1
|
Alhomaid AM, Moin Ahmed M. Prevalence of Non-diabetic Hyperglycemia in Young Adults and Its Impact on Periodontal Health. Cureus 2024; 16:e53847. [PMID: 38465110 PMCID: PMC10924652 DOI: 10.7759/cureus.53847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Background Non-diabetic hyperglycemia is a transitional phase of hyperglycemia that poses a hidden risk for the development of diabetes mellitus and related complications, including periodontal destruction. The current study sought to determine the prevalence of non-diabetic hyperglycemia in young adults and any possible links to periodontal health. Methods A total of 400 participants in this cross-sectional study were evaluated for non-diabetic hyperglycemia between the ages of 18 and 35 years. Group I consisted of non-diabetic hyperglycemic participants. Group II comprised an equal number of matched, healthy subjects. The groups' hyperglycemic and clinical periodontal characteristics were contrasted. Using a one-sample t-test and logistic regression analysis, the acquired data were subjected to statistical analysis. Results The prevalence of non-diabetic hyperglycemia was 19%, with men (13%) having a higher prevalence than women (6%). The mean fasting plasma glucose and hemoglobin A1c (HbA1c) levels were 114.47 ± 6.40 mg/dL and 6.10 ± 0.21%, respectively, for group I, and 85.72 ± 7.24 mg/dL and 4.38 ± 0.70% for group II. When compared to healthy controls, all periodontal parameters, including plaque index, gingival index, bleeding on probing, probing depth, and clinical attachment loss, were significantly higher in group I non-diabetic hyperglycemic patients. The regression analysis revealed statistically significant links between hyperglycemic and periodontal parameters. Conclusion The prevalence of non-diabetic hyperglycemia among young adults is a serious concern similar to that of older adults with the risk for periodontal diseases. Non-diabetic hyperglycemic considerations in young adults should be emphasized in dental and medical clinics to reduce the risk of developing diabetes mellitus and to avoid irreversible periodontal tissue damage.
Collapse
Affiliation(s)
| | - Muzammil Moin Ahmed
- Dental and Oral Health, College of Applied Health Sciences in Ar Rass, Qassim University, Ar Rass, SAU
| |
Collapse
|
2
|
Kabisch S, Hedemann OS, Pfeiffer AFH. Periodontitis, age-related diseases and diabetes in an endocrinological outpatient setting (PARADIES): a cross-sectional analysis on predictive factors for periodontitis in a German outpatient facility. Acta Diabetol 2022; 59:675-686. [PMID: 34984561 PMCID: PMC8995287 DOI: 10.1007/s00592-021-01838-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is a risk factor for periodontitis. Data on risk-modifying factors for periodontitis in diabetes patients are limited. AIMS We tested whether sex, age, type of diabetes, metabolic state, comorbidities, complications, measures of well-being and quality of life are predicting periodontitis in a German diabetes outpatient cohort. METHODS In total, 1180 out of 1293 participating DM patients completed questionnaires on quality of life, dental hygiene and health. All patients also filled out a modified version of the periodontitis risk questionnaire by the American Association for Periodontology, from which the status of "assumed periodontitis" was deducted. In a subset of participants (n = 461), we measured or inquired the most recent Community Parodontal Index (CPI), providing an objective measure for clinically diagnosed periodontitis. For all subjects, DM history and phenotype, major metabolic parameters (HbA1c, BMI, LDL and total cholesterol levels), general health risk factors, comorbidities and medication were collected. RESULTS Clinically diagnosed (CPI > 2) and assumed periodontitis was detected in 60-67% of our patients. Male sex and oral health-related quality of life were associated with clinically diagnosed periodontitis. Male sex, age, smoking, dental hygiene, dental control and diabetes-related quality of life independently predicted assumed periodontitis. CONCLUSION In DM patients, quality of life and lifestyle factors which systemically alter microvascular and immunological functions seem to predict periodontitis. Further studies are needed for replication and for pathomechanistic clarification.
Collapse
Affiliation(s)
- Stefan Kabisch
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Hindenburgdamm 30, 12203, Berlin, Germany.
- Deutsches Zentrum Für Diabetesforschung E.V., Geschäftsstelle Am Helmholtz-Zentrum München, Ingolstädter Landstraße 1, Neuherberg, 85764, Neuherberg, Germany.
| | - Oda Sophia Hedemann
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Hindenburgdamm 30, 12203, Berlin, Germany
- Deutsches Zentrum Für Diabetesforschung E.V., Geschäftsstelle Am Helmholtz-Zentrum München, Ingolstädter Landstraße 1, Neuherberg, 85764, Neuherberg, Germany
- Praxis Am Posthof, Hameln, Germany
| | - Andreas F H Pfeiffer
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Hindenburgdamm 30, 12203, Berlin, Germany
- Deutsches Zentrum Für Diabetesforschung E.V., Geschäftsstelle Am Helmholtz-Zentrum München, Ingolstädter Landstraße 1, Neuherberg, 85764, Neuherberg, Germany
| |
Collapse
|
3
|
Barutta F, Bellini S, Durazzo M, Gruden G. Novel Insight into the Mechanisms of the Bidirectional Relationship between Diabetes and Periodontitis. Biomedicines 2022; 10:biomedicines10010178. [PMID: 35052857 PMCID: PMC8774037 DOI: 10.3390/biomedicines10010178] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 02/01/2023] Open
Abstract
Periodontitis and diabetes are two major global health problems despite their prevalence being significantly underreported and underestimated. Both epidemiological and intervention studies show a bidirectional relationship between periodontitis and diabetes. The hypothesis of a potential causal link between the two diseases is corroborated by recent studies in experimental animals that identified mechanisms whereby periodontitis and diabetes can adversely affect each other. Herein, we will review clinical data on the existence of a two-way relationship between periodontitis and diabetes and discuss possible mechanistic interactions in both directions, focusing in particular on new data highlighting the importance of the host response. Moreover, we will address the hypothesis that trained immunity may represent the unifying mechanism explaining the intertwined association between diabetes and periodontitis. Achieving a better mechanistic insight on clustering of infectious, inflammatory, and metabolic diseases may provide new therapeutic options to reduce the risk of diabetes and diabetes-associated comorbidities.
Collapse
|
4
|
Nagasaki M, Nakai K, Tanaka H, Ozaki M, Kato K, Koshi R, Maeno M, Nishikubo S, Kawato T, Tonogi M. Lipopolysaccharide and High Concentrations of Glucose Enhances Zoledronate-induced Increase in RANKL/OPG Ratio by Upregulating PGE 2 Production in Osteoblasts. J HARD TISSUE BIOL 2021. [DOI: 10.2485/jhtb.30.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Kumiko Nakai
- Department of Oral Health Sciences, Nihon University School of Dentistry
- Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry
| | - Hideki Tanaka
- Department of Oral Health Sciences, Nihon University School of Dentistry
- Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry
| | - Manami Ozaki
- Department of Oral Health Sciences, Nihon University School of Dentistry
- Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry
| | - Kengo Kato
- Nihon University Graduate School of Dentistry
| | - Ryosuke Koshi
- Department of Oral Health Sciences, Nihon University School of Dentistry
| | | | - Shuichi Nishikubo
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry
- Division of Oral Structural and Functional Biology, Nihon University School of Dentistry
| | - Takayuki Kawato
- Department of Oral Health Sciences, Nihon University School of Dentistry
- Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry
| | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry
- Division of Oral Structural and Functional Biology, Nihon University School of Dentistry
| |
Collapse
|
5
|
Gaddikeri K, Abidullah M, Bhorgonde D. Cytological and Cytomorphometric Study of Exfoliated Cells of the Oral Mucosa in Diabetic Patients. J Pharm Bioallied Sci 2020; 12:S86-S90. [PMID: 33149436 PMCID: PMC7595538 DOI: 10.4103/jpbs.jpbs_32_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: 01/23/2020] [Revised: 02/24/2020] [Accepted: 03/13/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Systemic disorder like diabetes mellitus is on the rise in developing countries like India and in many parts of the world. Early diagnosis of this disease will help to prevent the complications due to uncontrolled diabetes mellitus. Dentist helps in the early diagnosis of this disease as patients manifest several oral manifestations. Aims and Objectives: The aim of this study was to study the cytological and cytomorphometric changes of exfoliated cells of oral mucosa in diabetic patients. Materials and Methods: Thirty diabetic patients and 15 healthy controls were included in the study. From the buccal mucosa, smears were collected and Papanicolaou stain was used for staining. Cytological and cytomorphometric study was carried out. The cell diameter and nuclear diameter were measured on these smears and were compared with the control group with the help of “unpaired Student t test.” Results: Buccal mucosa exfoliated cells’ mean nuclear diameter of diabetic group and control group was 11.198 and 9.494 µm, respectively and the difference was highly significant. Conclusion: Our study suggests significant cellular changes in the diabetic patients, which may aid us in early detection of diabetes.
