Tooth and Periodontal Clinical Attachment Loss Are Associated With Hyperglycemia in Patients With Diabetes

Oxidative balance scores in Korean adults are associated with periodontitis

BACKGROUND

The Oxidative Balance Score (OBS) is a comprehensive metric that assesses the state of a person's oxidative balance. This study aimed to investigate the relationship between the oxidative balance score and moderate and severe periodontitis in a representative sample of Korean adults.

METHODS

Healthcare big data from the 7th Korea National Health and Nutrition Examination Survey (2016-2018) was used, and 16,489 adults aged ≥19 years were included. Multivariate logistic regression analysis was performed to investigate the effect of sex-specific oxidative balance scores on periodontitis.

RESULTS

In comparison with participants with a lower oxidative balance score, those with a higher oxidative balance score had a lower incidence of moderate and severe periodontitis (p < 0.05). After adjusting for covariates, the oxidative balance score was negatively associated with moderate (odds ratio [OR] = 0.952; 95% confidence interval [CI]: 0.934-0.971) and severe (OR = 0.958; 95% CI: 0.931-0.986) periodontitis; however, the result was not significant for severe periodontitis in women's (OR = 0.975; 95% CI: 0.934-1.018). Our study showed a statistically significant association between OBS and moderate and severe periodontitis, the small effect size should be interpreted with caution.

CONCLUSIONS

The oxidative balance score was associated with moderate and severe periodontitis in Korean adults. Therefore, managing this score may help reduce the risk of periodontitis.

Expression of IL-1β, IL-6, TNF-α, and a-MMP-8 in sites with healthy conditions and with periodontal and peri-implant diseases: A case-control study

Background

This study evaluated the gingival crevicular fluid (GCF) and Peri- implant crevicular fluid (PICF) concentrations of interleukin-1 beta (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and active metalloproteinase-8 (a-MMP-8) in sites with healthy conditions vs. sites affected by periodontitis (PER) and peri-implantitis (PIM).

Methods

Periodontally healthy (PH) sites with PER, sites with peri-implant health (PIH), and sites with PIM were investigated intra-individually, according to the inclusion criteria of each group. Probing pocket depth (PPD), plaque index, gingival index, and the presence or absence of bleeding on probing (BoP) were evaluated. In GCF and PICF samples, IL-1β, IL-6, and TNF-α were quantified by ELISA Duoset® kit in combination with Ultramark® micro-ELISA digital reader; a-MMP8 concentration was analyzed by a chairside test (Perio/ImplantSafe®) in combination with a digital reader (ORALyzer®).

Results

The concentrations of IL-6 and IL-1β, TNF-α, and a-MMP-8 were significantly higher in the PIM and PER sites compared to healthy sites (P<0.05). Significantly higher concentrations of IL-1β and a-MMP-8 were found in PIM vs. PER sites (P<0.05), while the concentrations of IL-6 and TNF-α did not differ between the PIM and PER groups (P>0.05).

Conclusion

aMMP-8, IL-6, IL-1β, and TNF-α presented higher GCF/PICF concentrations in diseased periodontal and peri-implant sites. However, only the concentrations of IL-1β and a-MMP-8 were significantly higher in PIM than in PER sites.

Restoration of posterior teeth by narrow diameter implants in hyperglycemic and normoglycemic patients - 4-year results of a case-control study

OBJECTIVES

To investigate the four-year clinical outcome and marginal bone loss around narrow-diameter implants in patients with uncontrolled diabetes mellitus type 2 (T2DM) and normo-glycemic individuals.

MATERIALS AND METHODS

In 11 T2DM patients with a concentration of glycated hemoglobin (HbA1C) > 6.5% (test group) and 15 normoglycemic patients (HbA1C < 6.0%; control group), one narrow-diameter tissue level implant, placed in the posterior maxilla or mandible, was investigated. The clinical parameters probing depth (PD), bleeding on probing (BOP), attachment loss (CAL), recession, and papilla bleeding index (PBI) were assessed manually after 24 and 48 months of function. The paired digital periapical radiographs were analyzed regarding the change in marginal bone level (MBL) from baseline to 48 months post-op. The technical complications were recorded.

