically informed oral health interventions in pregnancy and type 2 diabetes: a scoping review protocol. BMJ Open 2022; 12:e062591. [PMID: 36123100 PMCID: PMC9486353 DOI: 10.1136/bmjopen-2022-062591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Periodontal health is becoming a recognised component in managing gestational diabetes. Gestational diabetes is characterised as raised blood glucose levels first discovered in pregnancy and managed similarly to type 2 diabetes. Currently, the standard intervention for gestational diabetes in the UK entails dietary modifications and physical activity interventions. However, considering the literature discussed in this review, it is argued that oral health advice and support should also become an integrated part of gestational diabetes management. OBJECTIVE The objective of this scoping review is to map out psychologically informed oral health interventions in pregnancy and type 2 diabetes. This will inform the development of a new behavioural intervention to promote oral health-related behaviours in women with gestational diabetes. As no literature exists on oral health interventions in gestational diabetes, it was deemed appropriate to synthesise the evidence on oral health interventions designed for pregnant women and individuals with type 2 diabetes. METHODOLOGY The scoping review will be conducted using the Joanna Briggs Institute's methodology for scoping reviews. Studies including pregnant women and individuals with type 2 diabetes over 18 years of age will be included. Only studies including a psychologically informed oral health intervention will be considered. The authors will consider experimental and quasi-experimental research designs. The Ovid Interface including EMBASE, Medline, Global Health, APA PsychInfo, Health Management Information, Maternity, Infant Care Database and the Cochrane Library will be used as information sources. The planned searches will commence on the week of the 25 July 2022. Only articles in Danish and English will be considered. The study selection will follow the Preferred Reporting Items for Scoping Reviews process. The data will be presented using narrative synthesis. ETHICS AND DISSEMINATION No ethical approval is needed for this review. The results will be published in a relevant scientific journal.
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Affiliation(s)
| | - Mark Ide
- Centre for Host-Microbiome Interactions, King's College London, London, UK
| | - Angus Forbes
- Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Tuncer E, Darby I. Knowledge and attitudes towards periodontal health among Australians diagnosed with diabetes. Aust J Prim Health 2021; 27:509-513. [PMID: 34823646 DOI: 10.1071/py20311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/08/2021] [Indexed: 12/20/2022]
Abstract
Diabetes and periodontitis are two major diseases affecting the Australian population. Despite the established interrelationship between the diseases, the knowledge of people with diabetes about this interrelationship is limited. This study investigated the knowledge of individuals with diabetes towards periodontal health in Australia. Adults diagnosed with diabetes participated in a survey asking about demographics, medical history, symptoms in the oral cavity, oral hygiene, attendance at the dentist and their knowledge of the interactions between periodontal disease and diabetes. The survey was completed by 113 participants, most of whom thought their diabetes was well controlled. Over half reported bleeding on brushing and one-third reported swollen gums. More than half (53.6%) the respondents were unaware of any complications of diabetes associated with the oral cavity, especially periodontal disease. Most respondents did not talk to their dentist about diabetes (53.6%), yet most wanted to know more about the effects of diabetes on gum health (75.3%). These findings demonstrate that, in this survey, adult Australians diagnosed with diabetes have limited knowledge about how periodontal disease affects them. These individuals, who are at a higher risk of periodontal disease, need to be better informed of the established bidirectional relationship between diabetes and oral health by all health professionals.
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Affiliation(s)
- Eren Tuncer
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, Vic. 3053, Australia
| | - Ivan Darby
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, Vic. 3053, Australia; and Corresponding author.
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State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature. J Clin Med 2021; 10:5383. [PMID: 34830663 PMCID: PMC8618619 DOI: 10.3390/jcm10225383&set/a 912874875+940716348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.
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State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature. J Clin Med 2021. [DOI: 10.3390/jcm10225383
expr 893869204 + 932072443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.
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9
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González-Moles MÁ, Ramos-García P. State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature. J Clin Med 2021; 10:5383. [PMID: 34830663 PMCID: PMC8618619 DOI: 10.3390/jcm10225383] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 12/24/2022] Open
Abstract
Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.
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Affiliation(s)
- Miguel Ángel González-Moles
- School of Dentistry, University of Granada, 18010 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Pablo Ramos-García
- School of Dentistry, University of Granada, 18010 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
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10
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Zhang X, Wang M, Wang X, Qu H, Zhang R, Gu J, Wu Y, Ni T, Tang W, Li Q. Relationship between periodontitis and microangiopathy in type 2 diabetes mellitus: a meta-analysis. J Periodontal Res 2021; 56:1019-1027. [PMID: 34254680 DOI: 10.1111/jre.12916] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Whether periodontitis increases the risk of diabetic microangiopathy remains controversial. The present meta-analysis aims to investigate the relationship between periodontitis and diabetic microangiopathy in patients with type 2 diabetes mellitus. METHODS PubMed, EMBASE, Web of Science, the Cochrane Library, CNKI, and WanFang data were searched without language restrictions. The methodological quality of the studies included was assessed using Newcastle-Ottawa Scale method, and meta-analysis was performed by Review Manager 5.3. Odds ratio (OR) and 95% confidence interval (CI) were used to assess the risk of periodontitis for diabetic microangiopathy among patients with type 2 diabetes. RESULTS Thirteen cross-sectional studies, covering 10 570 participants, were included in the present meta-analysis. The results demonstrated that periodontitis was associated with increased risk of type 2 diabetic microangiopathy (OR: 2.43, 95% CI: 1.65-3.56), diabetic retinopathy (OR: 4.33, 95% CI: 2.19-8.55), and diabetic nephropathy (OR: 1.75, 95% CI: 1.07-2.85), while periodontitis was not associated with diabetic neuropathy (OR: 0.99, 95% CI: 0.19-5.12). Subgroup analysis among the studies in Asian (OR: 3.06, 95% CI: 1.94-4.84) and North American (OR: 1.42, 95% CI: 1.08-1.86) populations confirmed the existed association between periodontitis and type 2 diabetic microangiopathy. The relationship still existed in groups with sample size larger than 500 (OR: 1.77, 95% CI: 1.34-2.34) and smaller than 500 (OR: 3.33, 95% CI: 1.38-8.03). A sensitivity analysis confirmed the stability of the results by excluding moderate quality studies or removing articles one after the other. CONCLUSION Current evidences have proved that periodontitis is associated with increased risk of diabetic microangiopathy in patients with type 2 diabetes mellitus. This conclusion may provide useful evidence for correlated clinical researches. PROSPERO registration number CRD42021247773.
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Affiliation(s)
- Xuexue Zhang
- Xiyuan hospital, China Academy of Chinese Medical Sciences, Beijing, China.,China Academy of Chinese Medical Sciences, Beijing, China
| | - Miaoran Wang
- Xiyuan hospital, China Academy of Chinese Medical Sciences, Beijing, China.,China Academy of Chinese Medical Sciences, Beijing, China
| | - Xujie Wang
- Xiyuan hospital, China Academy of Chinese Medical Sciences, Beijing, China.,China Academy of Chinese Medical Sciences, Beijing, China
| | - Hua Qu
- Xiyuan hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Rui Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | - Jiyu Gu
- Beijing University of Chinese Medicine, Beijing, China
| | - Yufei Wu
- Beijing University of Chinese Medicine, Beijing, China
| | - Tian Ni
- Xiyuan hospital, China Academy of Chinese Medical Sciences, Beijing, China.,China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei Tang
- Beijing University of Chinese Medicine, Beijing, China
| | - Qiuyan Li
- Xiyuan hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Kang WS, Jung WK, Park SB, Kim HR, Kim J. Gemigliptin suppresses salivary dysfunction in streptozotocin-induced diabetic rats. Biomed Pharmacother 2021; 137:111297. [PMID: 33493968 DOI: 10.1016/j.biopha.2021.111297] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 11/16/2022] Open
Abstract
Patients with diabetes commonly experience hyposalivation, which induces discomfort in eating, swallowing, dryness, smell, and speaking, as well as increases the incidence of periodontal disease. Dipeptidyl peptidase-4 (DPP4) inhibitors are frequently used as antidiabetic drugs that lower glucose levels by utilizing similar mechanisms; however, additional protective functions of each gliptin have been discovered. In this study, the protective roles of gemigliptin, a DPP4 inhibitor, against salivary dysfunction under diabetic conditions were investigated. Streptozotocin-induced diabetic rats received gemigliptin 10 mg/kg or 100 mg/kg via oral gavage for 3 weeks. The weights of salivary gland tissues, saliva secretion, and antioxidant capacity in salivary glands were reduced after diabetes induction, but were significantly preserved following gemigliptin treatment. In salivary gland analysis, expression of apoptotic proteins, as well as amylase and aquaporin-5 (AQP5) protein expression, were increased following gemigliptin treatment. Furthermore, the number of TUNEL-positive cells decreased after gemigliptin treatment. Therefore, gemigliptin has protective roles against salivary dysfunction observed in diabetes, mediated via antioxidant, anti-apoptotic, and salivary secretion mechanisms. These results may help in selecting a suitable drug for patients with diabetes experiencing salivary dysfunction.