Collapse
Affiliation(s)
- Kavitha Gaddikeri
- Department of Oral Pathology, ESIC Dental College, Gulburga, Karnataka, India
| | - Mohammed Abidullah
- Department of Dental and Biomedical Sciences, Faculty of Dentistry, Al Baha University, Al Baha, Saudi Arabia
| | - Deepak Bhorgonde
- Shree Guru Siddalingeshwara Dental Clinic, Bidar, Karnataka, India
| |
Collapse
|
6
|
Yadav A, Anmol Manaswini Yadav G, Nk K, Lg NK, Yadav GSN, Akulwar RK, Myakalwar PD. Predictors of periodontal disease among rural Indian type 2 diabetic population. Diabetes Metab Syndr 2020; 14:463-467. [PMID: 32380406 DOI: 10.1016/j.dsx.2020.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Periodontal Disease (PD) is associated with complications of diabetes. Control of the PD reduces glycated hemoglobin (HbA1c) level. This study aimed to evaluate the relationship of PD with duration, severity of diabetes and eGFR. MATERIAL AND METHOD A Prospective observational study conducted at Sidhi Vinayaka Hospitals (SVH) Sangareddy during the period of January 2014 to December 2019. Total 1436 patients with a definite diagnosis of type 2 diabetes (T2DM), between the ages of 45-60 years were included. They were classified according to CPITN score for PD and compared against the variables. RESULTS A total of 1436 consecutive outpatients attending to SVH were included. Among them 662 (46.1%) were males and 774(53.9%) were females. The mean age of the patients was 48.3(SD ± 10.62) and mean duration of diabetes was 2.9(SD ± 4.18). The mean fasting blood glucose was 198.5(SD ± 85), mean post prandial blood glucose was 277.2 (SD ± 107.7) and mean HBA1c was 9.98% (SD ± 2.6). Among the study group 1198 (83.4%) had none/mild (Grade I) PD, 192(13.4%) had moderate/severe (Grade II) PD and 46(3.2%) were completely edentulous (Grade III). CONCLUSION There is a linear correlation between PD and age of patient, duration of diabetes, eGFR and level of glycemic status among rural population with T2DM.
Collapse
Affiliation(s)
- Anurag Yadav
- Department of Biochemistry, MNR Medical College, MNR Nagar, Sangareddy, Telangana, 502295, India.
| | | | - Kaveri Nk
- Department of Physiology, MNR Medical College, MNR Nagar, Sangareddy, Telangana, 502295, India.
| | - Nanda Kumar Lg
- Department of Physiology, MNR Medical College, MNR Nagar, Sangareddy, Telangana, 502295, India.
| | | | - Ravi Kumar Akulwar
- Department of Prosthodontics Government Dental College and Hospital, St George Hospital Campus, PD Mello Road CST, Mumbai, 400001, India.
| | | |
Collapse
|
7
|
Rawal I, Ghosh S, Hameed SS, Shivashankar R, Ajay VS, Patel SA, Goodman M, Ali MK, Narayan KMV, Tandon N, Prabhakaran D. Association between poor oral health and diabetes among Indian adult population: potential for integration with NCDs. BMC Oral Health 2019; 19:191. [PMID: 31429749 PMCID: PMC6701092 DOI: 10.1186/s12903-019-0884-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/13/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Studies in high-income countries have reported associations between oral health and diabetes. There is however a lack of evidence on this association from low and middle-income countries, especially India. The current study aimed to assess the prevalence of common oral diseases and their association with diabetes. METHODS This cross-sectional study was nested within the second Cardiometabolic Risk Reduction in South Asia Surveillance Study. A subset of study participants residing in Delhi were administered the World Health Organization's Oral Health Assessment Questionnaire and underwent oral examination for caries experience and periodontal health assessment using standard indices. Diabetes status was ascertained by fasting blood glucose, glycosylated hemoglobin values or self-reported medication use. Information was captured on co-variates of interest. The association between oral health and diabetes was investigated using Multivariable Zero-Inflated Poisson (ZIP) regression analysis. RESULTS Out of 2045 participants, 47% were women and the mean age of study participants was 42.17 (12.8) years. The age-standardised prevalence (95% confidence interval) estimates were 78.9% (75.6-81.7) for dental caries, 35.9% (32.3-39.6) for periodontitis. Nearly 85% participants suffered from at least one oral disease. Compared to diabetes-free counterparts, participants with diabetes had more severe caries experience [Mean Count Ratio (MCR) = 1.07 (1.03-1.12)] and attachment loss [MCR = 1.10 (1.04-1.17)]. Also, the adjusted prevalence of periodontitis was significantly higher among participants with diabetes [42.3%(40.0-45.0)] compared to those without diabetes [31.3%(30.3-32.2)]. CONCLUSION We found that eight out of ten participants in urban Delhi suffered from some form of oral disease and participants with diabetes had worse oral health. This highlights the need for public health strategies to integrate oral health within the existing Non-Communicable Disease control programs.
Collapse
Affiliation(s)
- Ishita Rawal
- Centre for Chronic Disease Control, C-1/52, 2nd Floor, Safdarjung Development Area, New Delhi, 110016 India
| | - Shreeparna Ghosh
- Immunization Technical Support Unit (ITSU-MoHFW), B-28 Qutub Institutional Area (first floor), New Delhi, India
| | - Safraj Shahul Hameed
- Centre for Chronic Disease Control, C-1/52, 2nd Floor, Safdarjung Development Area, New Delhi, 110016 India
| | - Roopa Shivashankar
- Centre for Chronic Disease Control, C-1/52, 2nd Floor, Safdarjung Development Area, New Delhi, 110016 India
| | - Vamadevan S. Ajay
- Centre for Chronic Disease Control, C-1/52, 2nd Floor, Safdarjung Development Area, New Delhi, 110016 India
| | - Shivani Anil Patel
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA USA
| | - Michael Goodman
- Emory University Rollins School of Public Health, 1518 Clifton Road, NE CNR 3021, Atlanta, GA USA
| | - Mohammed K. Ali
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA USA
| | - K. M. Venkat Narayan
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA USA
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar (East), New Delhi, 110029 India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, C-1/52, 2nd Floor, Safdarjung Development Area, New Delhi, 110016 India
- Public Health Foundation of India, Plot No. 47, Sector 44, Gurgaon, 122002 India
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
8
|
Makkar H, Reynolds MA, Wadhawan A, Dagdag A, Merchant AT, Postolache TT. Periodontal, metabolic, and cardiovascular disease: Exploring the role of inflammation and mental health. Pteridines 2018; 29:124-163. [PMID: 30705520 PMCID: PMC6350811 DOI: 10.1515/pteridines-2018-0013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Previous evidence connects periodontal disease, a modifiable condition affecting a majority of Americans, with metabolic and cardiovascular morbidity and mortality. This review focuses on the likely mediation of these associations by immune activation and their potential interactions with mental illness. Future longitudinal, and ideally interventional studies, should focus on reciprocal interactions and cascading effects, as well as points for effective preventative and therapeutic interventions across diagnostic domains to reduce morbidity, mortality and improve quality of life.