RESULTS

In the T2DM group, 11 patients were available for follow-ups. The overall implant survival rate after 48 months was 100%. The differences in means for the clinical parameters and the MBL between the T2DM and normo-glycemic patients for the observation period were statistically non-significant. No technical complications were recorded.

CONCLUSIONS

The study demonstrated an encouraging clinical outcome with ND implants in patients with uncontrolled T2DM compared to non-diabetics after 48 months' post loading.

CLINICAL RELEVANCE

Patients with HbA1C > 6.5% may benefit from the treatment with narrow-diameter implants by avoiding complex surgical interventions with augmentation procedures. REGISTRATION NUMBER (CLINICALTRIALS.GOV): NCT04630691.

Dyslipidemia, diabetes and periodontal disease, a cross-sectional study in Rafsanjan, a region in southeast Iran

THE OBJECTIVES

The association between dyslipidemia, diabetes and alterations in periodontal health are inconsistent. The aim of this study was to determine the association between dyslipidemia, diabetes and periodontal disease in the Oral Health Branch of Rafsanjan Cohort Study (OHBRCS).

METHODS

Rafsanjan Cohort Study (RCS) was launched in 2015 in Rafsanjan City a region in the southeast of Iran. A total of 8682 participants aged 35-70 years of both gender were recruited into the OHBRCS as a part of RCS. Bleeding on probing (BOP), probing pocket depth (PPD) and Clinical attachment loss (CAL) were used to assess periodontal health status. When CAL progression was ≥ 1 mm and PPD was > 3 mm, it was defined as periodontitis.

RESULTS

The final sample consisted of 6751 individuals with mean age of 47.67 ± 8.79 years. Among this population, 73.32% (n = 4949), 13.75% (n = 928), 59.67% (n = 4028) and 11.76% (n = 794) had BOP, PPD > 3 mm, CAL ≥ 1 mm and periodontitis respectively. The odds of CAL ≥ 1 mm increased 14% in subjects with high LDL cholesterol (OR: 1.14; 95% CI: 1.01-1.30), 17% in subjects with diabetes (OR: 1.17; 95% CI: 1.01-1.36) and 23% in subjects with both dyslipidemia and diabetes (OR: 1.23; 95% CI: 1.05-1.44). Also, the odds of PPD > 3 mm in the group with high total cholesterol (TC) was 16% higher compared to those with normal TC (OR: 1.16; 95% CI: 1.01-1.34).

CONCLUSIONS

There was an increased odds in periodontal disease in association with high TC, high LDL cholesterol, diabetes and having both dyslipidemia and diabetes. This suggests that high TC, high LDL cholesterol, diabetes and having both dyslipidemia and diabetes might be potential indicators for the presence of periodontal disease.

Risk of periodontitis & dental caries among 35 to 44 year old diabetic individuals: A case control study

Background

The World Health Organization (WHO) has recommended the age group of 35-44 years for surveillance of oral health conditions in adults. There is a growing incidence of early onset of Type 2 diabetes mellitus (T2DM) worldwide.

Objective

This study was conducted to find the strength of association between dental caries and periodontitis in patients with T2DM.

Materials and Methods

This was a case-control study conducted among 35-44-year-old patients with T2DM (n = 185) reporting to various hospitals of Belagavi city and controls (n = 185), who met the inclusion criteria. Group matching was done for age and gender. The study participants were interviewed for their sociodemographic details, relevant medical history, oral health behaviors, and dietary behaviors using a self-designed questionnaire. Dental caries and periodontal status were recorded using the WHO criteria, 2013.

Results

The mean decayed missing filled teeth was significantly higher among controls than cases (P = 0.006). A significantly higher number of cases had periodontal pockets (crude odds ratio: 6.6) as compared to controls. Regression analysis showed that loss of attachment was significantly associated with T2DM (adjusted odds ratio: 5.9, 95% confidence interval: 2.81-6.89).

Conclusion

Periodontitis was found to be associated with T2DM. However, no such association was found between dental caries and T2DM.

Proportional relationship between periodontal inflamed surface area, clinical attachment loss, and glycated hemoglobin level in patients with type 2 diabetes mellitus on insulin therapy and on oral antidiabetic therapy

BACKGROUND

Treatment of diabetes includes oral antidiabetic drugs (OAD), insulin, or their combinations. Insulin can achieve faster glycemic control and have anabolic action on bone. This study was undertaken to assess the prevalence and severity of periodontitis, and to estimate the proportional relationship between periodontal inflamed surface area, clinical attachment loss, and glycated hemoglobin (HbA1c) level in patients with type 2 diabetes (T2DM) on OAD therapy and on insulin therapy.