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Affiliation(s)
- Wan Seok Kang
- Department of Oral Pathology, School of Dentistry, Jeonbuk National University, Jeonju, 54896, Republic of Korea; Central R&D Center, Bioresources and Technology (B&Tech) Co., Ltd., Gwangju, 61239, Republic of Korea
| | - Woo Kwon Jung
- Department of Oral Pathology, School of Dentistry, Jeonbuk National University, Jeonju, 54896, Republic of Korea
| | - Su-Bin Park
- Department of Oral Pathology, School of Dentistry, Jeonbuk National University, Jeonju, 54896, Republic of Korea
| | - Hyung Rae Kim
- Department of Oral Pathology, School of Dentistry, Jeonbuk National University, Jeonju, 54896, Republic of Korea
| | - Junghyun Kim
- Department of Oral Pathology, School of Dentistry, Jeonbuk National University, Jeonju, 54896, Republic of Korea.
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Zainal Abidin Z, Zainuren ZA, Noor E, Mohd Nor NS, Mohd Saffian S, Abdul Halim R. Periodontal health status of children and adolescents with diabetes mellitus: a systematic review and meta-analysis. Aust Dent J 2021; 66 Suppl 1:S15-S26. [PMID: 33864280 DOI: 10.1111/adj.12845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 01/02/2023]
Abstract
Diabetes mellitus (DM) is a complex metabolic disease characterized by hyperglycaemia resulted from defects in insulin secretion or action, or both. Various studies have reported on the bidirectional relationship between DM and periodontal disease. A systematic search of the literature was performed in several databases, EBSCO Medline Complete, PubMed, Science Direct and a manual search for articles from 2000 until 2019. Literature that fulfilled the inclusion criteria were identified, and data measuring plaque index (PI), gingival index (GI), clinical attachment loss (CAL) and periodontal probing depth (PPD) were extracted and subjected to Random-effects meta-analysis. From 947 titles and abstracts screened, 11 articles were included for meta-analysis. It was found that PI, GI, CAL and PPD were significantly higher in DM children than in non-DM children according to the Standardized Mean different (SMD) and 95% confidence intervals (CI) (SMD 0.54, 95% CI 0.20-0.87, P = 0.002; SMD 0.63, 95% CI 0.39-0.87, P < 0.001; SMD 0.79, 95% CI 0.52-1.05, P < 0.001, SMD 0.67, 95% CI 0.23-1.11, P = 0.003, respectively). The meta-analysis showed significant differences in PI, GI, PD and CAL between the two groups, favouring non-DM children. Therefore, early detection of DM children with periodontal disease is crucial to prevent periodontal disease.
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Affiliation(s)
- Z Zainal Abidin
- Centre of Paediatric Dentistry and Orthodontic Studies, Faculty of Dentistry, UniversitiTeknologi Mara (UiTM), Sungai Buloh, Malaysia
| | - Z A Zainuren
- Centre of Paediatric Dentistry and Orthodontic Studies, Faculty of Dentistry, UniversitiTeknologi Mara (UiTM), Sungai Buloh, Malaysia
| | - E Noor
- Centre of Periodontology Studies, Faculty of Dentistry, Universiti Teknologi Mara (UiTM), Sungai Buloh, Malaysia
| | - N S Mohd Nor
- Paediatric Department, Faculty of Medicine and Institute for Pathology, Laboratory and Forensic Medicine (IPPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia
| | - S Mohd Saffian
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - R Abdul Halim
- Centre of Paediatric Dentistry and Orthodontic Studies, Faculty of Dentistry, UniversitiTeknologi Mara (UiTM), Sungai Buloh, Malaysia
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Cardiovascular risks of periodontitis and oral hygiene indicators in patients with diabetes mellitus. DIABETES & METABOLISM 2021; 47:101252. [PMID: 33862198 DOI: 10.1016/j.diabet.2021.101252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 12/29/2022]
Abstract
AIM Periodontitis is a common chronic inflammatory disease prevalent in diabetes. The aim of this study was to evaluate periodontitis and poor oral hygiene as independent risk factors for either cerebral or myocardial infarction in the diabetes population. METHODS This retrospective cohort study included 17,009 patients with diabetes who had participated in a nationwide health-screening programme, including oral health examination, during 2002-2003 in South Korea. Presence of periodontitis, tooth loss and carious teeth were assessed by professional dentists, and the number of tooth brushings per day was evaluated through self-reported questionnaires. The primary study outcome was the development of cerebral or myocardial infarction, based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes, up to 31 December 2015. RESULTS The study enrolled 17,009 patients with diabetes. Over the mean 11.64 years of follow-up, 1341 patients presented with either cerebral or myocardial infarction. On multivariable Cox proportional hazards regression analysis, presence of periodontitis was an independent risk factor for either cerebral or myocardial infarction [adjusted hazard ratio (HR): 1.17, 95% confidence interval (CI): 1.02-1.34; P = 0.030]. An increased number of carious teeth (≥5) was also associated with risk of cerebral or myocardial infarction (adjusted HR: 1.67, 95% CI: 1.20-2.32; P = 0.002), whereas frequent tooth brushing (≥2 times/day) was negatively associated with risk of cerebral or myocardial infarction (adjusted HR: 0.79, 95% CI: 0.70-0.90; P < 0.001) compared with tooth brushing ≤1 time/day. CONCLUSION Early identification and intervention of periodontal disease may be effective in reducing cardiovascular complications in the diabetes population, and improved oral hygiene would probably be associated with lower cardiovascular risk in diabetes.
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14
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Beck JD, Papapanou PN, Philips KH, Offenbacher S. Periodontal Medicine: 100 Years of Progress. J Dent Res 2020; 98:1053-1062. [PMID: 31429666 DOI: 10.1177/0022034519846113] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Periodontal medicine is a term used to describe how periodontal infection/inflammation may impact extraoral health. Periodontitis has been linked to over 50 systemic diseases and conditions. As part of the Journal of Dental Research's Centennial Celebration, this narrative review discusses periodontal medicine research done over the past 100 y, with particular focus on the effects of periodontal disease on 3 pathological conditions: cardiovascular disease, diabetes mellitus, and adverse pregnancy outcomes. We selected 29 total studies that were the "first" of their kind, as they provided novel observations or contributed to shifting paradigms as well as important studies that made strong contributions to progress in understanding relationships to the systemic conditions. These studies were organized in an overview timeline and broken down into timelines by topic: cardiovascular disease (n = 10), diabetes (n = 12), and adverse pregnancy outcomes (n = 7). Overall, the majority of cross-sectional, case-control, and longitudinal studies have revealed positive associations between poor periodontal status and cardiovascular disease, diabetes metabolic control, and a number of adverse pregnancy outcomes, and these associations are upheld in systematic reviews. Findings from randomized controlled trials testing the effects of periodontal therapy on systemic health outcomes were conflicting and inconsistent. While there has been a great deal of progress, we highlight lessons learned and make comments and suggestions on a number of key aspects, including the heterogeneity of case definitions of periodontal disease across studies, accounting for features of the periodontal phenotype that are most relevant to the biological link between periodontitis and systemic outcomes, the role of other comorbid inflammatory conditions, selection of study participants, and timing and intensity of the periodontal intervention.
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Affiliation(s)
- J D Beck
- 1 Department of Periodontology, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | - P N Papapanou
- 2 Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York City, NY, USA
| | - K H Philips
- 3 Department of Oral and Craniofacial Health Sciences, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | - S Offenbacher
- 1 Department of Periodontology, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
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Nguyen ATM, Akhter R, Garde S, Scott C, Twigg SM, Colagiuri S, Ajwani S, Eberhard J. The association of periodontal disease with the complications of diabetes mellitus. A systematic review. Diabetes Res Clin Pract 2020; 165:108244. [PMID: 32526263 DOI: 10.1016/j.diabres.2020.108244] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
Abstract
This review investigated the association of periodontal disease with diabetes mellitus (DM) and diabetic complications. PubMed/MEDLINE was searched including search terms "periodontal" OR "periodontitis" AND "diabetic complications" OR "diabetic retinopathy" OR "diabetic nephropathy" OR "diabetic neuropathy" OR "cardiovascular disease diabetes" OR "myocardial infarction diabetes" OR "cerebrovascular disease diabetes" OR "stroke diabetes" OR "peripheral vascular disease diabetes". Fourteen studies included in this review consistently reported an increased risk for diabetic complications including microvascular, macrovascular and death in the presence of periodontal disease. Higher risks for diabetic retinopathy (odds ratios: 2.8-8.7), neuropathy (3.2-6.6), nephropathy (1.9-8.5), cardiovascular complications (1.28-17.7) and mortality (2.3-8.5) were reported for people with diabetes with periodontitis compared to those with diabetes who have no periodontitis. This novel review summarizes current data providing further evidence of a link between poor oral health and DM and its complications. It has also drawn attention to major limitations of the available data linking periodontal disease and diabetic complications.