Collapse
Affiliation(s)
- Hina Makkar
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Mark A Reynolds
- Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Abhishek Wadhawan
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Aline Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Teodor T Postolache
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO 80220, USA; Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD 21201, USA,
| |
Collapse
|
9
|
Catanzaro DP, Mena Laura EE, Cestari TM, Arantes RVN, Garlet GP, Taga R, Assis GF. Green tea prevents vascular disturbs and attenuates periodontal breakdown in long-term hyperglycaemia in T1D rats. J Clin Periodontol 2018; 45:557-569. [PMID: 29500839 DOI: 10.1111/jcpe.12883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 12/11/2022]
Abstract
AIM The effects of green tea on the modulation of vascularization during the progression of spontaneous periodontitis in long-term hyperglycaemia in streptozotocin-induced type 1 diabetic (T1D) rats were evaluated. MATERIALS AND METHODS Wistar rats normoglycaemic (NG) and T1D were divided into two control groups, which received water (NG-W and T1D-W) and two experimental groups that received green tea (NG-GT and T1D-GT). Periodontal structures were evaluated by microtomographic and histological analyses. Number of immunostained cells for VEGF (NcVEGF+/mm2 ) and CD31 (NcCD31+/mm2 ), as well microvessel density (MVD) in the periodontal ligament (PDL) were evaluated. RESULTS Long-term hyperglycaemia in T1D-W rats induced vascular alterations in PDL with a reduction of 36% in MVD, a decrease of 33% in NcCD31+/mm2 and an increase of 53% in NcVEGF+/mm2 . Concomitantly, a severe degree of periodontitis with higher reduction in bone volume and periodontal bone level was observed. In T1D-GT, green tea maintained the MVD, NcCD31+/mm2 and NcVEGF+/mm2 in the PDL similar to normoglycaemic groups. Clinically, in T1D-GT rats, green tea reduced dental plaque accumulation and the degree of periodontitis when compared to T1D-W. CONCLUSION Daily green tea consumption has a therapeutic effect on the diabetic vascular disorder in PDL and the progression of periodontitis in long-term hyperglycaemia in T1D rats.
Collapse
Affiliation(s)
- Daniela Pereira Catanzaro
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Ever Elias Mena Laura
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Tania Mary Cestari
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Gustavo Pompermaier Garlet
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Rumio Taga
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Gerson Francisco Assis
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| |
Collapse
|
10
|
Abu-Ashour W, Twells L, Valcour J, Randell A, Donnan J, Howse P, Gamble JM. The association between diabetes mellitus and incident infections: a systematic review and meta-analysis of observational studies. BMJ Open Diabetes Res Care 2017; 5:e000336. [PMID: 28761647 PMCID: PMC5530269 DOI: 10.1136/bmjdrc-2016-000336] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/03/2017] [Accepted: 03/21/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To quantify the association between diabetes and the risk of incident infections by conducting a systematic review and meta-analysis. RESEARCH DESIGN AND METHODS Two reviewers independently screened articles identified from PubMed, EMBASE, Cochrane Library, IPA, and Web of Science databases. Cohort studies (CS) or case-control studies (CCS) evaluating the incidence of infections in adults with diabetes were included. Infections were classified as: skin and soft tissue, respiratory, blood, genitourinary, head and neck, gastrointestinal, bone, viral, and non-specified infections. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Summary crude and adjusted OR with 95% CIs were calculated using random effects models, stratified by study design. Heterogeneity was measured using the I2statistic and explored using subgroup analyses. RESULTS A total of 345 (243 CS and 102 CCS) studies were included. Combining adjusted results from all CS, diabetes was associated with an increased incidence of skin (OR 1.94, 95% CI 1.78 to 2.12), respiratory (OR 1.35, 95% CI 1.28 to 1.43), blood (OR 1.72, 95% CI 1.48 to 2.00), genitourinary (OR 1.61, 95% CI 1.42 to 1.82), head and neck (OR 1.17, 95% CI 1.13 to 1.22), gastrointestinal (OR 1.48, 95% CI 1.40 to 1.57), viral (OR 1.29, 95% CI 1.13 to 1.46), and non-specified (OR 1.84, 95% CI 1.66 to 2.04) infections. A stronger association was observed among CCS: skin (OR 2.64, 95% CI 2.20 to 3.17), respiratory (OR 1.62, 95% CI 1.37 to 1.92), blood (OR 2.40, 95% CI 1.68 to 3.42), genitourinary (OR 2.59, 95% CI 1.60 to 4.17), gastrointestinal (OR 3.61, 95% CI 2.94 to 4.43), and non-specified (OR 3.53, 95% CI 2.62 to 4.75). CONCLUSION Diabetes is associated with an increased risk of multiple types of infections. A high degree of heterogeneity was observed; however, subgroup analysis decreased the amount of heterogeneity within most groups. Results were generally consistent across types of infections.
Collapse
Affiliation(s)
- Waseem Abu-Ashour
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Laurie Twells
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - James Valcour
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Amy Randell
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Jennifer Donnan
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Patricia Howse
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - John-Michael Gamble
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| |
Collapse
|
11
|
Huang Y, Guo W, Zeng J, Chen G, Sun W, Zhang X, Tian W. Prediabetes Enhances Periodontal Inflammation Consistent With Activation of Toll-Like Receptor-Mediated Nuclear Factor-κB Pathway in Rats. J Periodontol 2015; 87:e64-74. [PMID: 26643223 DOI: 10.1902/jop.2015.150522] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Clinical studies have showed that prediabetes (preDM) is a predisposing factor for periodontitis. However, the pathogenic mechanism involved is unclear. Because it is known that the activation of Toll-like receptor (TLR)-mediated nuclear factor-kappa B (NF-κB) signaling pathway plays a crucial role in periodontitis, it is hypothesized that preDM enhances periodontal inflammation by activation of the TLR-mediated NF-κB pathway. METHODS In this study, a preDM rat model is established by feeding a high-fat diet (HFD). HFD-induced rats with preDM (n = 7) and normal chow-fed rats (n = 7) were studied. The animal model was characterized in terms of body weight and the glycemic and insulinemic profiles. The following parameters were assessed to evaluate possible early periodontal alterations and underlying mechanisms: 1) histology analysis of periodontal tissue; and 2) serum and mRNA levels and/or the tissue protein expression of TLRs, myeloid differentiation factor 88 (MyD88), tumor necrosis factor (TNF) receptor-associated factor 6 (TRAF6), NF-κB, cytokines, advanced glucose ends (AGEs), and free fatty acids (FFAs). RESULTS Rats with preDM presented higher expression of TLR2 and TLR4 in periodontal tissue in the HFD group compared with the control group. The TLR2 and TLR4 was mostly expressed in gingiva, and TLR4 was expressed in periodontal ligament in rats. Furthermore, the MyD88 and TRAF6 protein levels were significantly increased in gingiva in rats with preDM compared with normal rats. The activity of NF-κB signals was higher in rats with preDM than in normal rats. Regarding cytokines expression, the TNF-α protein levels and interleukin-1β mRNA levels were significantly increased in the HFD group compared with the control group. In the serum, AGEs levels were significantly increased in the rats with preDM. Mean FFAs concentrations were increased in rats with preDM compared with normal rats, but it did not reach statistical significance. CONCLUSION In rats with preDM, TLR2 and TLR4 gene and protein levels were higher in periodontal tissue, and the activation of NF-κB may, through TLRs/MyD88, cause more cytokine secretion, which is associated with the onset or development of periodontal disease.
Collapse
Affiliation(s)
- Yanli Huang
- National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University.,Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University
| | - Weihua Guo
- National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University.,Department of Pedodontics, West China School of Stomatology, Sichuan University
| | - Jin Zeng
- National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University
| | - Guoqing Chen
- National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University
| | - Wenhua Sun
- National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University
| | - Xuexin Zhang
- National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University.,Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University
| | - Weidong Tian
- National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University.,Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University
| |
Collapse
|
12
|
Milic MS, Brkovic B, Krsljak E, Stojic D. Comparison of pulpal anesthesia and cardiovascular parameters with lidocaine with epinephrine and lidocaine with clonidine after maxillary infiltration in type 2 diabetic volunteers. Clin Oral Investig 2015; 20:1283-93. [PMID: 26427866 DOI: 10.1007/s00784-015-1610-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/21/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The pulpal anesthetic and cardiovascular parameters obtained by 2 % lidocaine with epinephrine (LE; 1:80,000) or clonidine (LC; 15 mcg/ml) were studied in diabetes mellitus (DM) type 2 and healthy volunteers (72), after maxillary infiltration anesthesia. MATERIALS AND METHODS Onset and duration of pulpal anesthesia were measured by electric pulp tester; vasoconstrictive effect of used local anesthetic mixtures by laser Doppler flowmetry (LDF) through pulpal blood flow (PBF); systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were registered by electrocardiogram monitoring. RESULTS Onset of pulpal anesthesia was shorter for LC than for LE in healthy, while it was not different in diabetic participants; duration of pulpal anesthesia was significantly longer in type 2 diabetic participants, regardless of used anesthetic mixture. Significant reduction of PBF with LE was observed during 45 min in healthy and 60 min in diabetic participants, while with LC such reduction was observed during 45 min in both groups. LE caused a significant increase of SBP in the 5th and 15th minutes in diabetic versus healthy participants, while LC decreased SBP from the 10th to 60th minutes in healthy versus diabetic participants. CONCLUSIONS DM type 2 influences duration of maxillary infiltration anesthesia obtained with LE and LC, and systolic blood pressure during LE anesthesia. CLINICAL RELEVANCE The obtained results provide elements for future protocols concerning intraoral local anesthesia in DM type 2 patients.