METHODS

This cross-sectional study comprised 130 patients with T2DM on OAD therapy (OAD group) and 130 patients with T2DM on insulin therapy (INSULIN group). All patients were assessed for sociodemographic, behavioral characteristics, clinical history, periodontal parameters (bleeding on probing, probing depth, clinical attachment loss [Clinical AL], Oral Hygiene Index-simplified, plaque index, and periodontal inflamed surface area [PISA]), and biochemical variables (HbA1c, fasting plasma glucose, postprandial plasma glucose).

RESULTS

Prevalence, extent, and severity of periodontitis and PISA were lower in the INSULIN group as compared with the OAD group. A proportional relationship was observed between HbA1c and PISA and between HbA1c and Clinical AL. A unit increase in HbA1c is associated with an increase in PISA of 130.47 mm² and an increase in Clinical AL of 0.182 mm.

CONCLUSION

A proportional relationship was observed between PISA, clinical attachment loss, and HbA1c level in patients with type 2 diabetes mellitus on insulin therapy and OAD therapy. Despite comparable oral hygiene status and glycemic control between the two groups, the periodontal parameters were lesser in the INSULIN group as compared with the OAD group.

Peri-Implant Repair Using a Modified Implant Macrogeometry in Diabetic Rats: Biomechanical and Molecular Analyses of Bone-Related Markers

DM has a high prevalence worldwide and exerts a negative influence on bone repair around dental implants. Modifications of the microgeometry of implants have been related to positive results in bone repair. This study assessed, for the first time, the influence of an implant with modified macrodesign based on the presence of a healing chamber in the pattern of peri-implant repair under diabetic conditions. Thirty Wistar rats were assigned to receive one titanium implant in each tibia (Control Implant (conventional macrogeometry) or Test Implant (modified macrogeometry)) according to the following groups: Non-DM + Control Implant; Non-DM + Test Implant; DM + Control Implant; DM + Test Implant. One month from the surgeries, the implants were removed for counter-torque, and the bone tissue surrounding the implants was stored for the mRNA quantification of bone-related markers. Implants located on DM animals presented lower counter-torque values in comparison with Non-DM ones, independently of macrodesign (p < 0.05). Besides, higher biomechanical retention levels were observed in implants with modified macrogeometry than in the controls in both Non-DM and DM groups (p < 0.05). Moreover, the modified macrogeometry upregulated OPN mRNA in comparison with the control group in Non-DM and DM rats (p < 0.05). Peri-implant bone repair may profit from the use of implants with modified macrogeometry in the presence of diabetes mellitus, as they offer higher biomechanical retention and positive modulation of important bone markers in peri-implant bone tissue.

The risk of tooth loss in patients with diabetes: A systematic review and meta-analysis

AIM

The aim of this systematic review was to comprehensively and critically summarize and synthesize the risk of losing teeth among with diabetes mellitus (DM) compared to those without DM, as established in observational studies.

MATERIALS AND METHODS

MEDLINE-PubMed and Cochrane databases were searched through a period from their inception through October 2020 to identify eligible studies. Papers that primarily evaluate the number of teeth in DM patients compared to non-DM individuals were included. A descriptive analysis of the selected studies was conducted, and when feasible, a meta-analysis was performed. The quality of the studies was assessed.

RESULTS

A total of 1087 references were generated, and screening of the papers resulted in 10 eligible publications. A descriptive analysis demonstrated that six of these studies indicate a significantly higher risk of tooth loss in DM patients. This was confirmed by the meta-analysis risk ratio of 1.63 95% CI (1.33; 2.00, p < 0.00001). Subgroup analysis illustrates that this is irrespective of the risk-of-bias assessment. The higher risk of tooth loss in DM patients was also higher when only DM type II patients or studies with a cross-sectional design were considered. Patients with a poor DM control status presented a significantly increased risk of tooth loss. When the data were separated by the world continent where the study was performed, Asia and South America had numerically higher risks and a 95% CI that did not overlap with Europe and North America.

CONCLUSION

There is moderate certainty for a small but significantly higher risk of tooth loss in DM patients as compared to those without DM.