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Affiliation(s)
- Anh Thi Mai Nguyen
- The University of Sydney School of Dentistry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Rahena Akhter
- The University of Sydney School of Dentistry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Siddharth Garde
- The University of Sydney School of Dentistry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Claire Scott
- Oral Health Clinic, Royal Prince Alfred Hospital, Sydney, Australia
| | - Stephen M Twigg
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Stephen Colagiuri
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia
| | - Shilpi Ajwani
- Oral Health Services, Sydney Dental Hospital, Sydney Local Health District, Australia
| | - Joerg Eberhard
- The University of Sydney School of Dentistry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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16
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Mahtani AA, Jacob C, Lakshmanan R. Prevalence of diabetes among patients and the assessment of the awareness of the bidirectional relation between diabetes and periodontal disease. J Family Med Prim Care 2020; 9:2774-2780. [PMID: 32984124 PMCID: PMC7491835 DOI: 10.4103/jfmpc.jfmpc_63_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/12/2020] [Accepted: 03/21/2020] [Indexed: 01/14/2023] Open
Abstract
AIM To assess the extent of self-awareness and knowledge of diabetes and its association with periodontal disease among patients seeking dental care. MATERIALS AND METHODS Data were collected in the form of a questionnaire from 150 consecutive adult patients from the outpatient department of Saveetha Dental College in Chennai, India. Complying patients were tested for diabetes mellitus by checking their random blood sugar and the results were correlated with the questionnaire and their periodontal findings. The findings were interpreted to examine the relationship between self-awareness and clinically diagnosed periodontitis. RESULTS One hundred fifty patients participated in the questionnaire and 70% were unaware of diabetes causing periodontal disease. A total of 47.3% of patients were also unwilling to get themselves tested for diabetes by their dentists as nearly 73.3% believed that they did not have diabetes. As a result, out of 150 patients, 41 consented to random blood sugar but only 23 patients followed up. Among these 23, 14 believed they were diabetic but only 12 of those 14 were proven to be so. Additionally, 20 patients were diagnosed with either localized or generalized chronic periodontitis while the remaining 3 patients had gingivitis. All 12 patients diagnosed with diabetes were affected by periodontitis as well. CONCLUSIONS Patients are generally apprehensive and misinformed regarding the influence of periodontitis and diabetes between both diseases and must be educated by both the medical and dental practitioners regarding the implications of these chronic inflammatory diseases.
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Affiliation(s)
- Anisha A. Mahtani
- Student, Department of Periodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Caroline Jacob
- Senior Lecturer, Department of Periodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Reema Lakshmanan
- Senior Lecturer, Department of Periodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
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17
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Lee JY, Choi YY, Choi Y, Jin BH. Efficacy of non-surgical treatment accompanied by professional toothbrushing in the treatment of chronic periodontitis in patients with type 2 diabetes mellitus: a randomized controlled clinical trial. J Periodontal Implant Sci 2020; 50:83-96. [PMID: 32395387 PMCID: PMC7192821 DOI: 10.5051/jpis.2020.50.2.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/11/2020] [Accepted: 04/20/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose The present study aimed to evaluate the clinical benefit of additional toothbrushing accompanying non-surgical periodontal treatment on oral and general health in patients with type 2 diabetes mellitus (T2DM). Methods We conducted a doubled-blind randomized controlled trial in 60 T2DM patients between June 2013 and June 2014. The patients were randomly assigned to the scaling and root planing (SRP) group; the scaling and root planing with additional toothbrushing (SRPAT) group, in which additional toothbrushing was performed by toothpick methods; or the control group. Microbiological and oral examinations were performed for up to 12 weeks following treatment. Non-surgical treatment was conducted in the experimental groups. The SRP group received scaling and root planing and the SRPAT group received additional toothbrushing with the Watanabe method once a week from the first visit through the fifth visit. The primary outcomes were changes in haemoglobin A1c (or glycated haemoglobin; HbA1c) levels, serum endotoxin levels, and interleukin-1 beta levels. Periodontal health status was measured by periodontal pocket depth, the calculus index, and bleeding on probing (BOP). Results Both the SRP and SRPAT groups showed improvements in periodontal health and HbA1c, but the SRPAT group showed significantly less BOP than the SRP group. Furthermore, only the SRPAT group showed a statistically significant decrease in serum endotoxin levels. Conclusions Non-surgical periodontal treatment was effective in improving HbA1c and serum endotoxin levels in T2DM patients. Furthermore, non-surgical treatment with additional tooth brushing had a more favourable effect on gingival bleeding management. Trial Registration Clinical Research Information Service Identifier: KCT000416
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Affiliation(s)
- Jae Young Lee
- Department of Preventive and Public Health Dentistry, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Yoon Young Choi
- Department of Preventive and Public Health Dentistry, Seoul National University School of Dentistry, Seoul, Korea
| | - Youngnim Choi
- Department of Immunology and Molecular Microbiology, Seoul National University School of Dentistry, Seoul, Korea
| | - Bo Hyoung Jin
- Department of Preventive and Public Health Dentistry, Seoul National University School of Dentistry, Seoul, Korea
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18
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Wang Y, Liu HN, Zhen Z, Pelekos G, Wu MZ, Chen Y, Tonetti M, Tse HF, Yiu KH, Jin L. A randomized controlled trial of the effects of non-surgical periodontal therapy on cardiac function assessed by echocardiography in type 2 diabetic patients. J Clin Periodontol 2020; 47:726-736. [PMID: 32350903 DOI: 10.1111/jcpe.13291] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/24/2020] [Accepted: 04/03/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Periodontitis significantly increases the risk of diabetic complications. This clinical trial investigated the effects of periodontal therapy on cardiac function in patients with type 2 diabetes mellitus (T2DM) and periodontitis. MATERIALS AND METHODS Fifty-eight subjects with T2DM and periodontitis were randomly allocated to Treatment Group (n = 29) receiving non-surgical periodontal therapy, and Control Group (n = 29) having only oral hygiene instructions with delayed periodontal treatment until completion of this 6-month study. The left ventricle (LV) diastolic function was assessed by echocardiography with the tissue Doppler imaging index (E/e' ratio); and LV hypertrophy was evaluated by LV mass index (LVMI). Blood samples were collected for biochemical analysis. RESULTS The intention-to-treat analysis showed that periodontal treatment significantly reduced the E/e' ratio by 1.66 (95% CI: -2.64 to -0.68, p < .01), along with marked improvement of periodontal conditions (p < .05). LVMI was not altered at the 6-month follow-up. The serum levels of N-terminal pro-B type natriuretic peptide (NT-proBNP) as a cardiac stress biomarker, C-reactive protein and interleukin-6 decreased numerically without reaching statistical significance. CONCLUSION The present study provides the first evidence that non-surgical periodontal therapy may improve cardiac diastolic function in type 2 diabetic patients with periodontitis.
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Affiliation(s)
- Yi Wang
- Division of Periodontology & Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,School & Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Hin Nam Liu
- Division of Periodontology & Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Zhe Zhen
- Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - George Pelekos
- Division of Periodontology & Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Mei Zhen Wu
- Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yan Chen
- Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Maurizio Tonetti
- Division of Periodontology & Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Hung Fat Tse
- Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kai Hang Yiu
- Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lijian Jin
- Division of Periodontology & Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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19
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Kato T, Fujiwara N, Kuraji R, Numabe Y. Relationship between periodontal parameters and non-vital pulp in dental clinic patients: a cross-sectional study. BMC Oral Health 2020; 20:109. [PMID: 32295592 PMCID: PMC7161001 DOI: 10.1186/s12903-020-01103-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 04/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endodontic diseases, such as apical periodontitis, communicate with periodontitis and mutually exacerbate them. However, it remains unclear whether pulp condition is a risk factor for periodontal disease. The purpose of this retrospective study was to examine relations between pulp condition and periodontal parameters in Japanese patients who visited a general dental clinic. METHODS Patients who visited a Japanese general dental clinic from 2016 to 2018 and aged 18 to 81 years were analyzed. Periodontal parameters, tooth condition, and general status of all teeth excluding third molars at the initial visit to the clinic were abstracted. A total of 7105 teeth were analyzed in this study by multiple classification analysis and the Mann-Whitney U test. We also performed a sub-analysis of non-vital teeth, which evaluated the presence or absence of unfavorable root canal obturation and apical periodontitis diagnosed by X-ray. RESULTS Significant relations between periodontal parameters and non-vital pulp were observed by multiple logistic regression analyses (odds ratio = 1.48; 95% CI = 1.03-2.14) and multiple linear regression analysis (p < 0.001). Significant relations between unfavorable root canal obturation tooth with periodontal pocket depth (p = 0.00837) and BOP (p = 0.0145) were also observed by the Mann-Whitney U test. CONCLUSIONS We demonstrated potential relations between periodontal disease and non-vital pulp.