Collapse
Affiliation(s)
- Marija S Milic
- Clinic of Oral Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Bozidar Brkovic
- Clinic of Oral Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Elena Krsljak
- Department of Physiology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragica Stojic
- Department of Pharmacology in Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
| |
Collapse
|
13
|
Llambés F, Arias-Herrera S, Caffesse R. Relationship between diabetes and periodontal infection. World J Diabetes 2015; 6:927-935. [PMID: 26185600 PMCID: PMC4499526 DOI: 10.4239/wjd.v6.i7.927] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/23/2014] [Accepted: 03/20/2015] [Indexed: 02/05/2023] Open
Abstract
Periodontal disease is a high prevalent disease. In the United States 47.2% of adults ≥ 30 years old have been diagnosed with some type of periodontitis. Longitudinal studies have demonstrated a two-way relationship between diabetes and periodontitis, with more severe periodontal tissue destruction in diabetic patients and poorer glycemic control in diabetic subjects with periodontal disease. Periodontal treatment can be successful in diabetic patients. Short term effects of periodontal treatment are similar in diabetic patients and healthy population but, more recurrence of periodontal disease can be expected in no well controlled diabetic individuals. However, effects of periodontitis and its treatment on diabetes metabolic control are not clearly defined and results of the studies remain controversial.
Collapse
|
14
|
Duarte PM, Sowa MG, Xiang X, Zhang C, Santos VR, Miranda TS, Reis AF, Liu KZ. Assessment of the hemodynamic profile in periodontal tissues of diabetic subjects with periodontitis by optical spectroscopy. J Periodontal Res 2014; 50:594-601. [PMID: 25369875 DOI: 10.1111/jre.12239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The influence of diabetes mellitus (DM) on the hemodynamics of periodontal tissues has not been assessed previously. The primary objective of this study was to validate optical spectroscopy as a periodontal diagnostic tool for subjects with type 2 DM and chronic periodontitis. MATERIAL AND METHODS Using a portable optical near-infrared spectrometer, optical spectra were obtained from healthy (n = 127), gingivitis (n = 115), and periodontitis (n = 109) sites of 65 subjects with type 2 DM and chronic periodontitis. Healthy (n = 65) sites of 15 nondiabetic subjects without periodontitis were used as controls. A modified Beer-Lambert unmixing model that incorporates a nonparametric scattering-loss function was used to determine the relative contribution of deoxygenated hemoglobin and oxygenated hemoglobin (HbO2 ) to the overall spectrum. The balance between tissue oxygen delivery and oxygen utilization in periodontal tissues was assessed. RESULTS In diabetic subjects, tissue oxygen saturation and HbO2 concentration were significantly decreased in the periodontitis sites (p < 0.01) compared with the healthy and gingivitis sites. Furthermore, tissue oxygenation in healthy sites of control subjects was significantly higher than that in sites of diabetic subjects (p < 0.01). CONCLUSION In summary, the results of this study suggest that optical spectroscopy can monitor the hemodynamic profile in diabetic subjects with chronic periodontitis. Furthermore, healthy sites of diabetic subjects presented lower tissue oxygenation than did those of nondiabetic subjects.
Collapse
Affiliation(s)
- P M Duarte
- Dental Research Division, Department of Periodontology, Guarulhos University, Guarulhos, SP, Brazil
| | - M G Sowa
- Medical Devices Portfolio, National Research Council of Canada, Winnipeg, Manitoba, Canada
| | - X Xiang
- Department of Dental Diagnostics and Surgical Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - C Zhang
- The Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - V R Santos
- Dental Research Division, Department of Periodontology, Guarulhos University, Guarulhos, SP, Brazil
| | - T S Miranda
- Dental Research Division, Department of Periodontology, Guarulhos University, Guarulhos, SP, Brazil
| | - A F Reis
- Dental Research Division, Department of Operative Dentistry, Guarulhos University, Guarulhos, SP, Brazil
| | - K-Z Liu
- Medical Devices Portfolio, National Research Council of Canada, Winnipeg, Manitoba, Canada.,Department of Dental Diagnostics and Surgical Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
15
|
Timonen P, Saxlin T, Knuuttila M, Suominen AL, Jula A, Tervonen T, Ylöstalo P. Role of insulin sensitivity and beta cell function in the development of periodontal disease in adults without diabetes. J Clin Periodontol 2014; 40:1079-86. [PMID: 24192072 DOI: 10.1111/jcpe.12162] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2013] [Indexed: 01/22/2023]
Abstract
AIM The goal of this study was to explore whether insulin resistance and beta cell function are related to periodontal pocket formation, indicative of infectious periodontal disease in non-smoking adults without manifest diabetes. MATERIAL AND METHODS We analysed data from a Health 2000 Survey consisting of dentate subjects without any indication of diabetes, aged between 30 and 64, who had never smoked and who had participated in the Follow-up Study on Finnish Adults' Oral Health about 4 years later (n = 157). The Homeostasis Model Assessment Indices were used to measure insulin resistance (HOMA-IR) and β-cell function (HOMA-B). The development of periodontal disease was measured by means of the incidence of deepened periodontal pockets (4 mm deep or deeper) during the follow-up period. Incidence rate ratios (IRR) were estimated using Poisson regression models. RESULTS Both HOMA-IR and HOMA-B indices were associated with periodontal pocket formation during the 4-year follow-up. CONCLUSION The results of this follow-up study suggest that impaired glucose metabolism measured as insulin resistance and altered beta cell function predict the breakdown of periodontal tissues. Further studies about their role in the pathogenesis of periodontal diseases are needed.
Collapse
Affiliation(s)
- Petra Timonen
- Department of Periodontology and Geriatric Dentistry, Institute of Dentistry, University of Oulu, Oulu, Finland
| | | | | | | | | | | | | |
Collapse
|
16
|
Soboku K, Kikuchi T, Fujita S, Takeda H, Naruse K, Matsubara T, Noguchi T. Altered Gene Expression in Gingival Tissues and Enhanced Bone Loss in Rats With Diabetes With Experimental Periodontitis. J Periodontol 2014; 85:455-64. [DOI: 10.1902/jop.2013.120705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
17
|
Andriankaja OM, Joshipura K. Potential association between prediabetic conditions and gingival and/or periodontal inflammation. J Diabetes Investig 2014; 5:108-114. [PMID: 24729853 PMCID: PMC3980950 DOI: 10.1111/jdi.12122] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 06/06/2013] [Accepted: 06/14/2013] [Indexed: 12/31/2022] Open
Abstract
AIMS/INTRODUCTION Prediabetic conditions, which include impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), might be associated with chronic gingival and/or periodontal inflammation. However, the occurrence of this oral inflammation in prediabetic conditions is poorly understood. The present study aimed to assess the association between prediabetes and gingival and/or periodontal inflammation. MATERIALS AND METHODS A total of 94 Puerto Rican men and women aged 40-65 years, who were residents of San Juan, Puerto Rico, and free of diabetes, were included in the study. All participants had at least one tooth site with clinical attachment loss ≥3 mm. Fasting and 2-h plasma glucose were collected. Gingival/periodontal inflammation was assessed by bleeding on gentle probing of the sulcus at six sites per tooth. RESULTS Participants with the percentage of teeth with bleeding on probing (BOP) equal to or greater than the median were compared with those with the percentage of teeth with BOP less than median. Participants with high BOP tended to present higher IFG (odds ratio [OR] 5.5, 95% confidence interval [CI] 1.2-25.3) and/or prediabetic condition (OR 3.6, 95% CI 1.0-13.2) than those with a low percentage of BOP, adjusting for age, sex, smoking, alcohol consumption, waist circumference and number of missing teeth. Using the continuous form of the outcome, the corresponding adjusted least squares means of percentage of BOP were 26.8 (standard error of the mean [SEM] 2.3) and 43.8 (SEM 6.0) in normal and IFG, respectively (P = 0.01), and 27.0 (SEM 2.4) and 39.0 (SEM 5.3) among healthy and prediabetic individuals, respectively (P = 0.05). CONCLUSION IFG and/or prediabetes are strongly associated with BOP, a marker of chronic gingival/periodontal inflammation.