Should the Quality of Glycemic Control Guide Dental Implant Therapy in Patients with Diabetes? Focus on Implant Survival

INTRODUCTION

Optimal glycemic control is crucial to dental implant long-term functional and esthetic success. Despite HbA1c levels of 7% or lower used is as an indicator for good glycemic control, however, this level may not be attainable for all diabetic patients. Most dentists do not consider patients with poor glycemic control candidates for implant therapy due to higher implant failure, infection or other complications.

AIM

This review challenges the concept of one size fits all and aims to critically appraise the evidence for the success or failure rate of dental implants and peri-implant health outcomes in patients with less than optimal glycemic control.

DISCUSSION

Evidence suggests that estimating glycemic control from HbA1c measurement alone is misleading. Moreover, elevated preoperative HbA1c was not associated with increased mortality and morbidity after major surgical procedures. Literature for the survival or success of implants in diabetic patients is inconsistent due to a lack of standardized reporting of clinical data collection and outcomes. While a number of studies report that implant treatment in patients with well controlled diabetes has a similar success rate to healthy individuals, other studies suggest that the quality of glycemic control in diabetic patients does not make a difference in the implant failure rate or marginal bone loss. This discrepancy could indicate that risk factors other than hyperglycemia may contribute to the survival of implants in diabetic patients.

CONCLUSION

In the era of personalized medicine, the clinician should utilize individualized information and analyze all risk factors to provide the patient with evidence-based treatment options.

Prevalence of periodontitis in people clinically diagnosed with diabetes mellitus: a meta-analysis of epidemiologic studies

AIMS

The relationship between diabetes mellitus and periodontitis has long been discussed, but the conclusion of this relationship was controversial. We conducted this meta-analysis to explore the association between diabetes mellitus and the prevalence of periodontitis.

METHODS

PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies reporting associations of periodontitis with diabetes. Gray literature was integrated from the Open-Gray database. Prevalence estimates and odds ratios were extracted by two independent reviewers and synthesized through meta-analyses.

RESULTS

Twenty-seven papers met the inclusion criteria involving 3092 diabetic patients and 23,494 controls. Overall prevalence of periodontitis was 67.8% in diabetics (combined types) and 35.5% in patients without diabetes (OR, 1.85; 95%CI, 1.61-2.11). Probing depth (MD 0.23; 95% CI, 0.17-0.29; I² = 25%) and plaque index (MD, 0.20; 95% CI, 0.18-0.23; P = 0.59; I² = 0%) severity scores were significantly greater among the diabetic group.

CONCLUSIONS

The prevalence and severity of periodontitis are greater in patients with diabetes than in non-diabetic populations.

Insight into the roles of melatonin in bone tissue and bone‑related diseases (Review)

Bone‑related diseases comprise a large group of common diseases, including fractures, osteoporosis and osteoarthritis (OA), which affect a large number of individuals, particularly the elderly. The progressive destruction and loss of alveolar bone caused by periodontitis is a specific type of bone loss, which has a high incidence and markedly reduces the quality of life of patients. With the existing methods of prevention and treatment, the incidence and mortality of bone‑related diseases are still gradually increasing, creating a significant financial burden to societies worldwide. To prevent the occurrence of bone‑related diseases, delay their progression or reverse the injuries they cause, new alternative or complementary treatments need to be developed. Melatonin exerts numerous physiological effects, including inducing anti‑inflammatory and antioxidative functions, resetting circadian rhythms and promoting wound healing and tissue regeneration. Melatonin also participates in the health management of bone and cartilage. In the present review, the potential roles of melatonin in the pathogenesis and progression of bone injury, osteoporosis, OA and periodontitis are summarized. Furthermore, the high efficiency and diversity of the physiological regulatory effects of melatonin are highlighted and the potential benefits of the use of melatonin for the clinical prevention and treatment of bone‑related diseases are discussed.