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Affiliation(s)
- Tomotaka Kato
- Department of Oral Health Sciences, School of Dentistry, University of Washington, 8901 Meridian Ave. N, Seattle, WA USA
- Division of General Dentistry, Nippon Dental University Hospital, Tokyo, Japan
| | | | - Ryutaro Kuraji
- Department of Life Science Dentistry, The Nippon Dental University, Tokyo, Japan
- Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo, Tokyo, Japan
| | - Yukihiro Numabe
- Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo, Tokyo, Japan
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20
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Borgnakke WS. IDF Diabetes Atlas: Diabetes and oral health - A two-way relationship of clinical importance. Diabetes Res Clin Pract 2019; 157:107839. [PMID: 31520714 DOI: 10.1016/j.diabres.2019.107839] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 12/22/2022]
Abstract
The current scientific evidence for the bi-directional associations between oral health and diabetes is summarized. The universal biologic mechanisms and demographic and behavioral risk drivers underlying these associations in both directions are also described. Dysglycemia, even slightly elevated blood sugar levels, adversely affects oral health, manifesting itself in several oral diseases and conditions. In the opposite direction, any oral infection with its subsequent local and systemic inflammatory responses adversely affects blood glucose levels. Moreover, painful, mobile, or missing teeth may lead to intake of soft food items representing a sub-optimal diet and hence poor nutrition, and thereby contribute to incident type 2 diabetes or to poorer glucose control in existing diabetes. Treatment of inflammation related oral conditions, such as non-surgical periodontal treatment and extraction of infected teeth, can lead to a clinically significant decrease in blood glucose levels. Attention to infectious oral diseases and referral to dental care professionals for treatment can therefore be an important novel tool for medical care professionals in preventing and managing diabetes mellitus. Dental professionals can detect unrecognized potential dysglycemia and refer for medical examination. Such interprofessional, patient centered care may contribute to improved health, wellbeing, and quality of life in people with diabetes.
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Affiliation(s)
- Wenche S Borgnakke
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Avenue Rm# 3060, Ann Arbor, MI 48109-1078, USA.
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21
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Cao X, Huo P, Li W, Li P, He L, Meng H. Interactions among moderate/severe periodontitis, ADIPOQ-rs1501299, and LEPR-rs1137100 polymorphisms on the risk of type 2 diabetes in a Chinese population. Arch Oral Biol 2019; 103:26-32. [PMID: 31128439 DOI: 10.1016/j.archoralbio.2019.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/05/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Type 2 diabetes mellitus (T2DM) is a complex disease influenced by genes and the environment. Periodontitis a demonstrated risk factor of T2DM. Previous studies related to gene-environment interactions on the risk of T2DM mainly focused on gene-obesity interactions. However, the impact of gene-periodontitis interaction on the risk of T2DM has not yet been investigated. This study aimed to investigate gene-environment interactions among moderate/severe periodontitis, polymorphisms of adiponectin (ADIPOQ)-rs1501299, and leptin receptor (LEPR)-rs1137100 on T2DM risk in Chinese subjects. DESIGN A case-control study was conducted in 239 Chinese participants from Beijing Hypertension Association Institute (BHAL). After full-mouth periodontal examinations, the participants underwent bilateral buccal swabs for DNA testing. ADIPOQ-rs1501299 and LEPR-rs1137100 were used for genotyping. Generalised multifactor dimensionality reduction (GMDR) and logistic regression were used to examine the interactions among single nucleotide polymorphisms (SNPs) and moderate/severe periodontitis on the risk of T2DM. RESULTS The risk of T2DM was higher in moderate/severe periodontitis [adjusted odds ratio (AOR) = 3.67, 95% confidence interval (95%CI): 1.26-10.71] in ADIPOQ-rs1501299 GG genotype (AOR = 3.42, 95%CI: 1.81-6.46) and LEPR-rs1137100 GG genotype (AOR = 3.16, 95%CI: 1.56-6.39). The GMDR model indicated that there was a significant three-factor model (p = 0.001) involving rs1501299, rs1137100, and moderate/severe periodontitis, demonstrating a potential gene-environment interaction among periodontitis, polymorphisms of rs1501299, and rs1137100 influencing the risk of T2DM. Moderate/severe periodontitis patients with rs1501299-GG and rs1137100-GG have the highest T2DM risk after adjusting for age, gender, BMI, WHR, smoking status, alcohol consumption, economic status, and hypertension (AOR = 20.39, 95%CI: 2.64-157.26). CONCLUSIONS Interactions among moderate/severe periodontitis, rs1501299-GG, and rs1137100-GG were associated with an increased risk of T2DM. This study may provide a new insight into the effect of gene-environment interactions on T2DM.
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Affiliation(s)
- Xiaojing Cao
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Pengcheng Huo
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wenjing Li
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Peng Li
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Lu He
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Huanxin Meng
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China.
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22
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Wallet SM, Puri V, Gibson FC. Linkage of Infection to Adverse Systemic Complications: Periodontal Disease, Toll-Like Receptors, and Other Pattern Recognition Systems. Vaccines (Basel) 2018; 6:E21. [PMID: 29621153 PMCID: PMC6027258 DOI: 10.3390/vaccines6020021] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/25/2018] [Accepted: 03/30/2018] [Indexed: 12/13/2022] Open
Abstract
Toll-like receptors (TLRs) are a group of pattern recognition receptors (PRRs) that provide innate immune sensing of conserved pathogen-associated molecular patterns (PAMPs) to engage early immune recognition of bacteria, viruses, and protozoa. Furthermore, TLRs provide a conduit for initiation of non-infectious inflammation following the sensing of danger-associated molecular patterns (DAMPs) generated as a consequence of cellular injury. Due to their essential role as DAMP and PAMP sensors, TLR signaling also contributes importantly to several systemic diseases including cardiovascular disease, diabetes, and others. The overlapping participation of TLRs in the control of infection, and pathogenesis of systemic diseases, has served as a starting point for research delving into the poorly defined area of infection leading to increased risk of various systemic diseases. Although conflicting studies exist, cardiovascular disease, diabetes, cancer, rheumatoid arthritis, and obesity/metabolic dysfunction have been associated with differing degrees of strength to infectious diseases. Here we will discuss elements of these connections focusing on the contributions of TLR signaling as a consequence of bacterial exposure in the context of the oral infections leading to periodontal disease, and associations with metabolic diseases including atherosclerosis and type 2 diabetes.
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Affiliation(s)
- Shannon M Wallet
- Department of Oral Biology, College of Dental Medicine, University of Florida, Gainesville, FL 32610, USA.
| | - Vishwajeet Puri
- Department of Biomedical Sciences and Diabetes Institute, Ohio University, Athens, OH 45701, USA.
| | - Frank C Gibson
- Department of Oral Biology, College of Dental Medicine, University of Florida, Gainesville, FL 32610, USA.
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23
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Tsobgny-Tsague NF, Lontchi-Yimagou E, Nana ARN, Tankeu AT, Katte JC, Dehayem MY, Bengondo CM, Sobngwi E. Effects of nonsurgical periodontal treatment on glycated haemoglobin on type 2 diabetes patients (PARODIA 1 study): a randomized controlled trial in a sub-Saharan Africa population. BMC Oral Health 2018; 18:28. [PMID: 29482543 PMCID: PMC5828384 DOI: 10.1186/s12903-018-0479-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/29/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There is a burglar association between diabetes and periodontitis. Many studies has shown that periodontitis treatment can help improving glycemic control in diabetes patients but little evidence of non-surgical treatment benefit is available in sub Saharan african diabetes patients. We aimed to assess the effects of non-surgical periodontal treatment (NSPT) of chronic periodontitis on glycaemic control in poorly controlled type 2 diabetes patients (T2D) in a sub-Saharan Africa urban setting. METHODS A total of 34 poorly controlled T2D patients with chronic periodontitis aged 51.4 ± 8.8 years (mean ± SD), with known duration of diabetes of 55.5 ± 42.6 months, and HbA1c of 9.3 ± 1.3% were randomly assigned to two groups. The treatment group (Group 1, n = 17) received immediate ultrasonic scaling, scaling and root planning along with subgingival 10% povidone iodine irrigation, whereas the control group (Group 2, n = 17) was assigned to receive delayed periodontal treatment 3 months later. Pharmacological treatment was unchanged and all participants received the same standardized education session on diabetes management and dental hygiene. The primary outcome was the 3-month change in HbA1c from baseline. Plaque index (PI), gingival bleeding index (GBI), pocket depth (PD), clinical attachment loss (CAL) were also assessed prior to, at 6 and 12 weeks after enrolment. RESULTS Two subjects in each group were excluded from the study. Data were analyzed on thirty patients (15 per group). Non-surgical periodontal treatment with education for better dental hygiene (group 1) significantly improved all periodontal parameters whereas education only (group 2) improved only the plaque index among all periodontal parameters. Immediate non-surgical periodontal treatment induced a reduction of HbA1c levels by 3.0 ± 2.4 points from 9.7 ± 1.6% at baseline to 6.7 ± 2.0% 3 months after NSPT, (p ˂ 0.001) but the change was not significant in group 2, from mean 8.9 ± 0.9% at baseline vs 8.1 ± 2.6% after 3 months (p = 0.24). CONCLUSION Non-surgical periodontal treatment markedly improved glycaemic control with an attributable reduction of 2.2 points of HbA1c in poorly controlled T2D patients in a sub Saharan setting. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02745015 Date of registration: July 17, 2016 'Retrospectively registered'.
