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Şimşek OK, Baser U, Özgünler Ö, Demirci O, Aydin AF, Kucukgergin C, Yalcin F. Comparison of oxidative stress markers in the saliva, gingival crevicular fluid, and serum samples of pregnant women with gestational diabetes and healthy pregnant women. J Periodontal Res 2023. [PMID: 37154237 DOI: 10.1111/jre.13132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 03/29/2023] [Accepted: 04/26/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND OBJECTIVE To compare oxidative stress (OS) markers in the saliva, gingival crevicular fluid (GCF), and serum samples of pregnant women with gestational diabetes (GDM) and healthy pregnant women and to investigate the association between periodontal health/diseases and OS and GDM. METHOD Eighty women with GDM and 80 healthy pregnant women were included in the study. Medical and clinical anamnesis was obtained from all the pregnant women included in the study, and their plaque index (PI), gingival index (GI), bleeding on probing (BoP), probing pocket depth (PPD), and clinical attachment level (CAL) measurements were performed. GCF, saliva, and serum samples were collected for the measurements of the local and systemic total antioxidant status (TAS) and total oxidant status (TOS). RESULTS Clinical periodontal parameters were found to be significantly higher in the GDM group compared to the control group. The serum and saliva TAS, TOS, and TAS/TOS values were significantly lower in the GDM group than in the control group. In the analysis of the GCF samples, the mean TAS and TAS/TOS values were significantly lower and the TOS value was significantly higher in the GDM group than in the control group. The multivariate reduced model indicated that gravidity, salivary TAS/TOS, and GCF TAS were significant independent variables in the development of GDM (p < .05). CONCLUSION Our results indicated that the OS of serum, saliva, and GCF samples increased in patients with GDM compared to healthy pregnant women. The role of local OS parameters in GDM may be associated with elevated clinical periodontal parameters.
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Affiliation(s)
- Oya Kaya Şimşek
- Faculty of Dentistry, Periodontology Department, Istanbul University, Istanbul, Turkey
| | - Ulku Baser
- Faculty of Dentistry, Periodontology Department, Istanbul University, Istanbul, Turkey
| | - Özgür Özgünler
- Faculty of Dentistry, Periodontology Department, Istanbul University, Istanbul, Turkey
| | - Oya Demirci
- Perinatology Clinic, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Abdurrahman Fatİh Aydin
- Faculty of Medicine, Department of Medical Biochemistry, Istanbul University, Istanbul, Turkey
| | - Canan Kucukgergin
- Faculty of Medicine, Department of Medical Biochemistry, Istanbul University, Istanbul, Turkey
| | - Funda Yalcin
- Faculty of Dentistry, Periodontology Department, Istanbul University, Istanbul, Turkey
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Pukkila J, Mustaniemi S, Lingaiah S, Lappalainen OP, Kajantie E, Pouta A, Kaaja R, Eriksson JG, Laivuori H, Gissler M, Vääräsmäki M, Keikkala E. Increased Oral Care Needs and Third Molar Symptoms in Women with Gestational Diabetes Mellitus: A Finnish Gestational Diabetes Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10711. [PMID: 36078430 PMCID: PMC9518339 DOI: 10.3390/ijerph191710711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/13/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
(1) Hyperglycemia and oral pathology accelerate each other in diabetes. We evaluated whether gestational diabetes mellitus (GDM) is associated with self-reported increased oral health care needs and oral symptoms, including third molar symptoms, during pregnancy. (2) Pregnant women with (n = 1030) and without GDM (n = 935) were recruited in this multicenter Finnish Gestational Diabetes study in 2009-2012. Of the women with GDM, 196 (19.0%) receiving pharmacological treatment, 797 (77.0%) receiving diet treatment and 233 (23.0%) with recurrent GDM were analyzed separately. Oral health was assessed using structured questionnaires and analyzed by multivariable logistic regression adjusted for background risk factors. (3) Women with GDM were more likely to report a higher need for oral care than controls (31.1% vs. 24.5%; odds ratio (OR) 1.39; 95% confidence interval (CI) 1.14-1.69), particularly women with recurrent GDM (38.1% vs. 24.5%; OR 1.90; 95% CI 1.40-2.58). Women with pharmacologically treated GDM (46.9%) more often had third molar symptoms than controls (36.1%; OR 1.57; 95% CI 1.15-2.15) than women with diet-treated GDM (38.0%; OR 1.47; 95% CI 1.07-2.02). (4) GDM is associated with perceived oral care needs. Third molar symptoms were associated with pharmacologically treated GDM.