Association of Periodontal Status, Number of Teeth, and Obesity: A Cross-Sectional Study in Japan

Recent reports have shown an association between obesity and periodontitis, but the precise relationship between these conditions has yet to be clarified. The purpose of this study was to compare the status of periodontitis, tooth loss, and obesity. Participants comprised 235 patients at the Center for Medical and Dental Collaboration in Kanagawa Dental University Hospital between 2018 and 2020. Clinical examinations such as blood testing, body composition analysis, periodontal measurement, assessment of chewing ability, salivary testing, and oral malodor analysis were performed. Periodontal inflamed surface area (PISA) was significantly associated with the number of teeth and body mass index (BMI). The number of teeth was negatively associated with age, but positively with chewing ability. Chewing ability was associated negatively with age, and positively with high-sensitivity C-reactive protein (hsCRP). The level of methyl-mercaptan in breath and protein and leukocyte scores from salivary testing were positively associated with PISA. The rate of insufficient chewing ability was increased in subjects with hemoglobin (Hb)A1c ≥ 7%. The high PISA group showed increased hsCRP. BMI as an obesity marker was positively associated with PISA, indicating periodontal inflammation. Chewing ability was related to serum markers such as HbA1c and hsCRP.

Management of periodontal disease in patients with diabetes- good clinical practice guidelines: A joint statement by Indian Society of Periodontology and Research Society for the Study of Diabetes in India

There is a huge body of literature suggesting an association and a bidirectional relationship between periodontal disease and diabetes. Diabetes and periodontal diseases are both chronic diseases with a high prevalence. Dentists/periodontists, in their daily clinical practice, very often attend to diabetes patients with diverse oral health conditions and cater to their dental treatment needs. Safe and effective periodontal therapy in this population requires a broad understanding of diabetes, medical management of diabetes, and essential modifications to dental/periodontal therapy that may be required. This paper describes a joint statement put forth by the Indian Society of Periodontology and the Research Society for the Study of Diabetes in India aiming to provide expert consensus and evidence-based guidelines for optimal clinical management of periodontal conditions in diabetes patients or patients at risk for diabetes. Although this paper is not envisioned to be a comprehensive review of this topic, it intends to provide the guidelines for dental professionals and periodontists.

Diabetes as a risk factor for periodontal disease-plausible mechanisms

The present narrative review examines the scientific evidence of the biological mechanisms that may link periodontitis and diabetes, as a source of comorbidity. Publications regarding periodontitis and diabetes, in human, animals, and in vitro were screened for their relevance. Periodontal microbiome studies indicate a possible association between altered glucose metabolism in prediabetes and diabetes and changes in the periodontal microbiome. Coinciding with this, hyperglycemia enhances expression of pathogen receptors, which enhance host response to the dysbiotic microbiome. Hyperglycemia also promotes pro-inflammatory response independently or via the advanced glycation end product/receptor for advanced glycation end product pathway. These processes excite cellular tissue destruction functions, which further enhance pro-inflammatory cytokines expression and alteration in the RANKL/osteoprotegerin ratio, promoting formation and activation of osteoclasts. The evidence supports the role of several pathogenic mechanisms in the path of true causal comorbidity between poorly controlled diabetes and periodontitis. However, further research is needed to better understand these mechanisms and to explore other mechanisms.

Oral health status and oral health-related quality of life among patients with type 2 diabetes mellitus in the United Arab Emirates: a matched case-control study

BACKGROUND

Nearly a quarter of the population in the UAE has type 2 diabetes mellitus (T2DM), and this medical condition is associated with poorer oral health. The effects on oral health-related quality of life (OHRQoL), however, have not been examined in this population. Therefore, the objective of this study was to assess the impact of oral health problems, such as caries and periodontitis, on OHRQoL among Arab patients with and without T2DM.

METHODS

This matched case-control study included 88 diabetic and 88 non-diabetic participants recruited from University Dental Hospital Sharjah and University Hospital Sharjah, UAE. Participants completed a sociodemographic questionnaire as well as the Oral Health Impact Profile short form (OHIP-14), which measures OHRQoL. Clinical examinations were conducted to assess participants' dental caries status, using the Decayed Missing Filled Teeth (DMFT) Index, and periodontal condition, via clinical attachment loss (CAL) dichotomized to CAL < 3 mm and CAL ≥3 mm. Linear regression models were used to identify the association among OHIP domains, clinical attachment loss, DMFT scores, and diabetes status.