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Affiliation(s)
- Nadia-Flore Tsobgny-Tsague
- Department of periodontology, oral and maxillofacial surgery, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon
- National Obesity Center, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Eric Lontchi-Yimagou
- Diabetes Research and Training Center, Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, Yaoundé, Cameroon
| | - Arnel Redon Nana Nana
- Department of periodontology, oral and maxillofacial surgery, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon
- National Obesity Center, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Aurel T Tankeu
- National Obesity Center, Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Internal Medicine and specialties, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon
| | - Jean Claude Katte
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, Yaoundé, Cameroon
- Department of Public Health, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon
| | - Mesmin Y Dehayem
- National Obesity Center, Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Internal Medicine and specialties, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon
| | - Charles Messanga Bengondo
- Department of periodontology, oral and maxillofacial surgery, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon
- Dental surgery Unit, Yaoundé Teaching Hospital, Yaoundé, Cameroon
| | - Eugene Sobngwi
- National Obesity Center, Yaoundé Central Hospital, Yaoundé, Cameroon.
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, Yaoundé, Cameroon.
- Department of Internal Medicine and specialties, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon.
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24
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Chen TC, Lin CT, Chien SJ, Chang SF, Chen CN. Regulation of calcification in human aortic smooth muscle cells infected with high-glucose-treated Porphyromonas gingivalis. J Cell Physiol 2018; 233:4759-4769. [PMID: 29150938 DOI: 10.1002/jcp.26268] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 10/18/2017] [Indexed: 12/30/2022]
Abstract
Porphyromonas (P.) gingivalis infection leading to the periodontitis has been associated with the development of systemic diseases, including cardiovascular diseases and diabetes. However, the effect of a high concentration of glucose (HG) on the invasion efficiency of P. gingivalis and the consequent modulation of pathogenesis in vascular cells, especially in the vascular smooth muscle cells (VSMCs), remains unclear. Hence, the aim of this study was to investigate whether treating P. gingivalis with HG could change its invasion capability and result in VSMC calcification and the underlying mechanism. Human aortic SMCs (HASMCs) and P. gingivalis strain CCUG25226 were used in this study. We found that HGPg infection of HASMCs could initiate the HASMC calcification by stimulating the autocrine regulation of bone morphogenetic protein (BMP) 4 in HASMCs. The upregulation of BMP4 expression in HASMCs was mediated by toll-like receptor 4 and ERK1/2-p38 signaling after P. gingivalis infection. Moreover, the autocrine action of BMP4 in HGPg infection-initiated HASMC calcification upregulated BMP4-specific downstream smad1/5/8-runx2 signaling to increase the expressions of bone-related matrix proteins, that is, osteopontin, osteocalcin, and alkaline phosphatase. This study elucidates the detailed mechanism of HGPg infection-initiated calcification of HASMCs and indicates a possible therapeutic role of BMP4 in P. gingivalis infection-associated vascular calcification.
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Affiliation(s)
- Te-Chuan Chen
- Division of Nephrology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Tsong Lin
- Center for General Education, National Formosa University, Yunlin, Taiwan.,Department of Wood Based Materials and Design, National Chiayi University, Chiayi, Taiwan
| | - Shao-Ju Chien
- Disivion of Pediatric Cardiology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Fu Chang
- Department of Medical Research and Development, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Cheng-Nan Chen
- Department of Biochemical Science and Technology, National Chiayi University, Chiayi, Taiwan
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Graziani F, Gennai S, Solini A, Petrini M. A systematic review and meta-analysis of epidemiologic observational evidence on the effect of periodontitis on diabetes An update of the EFP-AAP review. J Clin Periodontol 2017; 45:167-187. [PMID: 29277926 DOI: 10.1111/jcpe.12837] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2017] [Indexed: 12/23/2022]
Abstract
AIM To update the available evidence on the impact of periodontitis on diabetes control, incidence and complications. METHODS Observational studies on the effect of periodontitis on diabetes, published after 2012, were identified through electronic databases and hand-searched journals. Findings were summarized by evidence tables, using PRISMA statement. Quality of the included studies was evaluated through the Newcastle Ottawa scale. RESULTS Healthy individuals with periodontitis exhibit a poor glycaemic control and a higher risk of developing diabetes. Individuals affected by diabetes show a deterioration of glycaemic control if also affected by periodontitis and significantly higher prevalence of diabetes-related complications. Limited evidence is available on gestational diabetes and type 1 diabetes. CONCLUSIONS Periodontitis has a significant impact on diabetes control, incidence and complications. Nevertheless, the heterogeneity and quality of the included publications suggest that caution should be exercised when interpreting the data and that there remains an important need for additional evidence.
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Affiliation(s)
- Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology, Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology, Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Anna Solini
- Department of Surgical, Medical and Molecular Pathology, Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy.,Unit of Internal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Morena Petrini
- Department of Surgical, Medical and Molecular Pathology, Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
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26
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Yuan Q, Xiong QC, Gupta M, López-Pintor RM, Chen XL, Seriwatanachai D, Densmore M, Man Y, Gong P. Dental implant treatment for renal failure patients on dialysis: a clinical guideline. Int J Oral Sci 2017; 9:125-132. [PMID: 28644432 PMCID: PMC5709544 DOI: 10.1038/ijos.2017.23] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 02/05/2023] Open
Abstract
Chronic kidney disease (CKD) is a worldwide public health problem that is growing in prevalence and is associated with severe complications. During the progression of the disease, a majority of CKD patients suffer oral complications. Dental implants are currently the most reliable and successful treatment for missing teeth. However, due to complications of CKD such as infections, bone lesions, bleeding risks, and altered drug metabolism, dental implant treatment for renal failure patients on dialysis is more challenging. In this review, we have summarized the characteristics of CKD and previous publications regarding dental treatments for renal failure patients. In addition, we discuss our recent research results and clinical experience in order to provide dental implant practitioners with a clinical guideline for dental implant treatment for renal failure patients undergoing hemodialysis.
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Affiliation(s)
- Quan Yuan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qiu-Chan Xiong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Megha Gupta
- Department of Preventive Dental Sciences, Division of Pedodontics, College of Dentistry, Al-Showajra Academic Campus, Jazan University, Gizan, Kingdom of Saudi Arabia
| | - Rosa María López-Pintor
- Department of Oral Medicine and Surgery, School of Dentistry, Complutense University, Madrid, Spain
| | - Xiao-Lei Chen
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Michael Densmore
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Yi Man
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ping Gong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Abstract
Periodontal diseases comprise a wide range of inflammatory conditions that affect the supporting structures of the teeth (the gingiva, bone and periodontal ligament), which could lead to tooth loss and contribute to systemic inflammation. Chronic periodontitis predominantly affects adults, but aggressive periodontitis may occasionally occur in children. Periodontal disease initiation and propagation is through a dysbiosis of the commensal oral microbiota (dental plaque), which then interacts with the immune defences of the host, leading to inflammation and disease. This pathophysiological situation persists through bouts of activity and quiescence, until the affected tooth is extracted or the microbial biofilm is therapeutically removed and the inflammation subsides. The severity of the periodontal disease depends on environmental and host risk factors, both modifiable (for example, smoking) and non-modifiable (for example, genetic susceptibility). Prevention is achieved with daily self-performed oral hygiene and professional removal of the microbial biofilm on a quarterly or bi-annual basis. New treatment modalities that are actively explored include antimicrobial therapy, host modulation therapy, laser therapy and tissue engineering for tissue repair and regeneration.