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Affiliation(s)
- Jenni Pukkila
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Population Health, Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki and 90220 Oulu, Finland
| | - Sanna Mustaniemi
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Population Health, Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki and 90220 Oulu, Finland
| | - Shilpa Lingaiah
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Population Health, Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki and 90220 Oulu, Finland
| | - Olli-Pekka Lappalainen
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland
| | - Eero Kajantie
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Population Health, Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki and 90220 Oulu, Finland
- Children’s Hospital, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7028 Trondheim, Norway
| | - Anneli Pouta
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Department of Government Services, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Risto Kaaja
- Internal Medicine, Institute of Clinical Medicine, Turku University Hospital, University of Turku, 20521 Turku, Finland
| | - Johan G. Eriksson
- Technology and Research, Agency for Science, Singapore Institute for Clinical Sciences, Singapore 117609, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Young Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of General Practice and Primary Health Care, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland
- Folkhälsan Research Center, 00250 Helsinki, Finland
| | - Hannele Laivuori
- Adolescent and Maternal Health Research, Center for Child, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Department of Obstetrics and Gynaecology, Tampere University Hospital, 33520 Tampere, Finland
- Medical and Clinical Genetics, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, 00290 Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, 104 35 Stockholm, Sweden
- Region Stockholm, Academic Primary Health Care Centre, 113 65 Stockholm, Sweden
| | - Marja Vääräsmäki
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Population Health, Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki and 90220 Oulu, Finland
| | - Elina Keikkala
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Population Health, Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki and 90220 Oulu, Finland
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Bunpeng N, Boriboonhirunsarn D, Boriboonhirunsarn C, Sawangpanyangkura T, Tansriratanawong K. Association between gestational diabetes mellitus and periodontitis via the effect of reactive oxygen species in peripheral blood cells. J Periodontol 2022; 93:758-769. [PMID: 34787908 DOI: 10.1002/jper.21-0455] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Periodontitis (P) has emerged as a risk factor for gestational diabetes mellitus (GDM) through immune cell function alterations, elevated proinflammatory mediators, and increased reactive oxygen species (ROS). The main objective of present study was to determine associations between pregnancy with and without GDM and P. The secondary objective was to compare ROS production in peripheral blood cells (PBCs) of pregnant women with and without GDM. METHODS This cross-sectional case-control study included 128 pregnant women: 64 with and 64 without GDM. All participants were examined for clinical parameters of GDM and periodontal conditions. Associations between GDM-related periodontal data and GDM risk were evaluated by multiple logistic regression. PBCs were isolated and cultured. ROS productions in each PBCs types was investigated by flow cytometry with ROS antibodies. RESULTS P was significantly more prevalent in pregnant women with GDM than in those without GDM (57.8% versus 37.5%), with an odds ratio (OR) of 2.28, and a 95% confidence interval (CI) of 1.12 to 4.64 (P = 0.022). The OR (95% CI) was 2.59 (1.19 to 5.65) (P = 0.017) after adjusting for potential confounding factors, including diabetes mellitus (DM) family history, age ≥30 years, body mass index, and maternal age. ROS levels in all PBCs types were significantly higher in the GDM than in the non-GDM group (P < 0.05). CONCLUSION This study supported the association between P and GDM and indicated that P may be a risk factor for GDM. High levels of ROS production in the PBCs of pregnant women with GDM emphasized the association with GDM.