Collapse
Affiliation(s)
- Oelisoa Mireille Andriankaja
- Center for Clinical Research and Health PromotionSchool of Dental MedicineUniversity of Puerto RicoSan JuanPuerto Rico
| | - Kaumudi Joshipura
- Center for Clinical Research and Health PromotionSchool of Dental MedicineUniversity of Puerto RicoSan JuanPuerto Rico
| |
Collapse
|
18
|
Patel PV, Gujjari SK. Cytomorphometric analysis of the gingival epithelium in type 2 diabetic patients with and without smoking habit. J Cytol 2013; 30:109-15. [PMID: 23833400 PMCID: PMC3701334 DOI: 10.4103/0970-9371.112653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: It has been shown that cigarette smoking as well as diabetes mellitus can produce cytomorphometric alterations in oral epithelial cells with the significant increase in the nuclear area (NA) and significant decrease in the cytoplasmic/nuclear ratio in comparison to healthy control. However, the synergistic effect of tobacco smoking and diabetes on the morphology of gingival epithelial cells is not been explored until date. Aim: This study was carried out to investigate the effects of diabetes and the synergistic effects of smoking and diabetes on the cytomorphometry of gingival epithelium. Materials and Methods: Gingival smears were collected from 30 male subjects diagnosed with type 2 diabetes with (n = 10) or without history of smoking habit (n = 10). Healthy subjects with no history of smoking or diabetes served as the control group (n = 10). The smears were stained using Papanicolaou procedure. The cellular (CA) and nuclear areas (NA)
were measured using image analysis software. One-way ANOVA and Tukey-HSD procedure (at P = 0.05) were used to
analyze all the parametric variables. Results: A statistically significant (P < 0.001) increase in NA and N:C ratio in smoker diabetic group was observed compared to the non-smoker diabetic group and the control group. The non-smoker diabetic group also showed significant increase Conclusions: There were significant alterations in the cellular pattern of gingival mucosa cells in a non-smoker diabetic, but the alteration was to a greater extent in smoker diabetics demonstrating a synergistic effect of smoking and diabetes on gingival mucosa.
Collapse
Affiliation(s)
- Punit Vaibhav Patel
- Department of Dentistry, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | | |
Collapse
|
19
|
Yoshida S, Noguchi K, Imura K, Miwa Y, Sunohara M, Sato I. A morphological study of the blood vessels associated with periodontal probing depth in human gingival tissue. Okajimas Folia Anat Jpn 2012; 88:103-9. [PMID: 22519069 DOI: 10.2535/ofaj.88.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Gingival tissues in human cadavers were examined the blood vessel diameter in the depths of the gingival pockets such as three groups: gingiva adjacent to a sulcus of 2 mm (Group 1); gingiva adjacent to a 2-4-mm sulcus (Group 2); and gingiva adjacent to a sulcus of > 4 mm (Group 3). A meaningful significant difference was seen observed in gingival pocket side, intermediate and outer layer side regions of the gingiva. A meaningful significant difference was seen found in intermediate part and the outer layer of the gingiva in Group 3. Other gingival biopsies were performed on a human body donation specimen to examine CD-31 positive endothelial cells of blood vessels by an immnohistochemical method. Our results suggest that the periodontal probing depth reflect the blood vessel organization of human gingival tissue.
Collapse
Affiliation(s)
- Shunji Yoshida
- Department of Anatomy, School of Life Dentistry at Tokyo, Nippon Dental University 1-9-20 Fujimi, Chiyoda-ku, Tokyo 102-8159, Japan
| | | | | | | | | | | |
Collapse
|
20
|
Deshpande K, Jain A, Sharma R, Prashar S, Jain R. Diabetes and periodontitis. J Indian Soc Periodontol 2011; 14:207-12. [PMID: 21731243 PMCID: PMC3118068 DOI: 10.4103/0972-124x.76917] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 08/23/2010] [Indexed: 01/12/2023] Open
Abstract
The main aim of this review is to update the reader with practical knowledge concerning the relationship between diabetes mellitus and periodontal diseases. Exclusive data is available on the association between these two chronic diseases till date. Articles published on this relationship often provide the knowledge of definitions of diabetes mellitus and periodontal diseases, prevalence, extent, severity of periodontal disease, complications of diabetes along with the possible underlying mechanisms. The authors reviewed human epidemiological studies, cross-sectional observations and longitudinal cohort, case control that evaluated variables exclusively over the past 30 years and the predominant findings from the “certain” articles are summarized in this review. This review clarifies certain queries such as 1) Do periodontal diseases have an effect on the metabolic control of diabetes? 2) Does diabetes act as a risk factor of periodontitis? 3) What are the possible underlying mechanisms relating the connection between these two chronic diseases? 4) What is the effect of periodontal intervention on metabolic control of diabetes? After a thorough survey of literature, it was observed that diabetes acts as a risk factor in development of periodontitis as periodontitis is significantly aggravated in patients suffering from diabetes having long term hyperglycemia. Different mechanisms underlying the association between the accelerated periodontal disease and diabetes are emerging but still more work is required. Major efforts are required to elucidate the impact of periodontal diseases on diabetes. At the same time, patients are needed to be made aware of regular periodontal maintenance schedule and oral hygiene.
Collapse
Affiliation(s)
- Kalyani Deshpande
- Department of Biochemistry, Dr. HS Judge Institute of Dental Sciences & Hospital, Panjab University, Sector 25, Chandigarh, India
| | | | | | | | | |
Collapse
|
21
|
Abstract
Diabetes mellitus (a group of metabolic disorders characterized by hyperglycemia) and periodontitis (a microbially induced inflammatory disorder that affects the supporting structures of teeth) are both common, chronic conditions. Multiple studies have demonstrated that diabetes mellitus (type 1 and type 2) is an established risk factor for periodontitis. Findings from mechanistic studies indicate that diabetes mellitus leads to a hyperinflammatory response to the periodontal microbiota and also impairs resolution of inflammation and repair, which leads to accelerated periodontal destruction. The cell surface receptor for advanced glycation end products and its ligands are expressed in the periodontium of individuals with diabetes mellitus and seem to mediate these processes. The association between the two diseases is bidirectional, as periodontitis has been reported to adversely affect glycemic control in patients with diabetes mellitus and to contribute to the development of diabetic complications. In addition, meta-analyses conclude that periodontal therapy in individuals with diabetes mellitus can result in a modest improvement of glycemic control. The effect of periodontal infections on diabetes mellitus is potentially explained by the resulting increase in levels of systemic proinflammatory mediators, which exacerbates insulin resistance. As our understanding of the relationship between diabetes mellitus and periodontitis deepens, increased patient awareness of the link between diabetes mellitus and oral health and collaboration among medical and dental professionals for the management of affected individuals become increasingly important.
Collapse
Affiliation(s)
- Evanthia Lalla
- Division of Periodontics, College of Dental Medicine, Columbia University, 630 West 168th Street, PH7E-110, New York, NY 10032, USA.
| | | |
Collapse
|
22
|
Acharya AB, Satyanarayan A, Thakur SL. Status of association studies linking diabetes mellitus and periodontal disease in India. Int J Diabetes Dev Ctries 2010; 30:69-74. [PMID: 20535309 PMCID: PMC2878693 DOI: 10.4103/0973-3930.62595] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 03/04/2010] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The prevalence of diabetes mellitus (DM) and periodontal disease / periodontitis (PD) is high, and the association of these two as risk factors influencing each other has been recognized and is extensively documented. However, a majority of these association studies have been done in developed countries and / or in developing countries other than India. OBJECTIVE To review, quantify and qualify the status of the published indexed scientific literature regarding the bidirectional association of DM and PD in India. METHOD An internet search of the literature was conducted to examine relevant association studies of DM and PD in India. As a matter of interest, the related articles were searched manually from one non-indexed national (India) publication of periodontology until October 2008. Specific focus was on indexed literature and only these were considered for the review. RESULT Eleven pertinent indexed publications addressing the concern with regard to population in India were identified. Most of them were in agreement with the accepted mechanisms involving these two diseases, but more supported a unidirectional view of interaction, that is, advocating the role of DM in a worsened periodontal condition. One study with an opposite view was recognised. CONCLUSION The paucity of such research in India, which will be a hub of diabetics in the near future, reflects the need to make available a strong body of evidence in the indexed literature relating not only to DM and its 'sixth complication', PD, but also the strong influence of PD on DM.