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Affiliation(s)
- Denis F Kinane
- University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, Pennsylvania 19104, USA
| | - Panagiota G Stathopoulou
- University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, Pennsylvania 19104, USA
| | - Panos N Papapanou
- Columbia University College of Dental Medicine, New York, New York, USA
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28
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Chan S, Pasternak GM, West MJ. The place of periodontal examination and referral in general medicine. Periodontol 2000 2017; 74:194-199. [DOI: 10.1111/prd.12199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 12/13/2022]
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Hayashi J, Hasegawa A, Hayashi K, Suzuki T, Ishii M, Otsuka H, Yatabe K, Goto S, Tatsumi J, Shin K. Effects of periodontal treatment on the medical status of patients with type 2 diabetes mellitus: a pilot study. BMC Oral Health 2017; 17:77. [PMID: 28431542 PMCID: PMC5399866 DOI: 10.1186/s12903-017-0369-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/12/2017] [Indexed: 01/22/2023] Open
Abstract
Background Studies have demonstrated that periodontal disease is associated with the development of systemic complications in patients with type 2 diabetes mellitus (T2DM). The purpose of this pilot study was to investigate which markers among various systemic disease parameters are affected by periodontal treatment in patients with T2DM. Methods Twelve patients with T2DM were given oral hygiene instructions and subsequent subgingival scaling and root planing. The periodontal status was recorded, and blood and urine samples were taken to measure various parameters of glucose control and systemic status at baseline and 1 month following the periodontal treatment. Serum concentrations of tumor necrosis factor-α and high-sensitivity C-reactive protein were measured by enzyme-linked immunosorbent assay. Results After the periodontal treatment, the glycated hemoglobin value was significantly improved. The levels of urinary N-acetyl-β-D-glucosaminidase and albumin, which are markers of renal dysfunction, also decreased significantly after treatment. Among the parameters measured in serum, the γ-glutamyl transpeptidase level, which is usually interpreted as a marker of liver dysfunction, was significantly reduced. The serum concentrations of tumor necrosis factor-α and high-sensitivity C-reactive protein were also significantly reduced by periodontal treatment. Conclusion Within the limitations of this pilot study, periodontal treatment may be effective not only in improving metabolic control, but also in reducing the risk of diabetic kidney and liver disease in patients with T2DM.
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Affiliation(s)
- Joichiro Hayashi
- Division of Periodontology, Department of Oral Biology and Tissue Engineering, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado-shi, Saitama-ken, 350-0283, Japan.
| | | | - Kohei Hayashi
- Division of Periodontology, Department of Oral Biology and Tissue Engineering, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado-shi, Saitama-ken, 350-0283, Japan
| | - Takafumi Suzuki
- Division of Periodontology, Department of Oral Biology and Tissue Engineering, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado-shi, Saitama-ken, 350-0283, Japan
| | - Makiko Ishii
- Division of Periodontology, Department of Oral Biology and Tissue Engineering, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado-shi, Saitama-ken, 350-0283, Japan
| | - Hideharu Otsuka
- Division of Periodontology, Department of Oral Biology and Tissue Engineering, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado-shi, Saitama-ken, 350-0283, Japan
| | - Kazuhiro Yatabe
- Division of Periodontology, Department of Oral Biology and Tissue Engineering, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado-shi, Saitama-ken, 350-0283, Japan
| | - Seiichi Goto
- Meikai University School of Dentistry, Saitama-ken, Japan
| | - Junichi Tatsumi
- Division of Periodontology, Department of Oral Biology and Tissue Engineering, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado-shi, Saitama-ken, 350-0283, Japan
| | - Kitetsu Shin
- Division of Periodontology, Department of Oral Biology and Tissue Engineering, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado-shi, Saitama-ken, 350-0283, Japan
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30
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Song SJ, Lee SS, Han K, Park JB. Periodontitis is associated with diabetic retinopathy in non-obese adults. Endocrine 2017; 56:82-89. [PMID: 28032209 DOI: 10.1007/s12020-016-1215-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/19/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE Patients with diabetes retinopathy appear to show increased susceptibility to periodontal disease. This study was performed to assess the relationship between periodontitis and the prevalence of diabetic retinopathy in a large probability sample of the Korean population. A subgroup analysis was performed using body mass index <25 kg/m2 as the criterion to evaluate the effect of obesity on this relationship. METHODS This study is based on data from the Korean National Health and Nutrition Examination Survey of the Korean population, conducted between 2008 and 2010. The presence of diabetic retinopathy in relation to demographic variables and anthropometric characteristics of the participants is presented as means with their standard errors. The presence of periodontitis and presence of retinopathy categorized by body mass index (<25 and ≥25 kg/m2) were evaluated. Multiple logistic regression analyses were used to assess the associations between periodontitis and diabetic retinopathy after adjustment with variables, including age, sex, smoking, drinking, exercise, hypertension, metabolic syndrome, HbA1c, and duration of diabetes mellitus. RESULTS There was a statistically significant increase in the prevalence of periodontitis in individuals who had proliferative diabetic retinopathy. The odds ratios [95% confidence intervals] of prevalence of diabetic retinopathy were 1.193 [0.757-1.881] for the whole population after adjustments with confounding factors. Subgroup analysis after adjustments with confounding factors showed that the odds ratios [95% confidence intervals] of prevalence were 2.206 [1.114-4.366] and 0.588 [0.326-1.061] among participants with body mass index <25 kg/m2 and body mass index 37 ≥25 kg/m2, respectively. CONCLUSIONS The diabetic retinopathy was positively associated with the presence of periodontitis in non-obese diabetic Korean adults after adjustment with confounding variables. Our findings suggest that when a periodontist finds the presence of periodontitis in non-obese diabetic patients, timely evaluation of the patient's ophthalmic evaluation should be 44 recommended.
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Affiliation(s)
- Su Jeong Song
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong-Su Lee
- Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun-Beom Park
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Oliveira LS, Lira-Junior R, Figueredo CM, Gomes MB, Fischer RG. Self-Reported Periodontitis and Complications in Type 1 Diabetes Patients: A Brazilian Nationwide Survey. Braz Dent J 2016; 27:599-603. [DOI: 10.1590/0103-6440201601054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 07/15/2016] [Indexed: 11/22/2022] Open
Abstract
Abstract This study aimed to evaluate the possible association between periodontitis and systemic complications in a Brazilian type 1 diabetes population. A multicentre, sectional study was carried out in 28 public clinics located in 20 Brazilian cities. Data from 3,591 patients were obtained (56.0% females, 57.2% Caucasians), with an average age of 21.2 ± 11.7 years and whose mean duration of type 1 diabetes was 9.6 ± 8.1 years. Periodontitis was evaluated through self-report. Odds ratios (OR) and 95% confidence intervals were calculated to evaluate the association between periodontitis and systemic diabetes complications (chronic micro and macrovascular complications and hospitalizations by hyperglycemia and diabetic ketoacidosis). The prevalence of periodontitis was 4.7% (n=170). Periodontitis patients had mean age of 27.4 ± 12.9. This group was older (p<0.001), exhibited longer diabetes duration (p<0.0001) and had elevated total cholesterol (p<0.05), triglycerides (p<0.001) and lower HDL (p<0.05) values than patients without periodontitis. Systolic and diastolic blood pressures were significantly increased in periodontitis patients (p<0.01). Periodontitis patients had increased odds of microvascular complications (2.43 [1.74-3.40]) and of hospitalizations related to hyperglycemia (2.76 [1.72-4.42]) and ketoacidosis (2.72 [1.53-4.80]). In conclusion, periodontitis was associated to systemic complications in Brazilian type 1 diabetes patients.
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Abstract
Periodontitis and diabetes are common, complex, chronic diseases with an established bidirectional relationship. That is, diabetes (particularly if glycaemic control is poor) is associated with an increased prevalence and severity of periodontitis, and, severe periodontitis is associated with compromised glycaemic control. Periodontal treatment (conventional non-surgical periodontal therapy) has been associated with improvements in glycaemic control in diabetic patients, with reductions in HbA1c of approximately 0.4% following periodontal therapy. For these reasons, management of periodontitis in people with diabetes is particularly important. The dental team therefore has an important role to play in the management of people with diabetes. An emerging role for dental professionals is envisaged, in which diabetes screening tools could be used to identify patients at high risk of diabetes, to enable them to seek further investigation and assessment from medical healthcare providers.
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Abstract
BACKGROUND To assess the extent of self-awareness of gum disease among adults in the United States. METHODS Data were from the 2009-2012 National Health and Nutrition Examination Survey. The outcome variable is self-awareness of gum disease. Multivariate logistic regression models were used to examine the relationship between self-awareness and clinically diagnosed periodontitis. The analytical sample included 6876 participants. RESULTS Among those participants (30 years or older) who were classified as having periodontitis, 27% (95% confidence interval [CI], 24.4-29.8) were self-aware of the disease (positive predicted value = 25%). Of those who self-reported having gum disease, 14.1% had a diagnosis of periodontitis (sensitivity = 75%). Older adults were less likely to be aware of gum disease (P < .05). Non-Hispanic blacks (adjusted odds ratio [AOR] = 0.67; 95% CI, 0.53-0.85) were less likely to be aware of the disease than non-Hispanic whites. Adults with diabetes (AOR = 1.61; 95% CI, 1.25-2.06), or with lung disease (AOR = 1.61; 95% CI, 1.25-2.08), or current smokers (AOR = 1.72; 95% CI, 1.29-2.31) were more likely to be aware of the disease. CONCLUSION The study showed that self-awareness of gum disease among adults was low. Our study findings suggest that there is a great need to improve oral health knowledge and awareness among the adult population in the United States.