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Affiliation(s)
- Nattawan Bunpeng
- Department of Oral Medicine and Periodontology, Mahidol University, Bangkok, Thailand
| | - Dittakarn Boriboonhirunsarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Teerat Sawangpanyangkura
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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Liu F, Sui W, Zhou ZF, Mi Y, He TQ, Li ZB, Hong YL, Chen FM. Development of gestational diabetes mellitus in women with periodontitis in early pregnancy: A population-based clinical study. J Clin Periodontol 2021; 49:164-176. [PMID: 34865247 DOI: 10.1111/jcpe.13578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to determine whether periodontitis in early pregnancy and periodontal therapy during gestation affect the incidence of gestational diabetes mellitus (GDM) through a population-based clinical study. MATERIALS AND METHODS Subjects without periodontitis at 1-4 weeks of gestation who met our inclusion criteria were enrolled in the non-periodontitis group. Periodontitis patients who agreed or refused to receive periodontal therapy during pregnancy were separately enrolled in the periodontitis treated or untreated group. At 12-16 weeks of gestation, gingival crevicular fluid (GCF) and venous blood were collected for analyses of bacterial species and serum inflammatory mediators, respectively. At 24-28 weeks of gestation, GDM patients were identified by oral glucose tolerance tests. The association tests were performed using Chi-squared statistics and regression analyses. RESULTS The complete data of 3523 pregnant women were recorded during the study period. GDM incidence among the untreated periodontitis participants (84/749, 11.21%) was significantly higher than that among the non-periodontitis participants (108/2255, 4.79%) (p < .05), and periodontal treatment during gestation reduced the incidence from 11.21% (untreated group) to 7.32% (38/519, treated group) (p < .05). Based on multiple logistic regression analyses, it was found that periodontitis in early pregnancy was associated with GDM, and three-step regression analyses showed that Porphyromonas gingivalis (P. gingivalis) and the serum TNF-α and IL-8 levels played a role in the association between untreated periodontitis and GDM. Furthermore, Pearson's correlation test indicated that the existence of P. gingivalis in GCF was positively correlated with high serum levels of these two inflammatory mediators. CONCLUSIONS This study establishes a connection between periodontitis in early pregnancy and GDM and demonstrates that the presence of P. gingivalis is associated with high levels of inflammatory mediators in serum, and thereby may contribute to the development of GDM. In-depth mechanistic studies are needed to further support these findings.
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Affiliation(s)
- Fen Liu
- Stomatology Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,Department of Stomatology, Northwest Women's and Children's Hospital, Xi'an, China.,State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Periodontology, School of Stomatology, Fourth Military Medical University, Xi'an, China
| | - Wen Sui
- Stomatology Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Zhi-Fei Zhou
- Department of Stomatology, General Hospital of Tibetan Military Command, Lhasa, China
| | - Yang Mi
- Department of Obstetrics, Northwest Women's and Children's Hospital, Xi'an, China
| | - Tong-Qiang He
- Department of Obstetrics, Northwest Women's and Children's Hospital, Xi'an, China
| | - Zhi-Bin Li
- Department of Obstetrics, Northwest Women's and Children's Hospital, Xi'an, China
| | - Yong-Long Hong
- Stomatology Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Fa-Ming Chen
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Periodontology, School of Stomatology, Fourth Military Medical University, Xi'an, China
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Enfermedad periodontal y diabetes mellitus gestacional: estudio caso-control. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Yamunadevi A, Pratibha R, Rajmohan M, Ganapathy N, Porkodisudha J, Pavithrah D, Mahendraperumal S. Molecular Insight into Odontogenesis in Hyperglycemic Environment: A Systematic Review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2020; 12:S49-S56. [PMID: 33149430 PMCID: PMC7595462 DOI: 10.4103/jpbs.jpbs_159_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022] Open
Abstract