Collapse
Affiliation(s)
- Anirudh B. Acharya
- Department of Periodontics, S.D.M. College of Dental Sciences and Hospital, Dhavalnagar, Dharwad - 580 009, Karnataka, India
| | - Aparna Satyanarayan
- Department of Periodontics, S.D.M. College of Dental Sciences and Hospital, Dhavalnagar, Dharwad - 580 009, Karnataka, India
| | - Srinath L. Thakur
- Department of Periodontics, S.D.M. College of Dental Sciences and Hospital, Dhavalnagar, Dharwad - 580 009, Karnataka, India
| |
Collapse
|
23
|
Javed F, Romanos GE. Impact of Diabetes Mellitus and Glycemic Control on the Osseointegration of Dental Implants: A Systematic Literature Review. J Periodontol 2009; 80:1719-30. [DOI: 10.1902/jop.2009.090283] [Citation(s) in RCA: 215] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
24
|
Dall Agnol MA, Nicolau RA, de Lima CJ, Munin E. Comparative analysis of coherent light action (laser) versus non-coherent light (light-emitting diode) for tissue repair in diabetic rats. Lasers Med Sci 2009; 24:909-16. [DOI: 10.1007/s10103-009-0648-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 01/22/2009] [Indexed: 11/28/2022]
|
25
|
Wightman AP. Effect of Nitric Oxide Donor on IL-6 and PDGF-BB: Comparison of Diabetic Versus Normal Tissue Under Hypoxic and Normoxic Conditions. J Oral Maxillofac Surg 2008. [DOI: 10.1016/j.joms.2008.05.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
26
|
Alloxan-induced diabetes triggers the development of periodontal disease in rats. PLoS One 2007; 2:e1320. [PMID: 18091993 PMCID: PMC2121129 DOI: 10.1371/journal.pone.0001320] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Accepted: 11/21/2007] [Indexed: 11/21/2022] Open
Abstract
Background Periodontal disease in diabetic patients presents higher severity and prevalence; and increased severity of ligature-induced periodontal disease has been verified in diabetic rats. However, in absence of aggressive stimuli such as ligatures, the influence of diabetes on rat periodontal tissues is incompletely explored. The aim of this study was to evaluate the establishment and progression of periodontal diseases in rats only with diabetes induction. Methodology/Principal Findings Diabetes was induced in Wistar rats (n = 25) by intravenous administration of alloxan (42 mg/kg) and were analyzed at 1, 3, 6, 9 and 12 months after diabetes induction. The hemimandibles were removed and submitted to radiographical and histopathological procedures. A significant reduction was observed in height of bone crest in diabetic animals at 3, 6, 9 and 12 months, which was associated with increased numbers of osteoclasts and inflammatory cells. The histopathological analyses of diabetic rats also showed a reduction in density of collagen fibers, fibroblasts and blood vessels. Severe caries were also detected in the diabetic group. Conclusions/Significance The results demonstrate that diabetes induction triggers, or even co-induces the onset of alterations which are typical of periodontal diseases even in the absence of aggressive factors such as ligatures. Therefore, diabetes induction renders a previously resistant host into a susceptible phenotype, and hence diabetes can be considered a very important risk factor to the development of periodontal disease.
Collapse
|
27
|
Pontes Andersen CC, Flyvbjerg A, Buschard K, Holmstrup P. Relationship Between Periodontitis and Diabetes: Lessons From Rodent Studies. J Periodontol 2007; 78:1264-75. [PMID: 17608582 DOI: 10.1902/jop.2007.060491] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND A great amount of investigations have provided evidence that both type 1 and type 2 diabetes increase the risk and severity of periodontitis; several alterations in the diabetic periodontium are likely to be involved. Conversely, periodontitis has been shown to have an impact on diabetes, although less evidence is available on the underlying mechanisms. The association between periodontitis and diabetes has been discussed in several reviews over the past years; however, none has focused on the use and contribution of rodent models. METHODS This review describes the most commonly used rodent models of diabetes, periodontitis, and the association between the two diseases. Further, we summarize the influence of diabetes in the periodontium as well as the effect of periodontitis on diabetes status with special focus on evidence from experimental studies. RESULTS Rodent studies have confirmed human findings and further increased our knowledge on the alterations in the diabetic periodontium. On the other hand, few rodent investigations have explored the consequences of periodontitis for diabetes. Their results clearly indicate that periodontitis can become a health hazard not only for diabetes but also for prediabetes; the exact mechanisms are still to be unraveled. CONCLUSIONS Findings from rodent studies have been useful in increasing our understanding of periodontitis, diabetes, and their association and hold great promise for future investigations given the wide variety of possibilities for testing biologic hypotheses.
Collapse
Affiliation(s)
- Carla C Pontes Andersen
- Department of Periodontology, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | | | | |
Collapse
|
28
|
Sakallioğlu EE, Ayas B, Sakallioğlu U, Yavuz U, Açikgöz G, Firatli E. Osmotic pressure and vasculature of gingiva in experimental diabetes mellitus. J Periodontol 2007; 78:757-63. [PMID: 17397326 DOI: 10.1902/jop.2007.060332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alterations in tissue osmotic pressure (OP) and vasculature are considered to be the inevitable aspects of an inflammatory process that subsequently alter the fluid dynamics of the tissues involved. The aim of this study was to reveal a profile of OP and vascular changes in periodontally healthy gingival tissues and analyze the relationship between them in diabetes mellitus (DM) to evaluate the possible effects of DM on the fluid dynamics of the periodontium. METHODS Experimental DM was created by intraperitoneal streptozotocin injection in 10 periodontally healthy rats. These rats were used as the test group, and 10 systemically and periodontally healthy rats served as the control group. Gingival tissue samples obtained from the groups were used for the test procedures. OP was measured in the supernatants of these samples by a semimicrodigital osmometer. Vasculature was assessed as the alterations in vascularization (vessel number [VN]) and vasodilatation (vessel diameter [VD]) by histomorphometric means. RESULTS There was a gross increase in the OP level of the test group (172.7 +/- 59.7 mOsm/kg) compared to the control group (11.4 +/- 4.2 mOsm/kg; P <0.001). VN was found to be significantly larger in the test group (12.7 +/- 2.8) than in the control group (6.8 +/- 1.1; P <0.001). VD was found to be smaller in the test group (10.1 +/- 2.8 microm) than in the control group (15.5 +/- 2.4 microm), and this difference was statistically significant (P <0.001). A positive correlation between OP and VN (r = 0.77; P <0.001) and a negative correlation between OP and VD (r = 0.1; P >0.05) were observed in the test group. CONCLUSION Our results reveal that the fluid dynamics of periodontal soft tissues may be affected by the diabetic conditions in this diabetic model because of the increased OP and VN during the pathogenesis of the disease.
Collapse
Affiliation(s)
- Elif Eser Sakallioğlu
- Department of Periodontology, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey.
| | | | | | | | | | | |
Collapse
|
29
|
Peleg AY, Weerarathna T, McCarthy JS, Davis TME. Common infections in diabetes: pathogenesis, management and relationship to glycaemic control. Diabetes Metab Res Rev 2007; 23:3-13. [PMID: 16960917 DOI: 10.1002/dmrr.682] [Citation(s) in RCA: 333] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Specific defects in innate and adaptive immune function have been identified in diabetic patients in a range of in vitro studies. However, the relevance of these findings to the integrated response to infection in vivo remains unclear, especially in patients with good glycaemic control. Vaccine efficacy seems adequate in most diabetic patients, but those with type 1 diabetes and high glycosylated haemoglobin levels are most likely to exhibit hypo-responsiveness. While particular infections are closely associated with diabetes, this is usually in the context of extreme metabolic disturbances such as ketoacidosis. The link between glycaemic control and the risk of common community-acquired infections is less well established but could be clarified if infection data from large community-based observational or intervention studies were available. The relationship between hospital-acquired infections and diabetes is well recognized, particularly among post-operative cardiac and critically ill surgical patients in whom intensive insulin therapy improves clinical outcome independent of glycaemia. Nevertheless, further research is needed to improve our understanding of the role of diabetes and glycaemic control in the pathogenesis and management of community- and hospital-acquired infections.