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Jahn CA. Good Oral Health Contributes to Good Total Health: The Role of the Diabetes Educator. DIABETES EDUCATOR 2016; 30:754, 757-60. [PMID: 15510529 DOI: 10.1177/014572170403000510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carol A Jahn
- Waterpik Technologies, Professional Oral Health, Fort Collins, Colorado, USA
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35
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Borgnakke WS, Ylöstalo PV, Taylor GW, Genco RJ. Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence. J Periodontol 2016; 84:S135-52. [PMID: 23631574 DOI: 10.1902/jop.2013.1340013] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Periodontal disease and diabetes mellitus are common, chronic diseases worldwide. Epidemiologic and biologic evidence suggest periodontal disease may affect diabetes. OBJECTIVE To systematically review non-experimental, epidemiologic evidence for effects of periodontal disease on diabetes control, complications and incidence. DATA SOURCES Electronic bibliographic databases, supplemented by hand searches of recent and future issues of relevant journals. Study eligibility criteria and participants: Longitudinal and cross-sectional epidemiologic, non-interventional studies that permit determination of directionality of observed effects were included. STUDY APPRAISAL AND SYNTHESIS METHODS Four reviewers evaluated pair-wise each study. Review findings regarding study results and quality were summarized in tables by topic, using the PRISMA Statement for reporting and the Newcastle-Ottawa System for quality assessment, respectively. From 2246 citations identified and available abstracts screened, 114 full-text reports were assessed and 17 included in the review. RESULTS A small body of evidence supports significant, adverse effects of periodontal disease on glycaemic control, diabetes complications, and development of type 2 (and possibly gestational) diabetes. LIMITATIONS There were only a limited number of eligible studies, several of which included small sample sizes. Exposure and outcome parameters varied, and the generalizability of their results was limited. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Current evidence suggests that periodontal disease adversely affects diabetes outcomes, and that further longitudinal studies are warranted.
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Affiliation(s)
- Wenche S Borgnakke
- School of Dentistry, University of Michigan, 1011 North University Avenue, Ann Arbor, MI 48109-1078, USA.
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36
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Borgnakke WS, Ylöstalo PV, Taylor GW, Genco RJ. Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence. J Clin Periodontol 2016; 40 Suppl 14:S135-52. [PMID: 23627324 DOI: 10.1111/jcpe.12080] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Periodontal disease and diabetes mellitus are common, chronic diseases worldwide. Epidemiologic and biologic evidence suggest periodontal disease may affect diabetes. OBJECTIVE To systematically review non-experimental, epidemiologic evidence for effects of periodontal disease on diabetes control, complications and incidence. DATA SOURCES Electronic bibliographic databases, supplemented by hand searches of recent and future issues of relevant journals. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS: Longitudinal and cross-sectional epidemiologic, non-interventional studies that permit determination of directionality of observed effects were included. STUDY APPRAISAL AND SYNTHESIS METHODS Four reviewers evaluated pair-wise each study. Review findings regarding study results and quality were summarized in tables by topic, using the PRISMA Statement for reporting and the Newcastle-Ottawa System for quality assessment, respectively. From 2246 citations identified and available abstracts screened, 114 full-text reports were assessed and 17 included in the review. RESULTS A small body of evidence supports significant, adverse effects of periodontal disease on glycaemic control, diabetes complications, and development of type 2 (and possibly gestational) diabetes. LIMITATIONS There were only a limited number of eligible studies, several of which included small sample sizes. Exposure and outcome parameters varied, and the generalizability of their results was limited. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Current evidence suggests that periodontal disease adversely affects diabetes outcomes, and that further longitudinal studies are warranted.
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Affiliation(s)
- Wenche S Borgnakke
- University of Michigan School of Dentistry, Ann Arbor, MI 48109-1078, USA.
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Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Clin Periodontol 2016; 40 Suppl 14:S70-84. [PMID: 23627335 DOI: 10.1111/jcpe.12062] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/19/2012] [Accepted: 11/14/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The objective of this study was to systematically review the epidemiological evidence for an association between periodontitis (PD) and incident atherosclerotic cardiovascular disease (ACVD), including coronary heart disease (CHD), cerebrovascular disease and peripheral arterial disease. METHODS Systematic review of cohort and case-control studies on the association of clinically or radiographically diagnosed PD and ACVD. RESULTS Overall, 12 studies were included in this study (six studies on CHD, three studies on cerebrovascular disease, two studies on both coronary heart and cerebrovascular disease mortality and one study on peripheral arterial disease). All but one study reported positive associations between various periodontal disease measures and the incidence of ACVD, at least in specific subgroups. The association was stronger in younger adults and there was no evidence for an association between PD and incident CHD in subjects older than 65 years. Only one study evaluated the association between PD and secondary cardiovascular events. CONCLUSIONS There is evidence for an increased risk of ACVD in patients with PD compared to patients without. However, this may not apply to all groups of the population. There is insufficient evidence for an association between PD and the incidence of secondary cardiovascular events.
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Affiliation(s)
- Thomas Dietrich
- Department of Oral Surgery, The School of Dentistry, University of Birmingham, Birmingham, UK
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Effect of high-glucose conditions on human periodontal ligament endothelial cells: in vitro analysis. Odontology 2016; 105:76-83. [DOI: 10.1007/s10266-016-0235-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/04/2016] [Indexed: 01/19/2023]
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39
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Ryan ME, Raja V. Diet, Obesity, Diabetes, and Periodontitis: a Syndemic Approach to Management. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s40496-016-0075-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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40
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Mesia R, Gholami F, Huang H, Clare-Salzler M, Aukhil I, Wallet SM, Shaddox LM. Systemic inflammatory responses in patients with type 2 diabetes with chronic periodontitis. BMJ Open Diabetes Res Care 2016; 4:e000260. [PMID: 27651910 PMCID: PMC5020743 DOI: 10.1136/bmjdrc-2016-000260] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/10/2016] [Accepted: 07/05/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The objective of this case-control study was to quantify the immune responsiveness in individuals with type 2 diabetes (T2D) as compared with patients without diabetes (NT2D) diagnosed with periodontitis. RESEARCH DESIGN AND METHODS Peripheral blood was collected from 20 patients with moderate-to-severe chronic periodontitis (10 T2D, 10 NT2D). Blood samples were stimulated with ultrapure Porphyromonas gingivalis and Escherichia coli lipopolysaccharide (LPS) for 24 hours. 14 cytokines/chemokines were quantified in culture supernatants using multiplex technology. RESULTS T2D individuals demonstrated higher unstimulated levels of interleukin 6 (IL-6), IL-1β, tumor necrosis factor α, interferon γ, IL-10, IL-8, macrophage inflammatory protein 1α (MIP1α), and 1β (MIP1β), and higher stimulated levels of IL-6, IL-8, IL-10, MIP1α and MIP1β, along with lower unstimulated and stimulated levels of granulocyte-macrophage colony-stimulating factor (GM-CSF) when compared with NT2D (p<0.05). Importantly, the LPS-induced levels of IL-6, IL-8, IL-10 and MIP1α strongly correlated with severity of disease, measured by pocket depths (PD), within the T2D group (r(2)≥0.7, p<0.05), but not within NT2D. CONCLUSIONS Among patients with chronic periodontitis, patients with T2D seem to have an enhanced LPS-induced immune responsiveness than individuals without diabetes, which correlates with periodontal disease severity, concomitant with a less robust GM-CSF response. This data may in part explain the higher predisposition to periodontitis in this population.
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Affiliation(s)
- Ruben Mesia
- Department of Periodontology, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Fatemeh Gholami
- Department of Periodontology, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Hong Huang
- Department of Periodontology, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Michael Clare-Salzler
- Department of Endocrinology, Diabetes and Metabolism, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ikramuddin Aukhil
- Department of Periodontology, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Shannon M Wallet
- Department of Oral Biology, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Luciana M Shaddox
- Department of Periodontology, University of Florida College of Dentistry, Gainesville, Florida, USA
- Department of Oral Biology, University of Florida College of Dentistry, Gainesville, Florida, USA
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Molina CA, Ojeda LF, Jiménez MS, Portillo CM, Olmedo IS, Hernández TM, Moreno GG. Diabetes and Periodontal Diseases: An Established Two-Way Relationship. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jdm.2016.64024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Merchant AT, Nahhas GJ, Wadwa RP, Zhang J, Tang Y, Johnson LR, Maahs DM, Bishop F, Teles R, Morrato EH. Periodontal Microorganisms and Cardiovascular Risk Markers in Youth With Type 1 Diabetes and Without Diabetes. J Periodontol 2015; 87:376-84. [PMID: 26616842 DOI: 10.1902/jop.2015.150531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND A subset of periodontal microorganisms has been associated with cardiovascular disease (CVD), which is the leading complication of type 1 diabetes (t1DM). The authors therefore evaluated the association between periodontal microorganism groups and early markers of CVD in youth with t1DM. METHODS A cross-sectional analysis was conducted among youth aged 12 to 19 years at enrollment; 105 had t1DM for ≥5 years and were seeking care at the Barbara Davis Center, University of Colorado, from 2009 to 2011, and 71 did not have diabetes. Subgingival plaque samples were assessed for counts of 41 periodontal microorganisms using DNA-DNA hybridization. Microorganisms were classified using cluster analysis into four groups named red-orange, orange-green, blue/other, and yellow/other, modified from Socransky's color scheme for periodontal microorganisms. Subsamples (54 with t1DM and 48 without diabetes) also received a periodontal examination at the University of Colorado School of Dental Medicine. RESULTS Participants were ≈15 years old on average, and 74% were white. Mean periodontal probing depth was 2 mm (SE 0.02), and 17% had bleeding on probing. In multivariable analyses, glycated hemoglobin (HbA1c) was inversely associated with the yellow/other cluster (microorganisms that are not associated with periodontal disease) among youth with t1DM. Blood pressure, triglycerides, low-density lipoprotein, high-density lipoprotein, and total cholesterol were not associated with microorganism clusters in this group. HbA1c was not associated with periodontal microorganism clusters among youth without diabetes. CONCLUSION Among youth with t1DM who had good oral health, periodontal microorganisms were not associated with CVD risk factors.