Diabetes mellitus is an endocrinal disorder affecting worldwide and the disease incidence is rising alarmingly high. The effects of diabetes on tooth development are explored by limited studies and their molecular insights are very rarely studied. This systematic review is aimed to provide the best scientific literature source on the molecular insights into odontogenesis in hyperglycemic environment caused by diabetes mellitus or by maternal diabetes on the offspring. The literature search was conducted on the databases, namely PubMed, PubMed Central, Cochrane, and Scopus. The original studies exploring the alterations in the molecular pathways of odontogenesis in diabetes mellitus were selected. Data were extracted, chosen, and evaluated by two independent researchers. At the end of thorough data search, four articles were eligible for the review. Three articles brought out the molecular pathways involved in the offspring of gestational diabetes through animal models. Fourth article was an in vitro study, which treated the stem cells in hyperglycemic environment and drafted the molecular pathway. The altered molecular pathways in dental epithelial stem cells (DESCs), dental papilla cells (DPCs), and stem cells from apical papilla were studied and empowered with statistical analysis. Thus with this systematic review, we conclude that apurinic/apyrimidinic endonuclease1 downregulation causing deoxyribonucleic acid hypermethylation and Oct4, Nanog gene silencing, activation of toll-like receptor-4/nuclear factor kappa B (TLR4/NF-κB) pathway are involved in suppressing cell proliferation and accelerated apoptosis in DESCs in high glucose environment. DPCs are suppressed from odonto differentiation by activation of TLR4 signaling and resulting inhibition of SMAD1/5/9 phosphorylation in diabetic condition. NF-κB pathway activation causes decreased cell proliferation and enhanced differentiation in apical papilla stem cells in hyperglycemia. Further studies targeting various stages of odontogenesis can reveal more molecular insight.
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Affiliation(s)
- Andamuthu Yamunadevi
- Department of Oral Pathology, Vivekanandha Dental College for Women, Namakkal, Tamil Nadu, India
| | - Ramani Pratibha
- Department of Oral Pathology, Saveetha Dental College, Chennai, Tamil Nadu, India
| | - Muthusamy Rajmohan
- Department of Oral Pathology, KSR Institute of Dental Science and Research, Namakkal, Tamil Nadu, India
| | - Nalliappan Ganapathy
- Department of Oral Pathology, Vivekanandha Dental College for Women, Namakkal, Tamil Nadu, India
| | | | - Dhanasing Pavithrah
- Department of Oral Pathology, Vivekanandha Dental College for Women, Namakkal, Tamil Nadu, India
| | - Sengottaiyan Mahendraperumal
- Department of Oral and Maxillofacial Surgery, KSR Institute of Dental Science and Research, Namakkal, Tamil Nadu, India
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Quantitative analysis of key periodontopathic bacteria in gestational diabetic and non-diabetic women. J Diabetes Metab Disord 2019; 18:363-369. [PMID: 31890661 DOI: 10.1007/s40200-019-00420-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
Purpose The aim of this study is to compare the periodontal status and quantify Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi) from plaque samples of both gestational diabetic mellitus (GDM) and non diabetic pregnant women. Materials and methods Sixty first time pregnant women were selected after adjusting for age, duration of pregnancy and educational status. They were then categorized into gestational diabetic women (GDM) (Group A) and healthy pregnant women (non GDM) (Group B). Periodontal examination was done by assessing gingival index, periodontal disease index and probing depth. Microbial analysis on sub-gingival plaque was performed using polymerase chain reaction (PCR). Statistical analysis was done by student t test, chi square test and Fischer exact test. Results Group A showed higher gingival index, probing depth and periodontal disease index scores than group B at p < 0.001. Pg was detected in 80% of group A and 40% of group B. Amongst these; it was measured over 2.0 × 104 in 33% of group A, while in the group B it never scored more than 1.0 × 104. While Pi were also detected in 73% of group A women and 40% Group B women but quantification showed Pi > 2.0 × 104 in more number of group A women. Conclusion This study showed that there is significant association between the severity of periodontal disease and increased levels of Pg and Pi in gestational diabetic women.