RESULTS

The mean age of participants was 43.0 years. A significantly (p = 0.01) higher proportion of diabetic patients (23%) had a CAL ≥3 mm than non-diabetic patients (10%). No significant differences in OHIP scores were observed between diabetic and non-diabetic patients. The results of the linear regression suggested that irrespective of diabetic status, DMFT scores were significantly associated with physical disability, physical pain, psychological discomfort, and psychological disability, as well as total OHIP scores. CAL was significantly associated with the handicap domain. Among non-diabetic patients, OHIP scores were significantly associated with DMFT scores in five OHIP domains (functional limitation, physical disability, physical pain, psychological discomfort, psychological disability), as well as total OHIP scores. Among diabetic patients, CAL was significantly associated with both the social disability and handicap domains, while only the handicap domain reached statistical significance among non-diabetic patients.

CONCLUSIONS

Participants who had decayed teeth, irrespective of their diabetic status, reported substantial physical and psychological impacts on OHRQoL. CAL also had a significant impact on OHRQoL, being primarily associated with the OHIP handicap domain in both diabetic and non-diabetic patients.

Host response and peri-implantitis

Considering the absence of predictable and effective therapeutic interventions for the treatment of peri-implantitis, scientific evidence concerning the host response profile around dental implants could be important for providing in the future a wider preventive and/or therapeutic window for this peri-implant lesion, indicating biomarkers that provide quantifiable measure of response to peri-implant therapy. Moreover, a better knowledge of pattern of host osteo-immunoinflammatory modulation in the presence of peri-implantitis could either benefit the early diagnostic of the disease or to cooperate to prognostic information related to the status of the peri-implant breakdown. Finally, new evidences concerning the host profile of modulators of inflammation and of osseous tissue metabolism around dental implants could explain the individual susceptibility for developing peri-implant lesions, identifying individuals or sites with increased risk for peri-implantitis. The focus of this chapter was, based on a systematically searched and critically reviewed literature, summarizing the existing knowledge in the scientific research concerning the host osteo-immunoinflammatory response to the microbiological challenge related to periimplantitis.

The effects of melatonin supplementation in adjunct with non-surgical periodontal therapy on periodontal status, serum melatonin and inflammatory markers in type 2 diabetes mellitus patients with chronic periodontitis: a double-blind, placebo-controlled trial

BACKGROUND

Diabetes mellitus (DM) and periodontitis are two common chronic diseases with bidirectional relationship. Oxidative stress plays a key role in the pathogenesis of these two diseases. The aim of this study was to investigate the effects of melatonin supplementation in adjunct with non-surgical periodontal therapy on periodontal status, serum melatonin and inflammatory markers in type 2 DM patients with chronic periodontitis (CP).

MATERIALS AND METHODS

In this double-blind clinical trial study, 50 type 2 DM patients with CP were randomly allocated to the intervention and control groups. The intervention and control groups received either 6 mg melatonin or placebo (2 tablets) once a day. Serum levels of melatonin, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), hs-C-reactive protein (hs-CRP), clinical attachment loss (CAL), pocket depth (PD), bleeding on probing (BOP) and plaque index were evaluated in all subjects pre- and post-intervention.

RESULTS

Melatonin supplementation significantly increased the mean serum levels of melatonin after intervention. The mean changes of melatonin were significantly higher in intervention group compared with control group. IL-6 and hs-CRP levels were significantly (p = 0.008 and p = 0.017, respectively) reduced in the intervention group. The mean changes of IL-6 were significantly lower in the intervention group compared with the control group (p = 0.04). In the intervention group, PD and CAL were significantly decreased after intervention (p < 0.001). There were significant differences in the mean change of PD and CAL between the intervention and control groups after intervention (p < 0.001).

CONCLUSIONS

Melatonin supplementation in adjunct with non-surgical periodontal therapy might improve inflammatory and periodontal status in T2DM with CP.