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Affiliation(s)
- Anwar T Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Georges J Nahhas
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - R Paul Wadwa
- University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Yifan Tang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | | | - David M Maahs
- University of Colorado, Anschutz Medical Campus, Aurora, CO
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Ahdi M, Teeuw WJ, Meeuwissen HGTA, Hoekstra JBL, Gerdes VEA, Loos BG, Meesters EW. Oral health information from the dentist to the diabetologist. Eur J Intern Med 2015; 26:498-503. [PMID: 26160771 DOI: 10.1016/j.ejim.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 05/17/2015] [Accepted: 06/12/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetes care includes annual evaluation of micro- and macrovascular complications, however, oral pathologies are not included. We studied retrieving oral health information, in particular periodontal disease, from the dentist and studied the association between the reported periodontal condition and variables of both diabetes and dental care. METHODS During their annual comprehensive diabetes evaluation, patients were asked to deliver an oral health questionnaire (OHQ) to their dentist. Based on the returned OHQs, the process of retrieving oral health information from the dentist was analyzed. In addition, reported oral health measures with special emphasis to periodontitis, using a Periodontal Screening Index (PSI), were related to diabetes-related variables. RESULTS We included 889 patients of whom 102 patients (11%) did not visit a dentist at all and 252 (28%) were edentulous. The response rate was <50% for oral information on patients with diabetes. For the second aim, OHQs of 207 patients could be further analyzed. A moderate to high PSI-score was found in 106 patients, of whom 65% were untreated for periodontitis. Furthermore high PSI-scores were associated with poor oral hygiene, soft tissue pathologies and periodontal treatment, but not significantly with glycemic control and presence of diabetes complications. CONCLUSION The transfer of information from the dentist to the diabetologist is far from optimal. An OHQ can be a valuable tool for the identification of patients with diabetes with poor oral health especially untreated periodontal disease, which is helpful for proper diabetes management.
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Affiliation(s)
- Mohamed Ahdi
- Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands.
| | - Wijnand J Teeuw
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands
| | | | - Joost B L Hoekstra
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Victor E A Gerdes
- Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands; Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Bruno G Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands
| | - Eelco W Meesters
- Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands
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Abstract
The oral health is influenced by systemic health, and one of the most common chronic diseases encountered in dental practice is diabetes mellitus. Diabetes can worsen oral infections and vice versa. In the literature, periodontitis and diabetes in the young to middle-aged adults have been the most widely researched area. Understanding the patho-physiology, clinical manifestations and management of different types of orofacial diseases in diabetic patients are important to the diabetologist and the dentist for the optimal care of patients with these diseases. This review explores the inter-link between diabetes and oral health.
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46
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Evaluation of different periodontal treatments modes for patients with type 2 diabetes mellitus. J Public Health (Oxf) 2014. [DOI: 10.1007/s10389-014-0648-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Chee B, Park B, Bartold PM. Periodontitis and type II diabetes: a two-way relationship. INT J EVID-BASED HEA 2014; 11:317-29. [PMID: 24298927 DOI: 10.1111/1744-1609.12038] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
For many years an association between diabetes and periodontitis has been suspected. In more recent times this relationship has been suggested to be bidirectional with each condition being able to influence the other. In this review the two-way relationship between diabetes and periodontitis is considered. For this narrative review a very broad search strategy of the literature was developed using both EMBASE and MEDLINE (via PubMed) databases. The reference lists from the selected papers were also scanned, and this provided an additional source of papers for inclusion and further assessment. The data available suggest that diabetes is a risk as well as a modifying factor for periodontitis. Individuals with diabetes are more likely to have periodontitis and with increased severity when diabetes is uncontrolled/poorly controlled. Possible mechanisms of how diabetes affects periodontitis include adipokine-mediated inflammation, neutrophil dysfunction, uncoupling of bone and advanced glycation end-products-receptor for advanced glycation end-products interaction. Evidence is accruing to support how periodontitis can affect diabetes and complications associated with diabetes. There is some evidence demonstrating that periodontal therapy can result in a moderate improvement in glycaemic control. Available evidence indicates that diabetes and peridontitis are intricately interrelated and that each condition has the capacity to influence clinical features of each other.
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Affiliation(s)
- Brian Chee
- Department of Dentistry, University of Adelaide, Adelaide, South Australia, Australia
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Tsubokawa M, Sato S. In Vitro Analysis of Human Periodontal Microvascular Endothelial Cells. J Periodontol 2014; 85:1135-42. [DOI: 10.1902/jop.2013.130209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Gay IC, Tran DT, Cavender AC, Weltman R, Chang J, Luckenbach E, Tribble GD. The effect of periodontal therapy on glycaemic control in a Hispanic population with type 2 diabetes: a randomized controlled trial. J Clin Periodontol 2014; 41:673-80. [PMID: 24797222 DOI: 10.1111/jcpe.12268] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In the Mexican-American population, the prevalence of Type 2 diabetes mellitus (T2DM) is as high as 50% of the population. This randomized controlled clinical trial was designed to elucidate how treatment of periodontal disease affects HbA1c values in this population. MATERIALS AND METHODS One hundred and fifty-four T2DM patients with periodontal disease were enrolled in the study. The test group was treated with scaling and root planing (SRP); the control group received oral hygiene instructions. At baseline and 4-6 weeks after therapy, a complete periodontal examination was performed. Blood was collected at baseline and 4 months later for HbA1c levels. RESULTS One hundred and twenty-six individuals completed the study. Baseline mean ± SD HbA1c for the test and control groups were 9.0 ± 2.3% and 8.4 ± 2.0% respectively. Non-significant difference in HbA1c reductions (0.6 ± 2.1% and 0.3 ± 1.7%) was found between test and control groups at 4 months. Comparisons of the periodontal clinical parameters between the test and control groups found significant differences with improved results in the test subjects. CONCLUSIONS No statistically significant differences were found in the changes of HbA1c levels between test and control groups. Non-surgical periodontal therapy improved the magnitude of change in periodontal parameters as compared to the control subjects. ClinicalTrials.gov Identifier: NCT01128374.
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Affiliation(s)
- Isabel C Gay
- Dental School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Kim JH, Lee DE, Gunawardhana KSND, Choi SH, Woo GH, Cha JH, Bak EJ, Yoo YJ. Effect of the interaction between periodontitis and type 1 diabetes mellitus on alveolar bone, mandibular condyle and tibia. Acta Odontol Scand 2014; 72:265-73. [PMID: 23931568 DOI: 10.3109/00016357.2013.822551] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study examined the effect of the interaction between periodontitis and type 1 diabetes mellitus on alveolar bone, mandibular condyle and tibia in animal models. MATERIALS AND METHODS Rats were divided into normal, periodontitis, diabetic and diabetic with periodontitis groups. After injection of streptozotocin to induce diabetes, periodontitis was induced by ligation of both lower-side first molars for 30 days. Alveolar bone loss and trabecular bone volume fraction (BVF) of the mandibular condyle and tibia were estimated via hematoxylin and eosin staining and micro-computed tomography, respectively. Osteoclastogenesis of bone marrow cells isolated from tibia and femur was assayed using tartrate-resistant acid phosphatase staining. RESULTS The cemento-enamel junction to the alveolar bone crest distance and ratio of periodontal ligament area in the diabetic with periodontitis group were significantly increased compared to those of the periodontitis group. Mandibular condyle BVF did not differ among groups. The BVF of tibia in the diabetic and diabetic with periodontitis groups was lower than that of the normal and periodontitis groups. Osteoclastogenesis of bone marrow cells in the diabetic groups was higher than that in the non-diabetic groups. However, the BVF of tibia and osteoclastogenesis in the diabetic with periodontitis group were not significantly different than those in the diabetic group. CONCLUSIONS Type 1 diabetes mellitus aggravates alveolar bone loss induced by periodontitis, but periodontitis does not alter the mandibular condyle and tibia bone loss induced by diabetes. Alveolar bone, mandibular condyle and tibia may have different responses to bone loss stimuli in the diabetic environment.
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Affiliation(s)
- Ji-Hye Kim
- Department of Applied Life Science, The Graduate School, Yonsei University , Seoul , Republic of Korea
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