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Seraphim APCG, Chiba FY, Pereira RF, Mattera MSDLC, Moimaz SAS, Sumida DH. Relationship among Periodontal Disease, Insulin Resistance, Salivary Cortisol, and Stress Levels during Pregnancy. Braz Dent J 2017; 27:123-7. [PMID: 27058372 DOI: 10.1590/0103-6440201600596] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/11/2016] [Indexed: 11/22/2022] Open
Abstract
Pregnancy is a period involving important metabolic changes that enable the maintenance of the mother's health and development of the fetus. This study aimed to assess the relationship among periodontal disease, insulin resistance, salivary cortisol concentration and level of perceived stress in pregnant women. This was a cross-sectional study. The sample comprised 96 pregnant women between the fifth and seventh month of pregnancy registered at the Basic Health Units of the Unified Health System (SUS). The periodontal condition was assessed after obtainment free and informed consent from the participants. Participants were divided into three groups: control subjects with a healthy periodontal condition (CN; n=46), patients with gingivitis (GI; n=26), and patients with periodontitis (PI; n=24). Saliva and blood samples were collected for evaluation of salivary cortisol concentration, glycemia, insulinemia and Homeostasis Model Assessment-Insulin Resistance index. A validated survey for the assessment of perceived stress levels was also performed. PI group showed significantly higher (p<0.05) blood glucose levels (CN: 4.43±0.05; GI: 4.46±0.04; PI: 4.68±0.08), insulinemia (CN: 6.93±0.45; GI: 8.87±0.79; PI: 12.77±1.30), insulin resistance (CN: 1.40±0.10; GI: 1.81±0.18; PI: 2.66±0.29) compared with the CN and GI groups. The levels of perceived stress were higher (p<0.05) in PI and GI groups when compared to CN group (CN: 20.5±1.26; GI: 25.8±1.95; PI: 26.6±1.36). There was no significant difference in the concentration of salivary cortisol between the groups (CN: 11.13±0.58; GI: 11.96±0.74; PI: 11.47±0.74). It was concluded that there is a relationship between higher levels of perceived stress, insulin resistance and the occurrence of periodontal disease during pregnancy. This study emphasizes the importance of preventing periodontitis in order to avoid insulin resistance and stress during pregnancy since these can cause systemic complications for the mother and the fetus.
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Affiliation(s)
| | - Fernando Yamamoto Chiba
- Department of Child and Social Dentistry, Araçatuba Dental School, Universidade Estadual Paulista, Araçatuba, SP, Brazil
| | - Renato Felipe Pereira
- Department of Basic Sciences, Araçatuba Dental School, Universidade Estadual Paulista, Araçatuba, SP, Brazil
| | | | - Suzely Adas Saliba Moimaz
- Department of Child and Social Dentistry, Araçatuba Dental School, Universidade Estadual Paulista, Araçatuba, SP, Brazil
| | - Doris Hissako Sumida
- Department of Basic Sciences, Araçatuba Dental School, Universidade Estadual Paulista, Araçatuba, SP, Brazil
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Abariga SA, Whitcomb BW. Periodontitis and gestational diabetes mellitus: a systematic review and meta-analysis of observational studies. BMC Pregnancy Childbirth 2016; 16:344. [PMID: 27825315 PMCID: PMC5101727 DOI: 10.1186/s12884-016-1145-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is glucose intolerance with first onset during pregnancy and is associated with serious maternal and fetal complications. The etiology of GDM is not well understood, but systemic inflammation effects on insulin signaling and glucose metabolism is suspected. Periodontal disease is a chronic inflammatory condition that induces local and host immune responses and has been evaluated for a potential role in development of GDM. Results from studies evaluating the association between periodontitis and GDM are mixed. We performed a systematic review and meta-analysis to summarize available data regarding the association between periodontitis and GDM. METHODS Twelve electronic databases were searched for observational studies of the association between periodontitis and GDM through March 2016. Eligible studies were assessed for quality and heterogeneity. Random effects models were used to estimate summary measures of association. RESULTS We identified 44 articles from 115 potentially relevant reports of which 10 studies met our eligibility criteria. Clinical diagnostic criteria for periodontitis and GDM varied widely among studies, and moderate heterogeneity was observed. Random effects meta-analysis of all included studies with a total of 5724 participants including 624 cases, showed that periodontitis is associated with an increased risk of GDM by 66 %, (OR = 1.66, 95 % CI: 1.17 to 2.36; p < 0.05), I2 = 50.5 %. Similar results were seen in sub-analysis restricted to data from methodologically high quality case-control studies including 1176 participants including 380 cases, (OR = 1.85, 95 % CI: 1.03 to 3.32); p < 0.05), I2 = 68.4 %. Meta-analysis of studies that adjusted for potential confounders estimated more than 2-fold increased odds of GDM among women with periodontitis (aOR = 2.08, 95 % CI: 1.21 to 3.58, p = 0.009, I2 = 36.9 %). CONCLUSION Meta-analysis suggests that periodontitis is associated with a statistically significant increased risk for GDM compared to women without periodontitis. Robust prospective study designs and uniform definition for periodontitis and GDM definitions are urgently needed to substantiate these findings.