HAMSCs/HBMSCs coculture system ameliorates osteogenesis and angiogenesis against glucolipotoxicity

Osteoporosis and vascular lesions induced by glucolipotoxicity are common complications of diabetes mellitus (DM). In order to deal with these complications, we designed a new therapeutic strategy, i.e. coculture system containing human amnion-derived mesenchymal stem cells (HAMSCs) and human bone marrow mesenchymal stem cells (HBMSCs). Two in vitro coculture models, transwell and mixed cocultures, were proposed for 7 days with variable HAMSCs: HBMSCs ratios. Then, supernatant from each coculture was used to reverse the deficiency of HBMSCs and human umbilical vein endothelial cells (HUVECs) impaired by high glucose and palmitic acid (GP). We found that glucolipotoxicity caused by GP remarkably inhibited cell proliferation, osteogenic differentiation and superoxide dismutase (SOD) activity, as well as induced the reactive oxygen species (ROS) level in HBMSCs. Meanwhile, glucolipotoxicity suppressed cell proliferation, tube formation capacity and angiogenic potential of HUVECs. Though, HAMSCs/HBMSCs coculture system reduced HBMSCs dysfunction by antioxidant properties and promoted angiogenesis in HUVECs. The mixed HAMSCs/HBMSCs coculture at the optimal ratio of 3/1 showed significantly greater cell proliferation, antioxidant properties, osteogenic and angiogenic differentiation than HBMSCs or HUVECs alone. In conclusion, the current coculture system of HAMSCs/HBMSCs can be a potential therapeutic material for advancing bone and vascular regeneration against DM-induced glucolipotoxicity.

Mitochondrial dysfunction is involved in the aggravation of periodontitis by diabetes

AIM

To elucidate whether mitochondrial dysfunction contributes to aggravated periodontitis in diabetes.

MATERIALS AND METHODS

Sixty-four wistar rats were randomly assigned into four groups: control, periodontitis, diabetes, and diabetic periodontitis. Two weeks after induction of diabetes, periodontitis was induced by silk ligation for 2 weeks and thereafter evaluated by assessing alveolar bone loss and apoptosis of periodontium cells. Mitochondrial oxidative stress was detected by MitoSOX staining. Mitochondrial function was determined by measuring ATP production, and by assessing mitochondrial DNA copy number, activities of electron transport chain complexes, and biogenesis with real-time PCR.

RESULTS

Significantly severer bone loss, enhanced periodontium cell apoptosis, and mitochondrial oxidative stress were found in the rats with diabetic periodontitis than the others. Furthermore, diabetic rats with periodontitis presented severer mitochondrial dysfunction than lean rats with periodontitis, as reflected by compromised ATP production, decreased mitochondrial DNA copy number, reduced gene expression of electron transport chain complex I subunits, and impaired mitochondrial biogenesis (p < 0.05). Multiple regression analysis further indicated a close correlation between these mitochondrial events and bone loss in diabetic periodontitis.

CONCLUSIONS

Mitochondrial dysfunction was positive correlated to aggravated periodontitis in diabetes and might represent a therapeutic target for diabetic periodontitis.

Bayesian semiparametric variable selection with applications to periodontal data

A normality assumption is typically adopted for the random effects in a clustered or longitudinal data analysis using a linear mixed model. However, such an assumption is not always realistic, and it may lead to potential biases of the estimates, especially when variable selection is taken into account. Furthermore, flexibility of nonparametric assumptions (e.g., Dirichlet process) on these random effects may potentially cause centering problems, leading to difficulty of interpretation of fixed effects and variable selection. Motivated by these problems, we proposed a Bayesian method for fixed and random effects selection in nonparametric random effects models. We modeled the regression coefficients via centered latent variables which are distributed as probit stick-breaking scale mixtures. By using the mixture priors for centered latent variables along with covariance decomposition, we could avoid the aforementioned problems and allow efficient selection of fixed and random effects from the model. We demonstrated the advantages of our proposed approach over other competing alternatives through a simulated example and also via an illustrative application to a data set from a periodontal disease study. Copyright © 2017 John Wiley & Sons, Ltd.

Dental Implant Sites in Healthy versus Diabetic Subjects: A Two-Year Clinical and Bacteriological Assessment