Collapse
Affiliation(s)
- Anton Y Peleg
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | | | | | | |
Collapse
|
30
|
Abstract
BACKGROUND The association between diabetes and inflammatory periodontal diseases has been studied extensively for more than 50 years. The author reviews the bidirectional relationships between diabetes and periodontal diseases. CONCLUSIONS A large evidence base suggests that diabetes is associated with an increased prevalence, extent and severity of gingivitis and periodontitis. Furthermore, numerous mechanisms have been elucidated to explain the impact of diabetes on the periodontium. While inflammation plays an obvious role in periodontal diseases, evidence in the medical literature also supports the role of inflammation as a major component in the pathogenesis of diabetes and diabetic complications. Research suggests that, as an infectious process with a prominent inflammatory component, periodontal disease can adversely affect the metabolic control of diabetes. Conversely, treatment of periodontal disease and reduction of oral inflammation may have a positive effect on the diabetic condition, although evidence for this remains somewhat equivocal. CLINICAL IMPLICATIONS Patients with diabetes who have periodontal disease have two chronic conditions, each of which may affect the other, and both of which require frequent professional evaluations, in-depth patient education and consistent educational reinforcement by health care providers.
Collapse
Affiliation(s)
- Brian L Mealey
- Specialist Division, Department of Periodontics, University of Texas Science Center, San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78229, USA.
| |
Collapse
|
31
|
Abstract
BACKGROUND The purpose of this review is to provide the reader with practical knowledge concerning the relationship between diabetes mellitus and periodontal diseases. Over 200 articles have been published in the English literature over the past 50 years examining the relationship between these two chronic diseases. Data interpretation is often confounded by varying definitions of diabetes and periodontitis and different clinical criteria applied to prevalence, extent, and severity of periodontal diseases, levels of glycemic control, and complications associated with diabetes. METHODS This article provides a broad overview of the predominant findings from research published in English over the past 20 years, with reference to certain "classic" articles published prior to that time. RESULTS This article describes current diagnostic and classification criteria for diabetes and answers the following questions: 1) Does diabetes affect the risk of periodontitis, and does the level of metabolic control of diabetes have an impact on this relationship? 2) Do periodontal diseases affect the pathophysiology of diabetes mellitus or the metabolic control of diabetes? 3) What are the mechanisms by which these two diseases interrelate? and 4) How do people with diabetes and periodontal disease respond to periodontal treatment? CONCLUSIONS Diabetes increases the risk of periodontal diseases, and biologically plausible mechanisms have been demonstrated in abundance. Less clear is the impact of periodontal diseases on glycemic control of diabetes and the mechanisms through which this occurs. Inflammatory periodontal diseases may increase insulin resistance in a way similar to obesity, thereby aggravating glycemic control. Further research is needed to clarify this aspect of the relationship between periodontal diseases and diabetes.
Collapse
Affiliation(s)
- Brian L Mealey
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
| | | |
Collapse
|
32
|
Safkan-Seppälä B, Sorsa T, Tervahartiala T, Beklen A, Konttinen YT. Collagenases in gingival crevicular fluid in type 1 diabetes mellitus. J Periodontol 2006; 77:189-94. [PMID: 16460243 DOI: 10.1902/jop.2006.040322] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Studies have demonstrated that high levels of collagenase activity in gingival crevicular fluid (GCF) are associated with degradation of periodontal tissues in progressive periodontitis compared to periodontally healthy tissues. Because the activation of collagenases is an important issue in periodontitis, we have studied the activation of collagenase in gingival crevicular fluid samples of diabetic patients. METHODS Collagenase activity was studied in human gingival crevicular fluids. Twenty-two poorly controlled diabetic patients (e.g., blood glucose: 11.0+/-0.7 mmol/l; hemoglobin A1c [HbA1c]: 9.6%+/-0.3%) and five well-controlled diabetic patients were compared to six chronic periodontitis subjects and five healthy controls. Collagenase activity against type I collagen was measured using sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis quantitated by laser densitometry. RESULTS The poorly controlled diabetic patients had more alveolar bone loss than the well-controlled diabetic subjects and controls (P<0.001; t test). The activity of collagenases in GCF in poorly controlled diabetic patients was similar to that seen in chronic periodontitis subjects (P>0.05) but higher than in healthy controls (P<0.01; t test), whereas there was no difference between the well-controlled diabetic subjects and systemically healthy controls (P>0.05; t test). CONCLUSION Poorly controlled diabetes is strongly related to periodontal tissue destruction, and collagenases in GCF may mediate and reflect this effect.
Collapse
Affiliation(s)
- Bedia Safkan-Seppälä
- Institute of Dentistry, University of Helsinki, and Department of Medicine/Invärtes Medicin, Helsinki University Hospital, Helsinki, Finland
| | | | | | | | | |
Collapse
|
33
|
Ujpál M, Matos O, Bíbok G, Somogyi A, Szabó G, Suba Z. Diabetes and oral tumors in Hungary: epidemiological correlations. Diabetes Care 2004; 27:770-4. [PMID: 14988300 DOI: 10.2337/diacare.27.3.770] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Numerous publications have already demonstrated that diabetes is a risk factor for the development of periodontal diseases and various inflammatory lesions in the oral mucosa. A possible correlation between diabetes and oral premalignancies and tumors was examined in this study, as no literature data are available concerning this problem. RESEARCH DESIGN AND METHODS Stomato-oncological screening was carried out on 200 diabetic patients in the medical departments; the control group included 280 adult dentistry outpatients. The lesions found were classified into three groups: inflammatory lesions, benign tumors, and precancerous lesions. A retrospective diabetes screening of 610 inpatients with histologically confirmed oral malignancies was also performed. The control group comprised 574 complaint- and tumor-free adults. Fasting blood glucose levels were determined in both groups, and the tumor location was registered in the cancer patients. RESULTS Benign tumors were found in 14.5% and precancerous lesions in 8% of diabetic patients. In the control group these values were significantly lower, at 6.4 and 3.2%, respectively (P>0.01). Earlier Hungarian screening studies indicated similar frequency of these lesions in the general population. The proportion of oral cavity lesions was higher among diabetic patients compared with that of the control patients. In the oral cancer patient group, diabetes was present in 14.6% and an elevated blood glucose level in 9.7%. These values are significantly higher than those for the tumor-free control group (P<0.01). The gingival and labial tumor location was significantly more frequent among diabetic cancer patients than in the nondiabetic group (P<0.01). The combination of diabetes and smoking means a higher risk for oral precancerous lesions and malignancies. CONCLUSIONS Diabetes may be a risk factor for oral premalignancies and tumors.
Collapse
Affiliation(s)
- Márta Ujpál
- Department of Oral and Maxillofacial Surgery, Semmelweis University, Budapest, Hungary.
| | | | | | | | | | | |
Collapse
|
34
|
García Mateos M, Ortiz Urdiain F. Manifestaciones orales como primer signo de diabetes mellitus. Semergen 2004. [DOI: 10.1016/s1138-3593(04)74296-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
35
|
Damante CA, Greghi SLA, Sant'Ana ACP, Passanezi E, Taga R. Histomorphometric study of the healing of human oral mucosa after gingivoplasty and low-level laser therapy. Lasers Surg Med 2004; 35:377-84. [PMID: 15611961 DOI: 10.1002/lsm.20111] [Citation(s) in RCA: 165] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of the present study was to analyze the effects of diode laser irradiation on the healing of human oral mucosa. MATERIALS AND METHODS After gingivoplasty, the right hemi-arch (test group) of 16 patients was irradiated with a diode laser. The left side (control group) was not irradiated. Incisional biopsies were performed on both sides at 7, 14, 21, and 60 days after surgery and morphometrically analyzed by light microscopy. RESULTS Epithelium width ranged from 260.6 to 393.5 microm. Volume densities of basal (20.2%), prickle cell (55.6%), and cornified (24.2%) layers remained stable. The peak number of neutrophils were 6 cells/mm(2) and the mononuclear cells were 44 cells/mm(2). Collagen fibers (80%) and fibroblasts (14%) occupied the main volume of connective tissue. The one-way ANOVA and the paired Student's t-test were used for statistical analysis (P < 0.05). CONCLUSION Low-level laser therapy did not accelerate the healing of oral mucosa after gingivoplasty.