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Affiliation(s)
- Samuel A Abariga
- Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, 415 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA.
| | - Brian W Whitcomb
- Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, 415 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
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Esteves Lima RP, Cyrino RM, de Carvalho Dutra B, Oliveira da Silveira J, Martins CC, Miranda Cota LO, Costa FO. Association Between Periodontitis and Gestational Diabetes Mellitus: Systematic Review and Meta-Analysis. J Periodontol 2015; 87:48-57. [PMID: 26334246 DOI: 10.1902/jop.2015.150311] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To the best of the authors' knowledge, there is no systematic review of the potential association between periodontitis and gestational diabetes mellitus (GDM) in the current literature. The aim of the present systematic review and meta-analysis is to search for scientific evidence regarding the association between periodontitis and GDM. METHODS The present study was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered (CRD2014010728) with PROSPERO (International prospective register for systematic reviews, University of York, York, UK). A search was conducted in three electronic databases without restrictions regarding language or date of publication. From 190 studies selected, 15 underwent full-text analysis. Eight studies were eligible (five cross-sectional and three case-control studies), and seven were entered in the meta-analysis. Meta-analysis was performed with tests for sensitivity and statistical heterogeneity. Summary effect measures were calculated by odds ratio (OR) and 95% confidence interval (CI). RESULTS There was a significant association between periodontitis and GDM in the meta-analyses of four cross-sectional studies (OR 1.67, 95% CI 1.20 to 2.32) and two case-control studies (OR 2.66, 95% CI 1.52 to 4.65). However, sensitivity tests for case-control studies showed a lack of consistency in data; when including one case-control study, the significance was null (meta-analysis of three case-control studies: OR 1.69, 95% CI 0.68 to 4.21). CONCLUSIONS There was substantial clinical, methodologic, and statistical heterogeneity among the studies. The scientific evidence cannot affirm a positive association between periodontitis and GDM. Future studies with different designs in distinct populations should be conducted to investigate this association.
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Affiliation(s)
| | - Renata Magalhães Cyrino
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Bernardo de Carvalho Dutra
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Carolina Castro Martins
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais
| | - Luis Otávio Miranda Cota
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Fernando Oliveira Costa
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Xie Y, Xiong X, Elkind-Hirsch KE, Pridjian G, Maney P, Delarosa RL, Buekens P. Prepregnancy Obesity and Periodontitis Among Pregnant Females With and Without Gestational Diabetes Mellitus. J Periodontol 2014; 85:890-8. [DOI: 10.1902/jop.2013.130502] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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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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Bullon P, Jaramillo R, Santos-Garcia R, Rios-Santos V, Ramirez M, Fernandez-Palacin A, Fernandez-Riejos P. Relation of Periodontitis and Metabolic Syndrome With Gestational Glucose Metabolism Disorder. J Periodontol 2014; 85:e1-8. [DOI: 10.1902/jop.2013.130319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Curtis M, Silk HJ, Savageau JA. Prenatal Oral Health Education in U.S. Dental Schools and Obstetrics and Gynecology Residencies. J Dent Educ 2013. [DOI: 10.1002/j.0022-0337.2013.77.11.tb05622.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Megan Curtis
- Swedish Family Medicine Residency First Hill Seattle WA
| | - Hugh J. Silk
- Department of Family Medicine and Community Health; University of Massachusetts Medical School
| | - Judith A. Savageau
- Department of Family Medicine and Community Health; University of Massachusetts Medical School
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15