Collapse
Affiliation(s)
- Carla A Damante
- Bauru School of Dentistry-University of São Paulo-Department of Periodontology, Bauru, São Paulo, Brazil.
| | | | | | | | | |
Collapse
|
36
|
Mealey BL, Moritz AJ. Hormonal influences: effects of diabetes mellitus and endogenous female sex steroid hormones on the periodontium. Periodontol 2000 2003; 32:59-81. [PMID: 12756034 DOI: 10.1046/j.0906-6713.2002.03206.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Brian L Mealey
- Chairman, Department of Periodontics and Program Director, US Air Force Periodontics Residency, Wilford Hall Medical Center, Lackland Air Force Base San Antonio, Texas, USA
| | | |
Collapse
|
37
|
Gül N, Ozsoy N. The ultrastructure of the capillaries in the gingiva of alloxan-induced diabetic rats. Cell Biochem Funct 2003; 21:311-5. [PMID: 14624468 DOI: 10.1002/cbf.1033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The diabetic effects of alloxan (type I diabetes mellitus) were investigated in 40 Wistar albino rats (18 controls and 22 diabetics). Alloxan in sterile physiological saline was injected into animals intravenously. After the induction of diabetes with alloxan, the ultrastructure of the capillaries in the gingiva was examined by transmission electron microscopy. The thickness of the basement membranes was observed closely adherent to the endothelial cells of the capillary alloxan-diabetic rats. It was greatly thickened owing to the increase in its amorphous, granular and filamentous material with occasional scattered collagen fibres. In some sections, the capillary lumens of the diabetics were closed by epithelial cells. Loss of cytoplasmic material and hyalinization were seen in some smooth muscle cells. In addition, the mitochondrial cristae of smooth muscle cell and epithelial cells disappeared. There was endothelial integrity throughout the smooth muscle cells.
Collapse
Affiliation(s)
- Nursel Gül
- Department of Biology, Faculty of Science, Ankara University, 06500 Beşevler, Ankara, Turkey.
| | | |
Collapse
|
38
|
Soskolne WA, Klinger A. The relationship between periodontal diseases and diabetes: an overview. ANNALS OF PERIODONTOLOGY 2001; 6:91-8. [PMID: 11887477 DOI: 10.1902/annals.2001.6.1.91] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diabetes mellitus, caused by the malfunction of insulin-dependent glucose and lipid metabolism, presents with the classical triad of symptoms: polydypsia, polyuria, and polyphagia which are often accompanied by chronic fatigue and loss of weight. Complications of diabetes mellitus include retinopathy, nephropathy, neuropathy, and cardiovascular disease. Periodontal diseases are infections affecting the periodontium and resulting in the loss of tooth support. The association between diabetes mellitus and periodontitis has long been discussed with conflicting conclusions. Both of these diseases have a relatively high incidence in the general population (diabetes 1% to 6% and periodontitis 14%) as well as a number of common pathways in their pathogenesis (both diseases are polygenic disorders with some degree of immunoregulatory dysfunction). On the one hand, numerous reports indicate a higher incidence of periodontitis in diabetics compared to healthy controls, while other reports fail to show such a relationship. Clarification of this dilemma is occurring as the diagnostic criteria for periodontitis and diabetes mellitus improve, controlled studies with increased sample sizes are carried out, and the studies take into account major confounding variables that impact on the pathogenesis of both diseases. Current studies tend to support a higher incidence and severity of periodontitis in patients with diabetes mellitus. The overview looks at the bidirectional relationship between periodontitis and diabetes. An analysis of the National Health and Nutrition Examination Survey (NHANES) III data set confirms the previously reported significantly higher prevalence of periodontitis in diabetics than in non-diabetics (17.3% versus 9%). The analysis of the data also shows that the prevalence of diabetes in patients with periodontitis is double that seen in the non-periodontitis patients (12.5% versus 6.3%) and that this difference is also statistically significant. The pathogenesis of the 2 diseases is reviewed with an emphasis on common genetic and immune mechanisms. On the basis of the overview, 2 hypotheses for testing the relationship between periodontitis and diabetes are discussed. The first proposes a direct causal or modifying relationship in which the hyperglycemia and hyperlipidemia of diabetes result in metabolic alterations that may then exacerbate bacteria-induced inflammatory periodontitis. The second hypothesis proposes that a fortuitous combination of genes (gene sets) could result in a host who, under the influence of a variety of environmental stressors, could develop either periodontitis or diabetes or both.
Collapse
Affiliation(s)
- W A Soskolne
- Department of Periodontics, Hebrew University-Hadassah, Faculty of Dental Medicine, Jerusalem, Israel
| | | |
Collapse
|
39
|
Lalla E, Lamster IB, Feit M, Huang L, Spessot A, Qu W, Kislinger T, Lu Y, Stern DM, Schmidt AM. Blockade of RAGE suppresses periodontitis-associated bone loss in diabetic mice. J Clin Invest 2000; 105:1117-24. [PMID: 10772656 PMCID: PMC300834 DOI: 10.1172/jci8942] [Citation(s) in RCA: 255] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Diabetes is associated with increased prevalence, severity, and progression of periodontal disease. To test the hypothesis that activation of RAGE (Receptor for Advanced Glycation End products) contributes to the pathogenesis of diabetes-associated periodontitis, we treated diabetic mice, infected with the human periodontal pathogen Porphyromonas gingivalis, with soluble RAGE (sRAGE). sRAGE is the extracellular domain of the receptor, which binds ligand and blocks interaction with, and activation of, cell-surface RAGE. Blockade of RAGE diminished alveolar bone loss in a dose-dependent manner. Moreover, we noted decreased generation of the proinflammatory cytokines TNF-alpha and IL-6 in gingival tissue, as well as decreased levels of matrix metalloproteinases. Gingival AGEs were also reduced in mice treated with sRAGE, paralleling the observed suppression in alveolar bone loss. These findings link RAGE and exaggerated inflammatory responses to the pathogenesis of destructive periodontal disease in diabetes.
Collapse
Affiliation(s)
- E Lalla
- Division of Periodontics, School of Dental and Oral Surgery, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Fontana G, Lapolla A, Sanzari M, Piva E, Mussap M, De Toni S, Plebani M, Fusetti F, Fedele D. An immunological evaluation of type II diabetic patients with periodontal disease. J Diabetes Complications 1999; 13:23-30. [PMID: 10232706 DOI: 10.1016/s1056-8727(98)00021-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Peridontal disease is a frequent complication of diabetes, and diabetic subjects often exhibit decreased immune response with increased susceptibility to infection. We evaluated the possible relationship between immune response and periodontal disease in 40 type II diabetic patients, mean (+/- SD) age 59 +/- 8 years and mean disease duration 17 +/- 4 years, with good metabolic control (mean fasting plasma glucose, 10.5 +/- 3.8 mM/L, mean HbA1c 8.1 +/- 1.66%), and in 40 age and gender-matched controls. Interproximal alveolar bone loss (ABL), as the percentage of bone loss from the cement enamel junction (CEJ) to the apex, was measured with a modified Schei ruler at the deepest point on the mesial/distal surface of the teeth, except third molars, on a panoramic radiograph. Immunological evaluation involved study of NADPH neutrophil superoxide production, neutrophil chemotaxis, lymphocyte subpopulations, immunoglobulins and complement. Diabetic patients showed significant differences compared with controls regarding ABL (30.6 +/- 14.7% versus 17.6 +/- 4.3%; p < 0.0001) and the T-helper/T-suppressor ratio (2.3 +/- 1.0% versus 1.8 +/- 0.8%; p < 0.05). Other parameters of cell-mediated immunity and humoral immune response did not show any significant variations. No correlation between immunological and radiographic analysis parameters were found. Further studies are needed to verify the exact role played by immunological factors in type II diabetic patients with periodontal disease.
Collapse
Affiliation(s)
- G Fontana
- Institute of Dentistry, Padova University, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|