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Esteves Lima RP, Miranda Cota LO, Costa FO. Association Between Periodontitis and Gestational Diabetes Mellitus: A Case-Control Study. J Periodontol 2013; 84:1257-65. [DOI: 10.1902/jop.2012.120350] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chokwiriyachit A, Dasanayake AP, Suwannarong W, Hormdee D, Sumanonta G, Prasertchareonsuk W, Wara-Aswapati N, Combellick J, Pitiphat W. Periodontitis and gestational diabetes mellitus in non-smoking females. J Periodontol 2012; 84:857-62. [PMID: 23075430 DOI: 10.1902/jop.2012.120344] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic inflammation has been implicated in the pathogenesis of gestational diabetes mellitus (GDM). Periodontal disease is associated with increased levels of inflammatory mediators and may be a risk factor for GDM. The authors aimed to examine the association between periodontitis and GDM among non-smoking pregnant females. METHODS This case-control study included 50 females who were diagnosed with GDM and 50 age- and hospital-matched females without diabetes in Khon Kaen, Thailand. Full-mouth periodontal examinations were performed during pregnancy by two calibrated dentists who were unaware of the case-control status. Periodontitis was defined as ≥1 site with probing depth (PD) ≥5 mm and clinical attachment level (CAL) ≥2 mm at the same site. Serum samples were collected to measure C-reactive protein (CRP), tumor necrosis factor-α, and interleukin-6 levels. Analyses were performed using conditional logistic regression. RESULTS Fifty percent of the case females had periodontitis compared to 26% of the controls. Females with GDM had significantly higher mean PD and CAL, more sites with bleeding on probing, and increased levels of CRP compared to the controls. Periodontitis was significantly associated with GDM (odds ratio = 3.00, 95% confidence interval = 1.19 to 7.56). The association remained significant with additional adjustment for family history of diabetes, prepregnancy body mass index, and weight gain during pregnancy. CONCLUSIONS The results suggest that periodontitis is associated with GDM. Therefore, clinicians should assess periodontal conditions of pregnant females.
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Affiliation(s)
- Anyarat Chokwiriyachit
- Department of Periodontology, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
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Xie Y, Xiong X, Elkind-Hirsch KE, Pridjian G, Maney P, Delarosa RL, Buekens P. Change of periodontal disease status during and after pregnancy. J Periodontol 2012; 84:725-31. [PMID: 22873653 DOI: 10.1902/jop.2012.120235] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study explored whether there is any change of periodontal disease status during and after pregnancy. We also examined whether the change is different between females with a history of gestational diabetes mellitus (GDM) and females without GDM during pregnancy. METHODS A follow-up study was conducted at Woman's Hospital, Baton Rouge, Louisiana. Thirty-nine females who were previously enrolled in a case-control study during pregnancy were followed an average of 22 months postpartum. Periodontal status was assessed through dental examinations performed both during and after pregnancy. Clinical periodontal parameters included bleeding on probing (BOP), mean probing depth (PD), and mean clinical attachment level (CAL). Periodontitis was defined as the presence of ≥1 sites exhibiting PD ≥4 mm or CAL ≥4 mm. We used generalized estimating equation analysis to examine the change of periodontal status. RESULTS Mean number and percentage of sites with BOP decreased from 10.7 ± 11.6 (mean ± SD) and 6.5% ± 7.0% during pregnancy to 7.1 ± 8.8 and 4.3% ± 5.3% at 22 months postpartum (P <0.05), respectively. Mean levels of PD and CAL decreased from 1.8 ± 0.4 mm and 1.9 ± 0.3 mm to 1.6 ± 0.3 mm and 1.6 ± 0.3 mm (P <0.01), respectively. The prevalence of periodontitis decreased from 66.7% to 33.3% (P <0.01, adjusted risk ratio = 2.1, 95% confidence interval = 1.3 to 3.4). There was no difference in the change of periodontal status between females with GDM and females without GDM during pregnancy. CONCLUSIONS Pregnancy may be associated with an increased risk of periodontal disease. The association is not different between females with GDM and females without GDM during pregnancy.
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Affiliation(s)
- Yiqiong Xie
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
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