The aim of this study was to analyze by Real-Time Polymerase Chain Reaction (PCR) possible differences in periimplant microbiota of patients without significant systemic diseases versus patients affected by non-insulin-dependent diabetes mellitus (NIDDM), both treated with dental implants with the same implant-abutment system. Patients suffering from NIDDM, and those with no history of major systemic diseases, treated with dental implants at the Prosthodontics Operative Unit of “Sapienza” University of Rome in the period February 2009 - March 2010 were considered. Clinical parameters as well as microbiological profile were evaluated for each implant site at 3, 6,12, and 24 month follow-up. Crevicular fluid was collected for microbial sampling and analyzed by Real-Time PCR in order to identify the possible presence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum and Prevotella intermedia. Eight patients suffering from NIDDM and 22 with no history of major systemic diseases were included in the present investigation, each having received one to three dental implants. All the implants had been loaded 3 months after surgery, and the average follow-up after implant placement was 26.37±3.86. Clinical parameters showed no noticeable difference between the two groups, except for the Implant Stability Quotient (ISQ) that showed significantly lower values in NIDDM patients. A slightly higher amount of the considered pathogenic bacteria were retrieved in samples collected from patients with NIDDM (7.38×105) in comparison with those of healthy subjects (6.78×105), though the differences were below statistical significance. Within the limitations of the present study, a slight correlation was empirically detected between gene expression profiles of microbial populations and history of NIDDM, which however remained below the statistical significance. Further well-designed clinical studies may be useful to conclusively clarify the impact of subgingival microflora on the increased susceptibility of diabetic patients to periimplantitis.

Periodontal treatment and glycaemic control in patients with diabetes and periodontitis: an umbrella review

BACKGROUND

Studies suggest that non-surgical periodontal treatment improves glycaemic control in patients with diabetes and periodontitis. The aim of this umbrella review is to summarize the effects of periodontal treatment on glycaemic control in patients with periodontitis and diabetes.

METHODS

A systematic review of systematic reviews with or without meta-analysis published between 1995 and 2015 was performed. Three independent reviewers assessed for article selection, quality and data extraction.

RESULTS

Thirteen (13) systematic reviews/meta-analysis were included for qualitative synthesis. A reduction (0.23 to 1.03 percentage points) in the levels of HbA1c at 3 months after periodontal intervention was found. This reduction was statistically significant in 10/12 meta-analysis. One review with sufficiently large samples found a non-significant reduction (-0.014 percentage points; 95% CI -0.18 to 0.16; p = 0.87). Only three studies separated the use of adjunctive antibiotics and found a reduction of 0.36 percentage points but the difference was not statistically significant.

CONCLUSIONS

Highly heterogeneous short-term studies with small sample size suggest that periodontal treatment could help improve glycaemic control at 3 months in patients with type 2 diabetes and periodontitis. However, longer term studies having sufficient sample size do not provide evidence that periodontal therapy improves glycaemic control in these patients.

Factors associated with having less than 20 natural teeth in rural adults: a cross-sectional study

BACKGROUND

Some systematic reviews have consistently indicated a positive link between Metabolic syndrome, impairedfasting glucose, all-cause or circulatory disease-related mortality, general health, periodontitis, and toothloss. This study was to examine the prevalence of number of remaining teeth <20 and associated risk factors among adults in a rural area of Taiwan.

METHODS

A community-based, cross-sectional study was conducted in southwestern coastal Taiwan in 2013; 6680 residents aged 20-64 years were studied. Oral hygiene, substance use, dietary habits, and metabolic syndrome were explored as potential risk factors for number of remaining teeth <20 using logistic regression analysis.

RESULTS

The mean number of remaining teeth was 24.6 (SD = 7.4), and 16.3 % (n = 1085) of the participants had number of remaining teeth <20. Men had significantly less frequent use of dental floss, unhealthy dietary habits, more substance use and metabolic syndrome than did women (p <0.001). However, women tended to have fewer teeth than men (p <0.001). After adjusting for potential confounders, older age (odds ratio [OR] = 4.56, 95 % confidence interval [CI]: 3.74-5.55), female (OR = 1.88, 95 % CI: 1.56-2.25), less education (OR = 2.40, 95 % CI: 1.90-3.02), infrequent use of dental floss (OR = 1.94, 95 % CI: 1.66-2.27), substance use (OR = 1.32, 95 % CI: 1.09-1.59), and number of metabolic syndrome components (OR = 1.10, 95 % CI: 1.04-1.16) were independently associated with a higher risk of number of remaining teeth <20.

CONCLUSIONS

Number of remaining teeth <20 was highly prevalent among rural adults. In addition to unmodifiable factors, infrequent use of dental floss, substance use, and metabolic syndrome were risk factors associated with tooth loss.

Effect of β-anhydroicaritin on the expression levels of tumor necrosis factor-α and matrix metalloproteinase-3 in periodontal tissue of diabetic rats

The present study aimed to investigate the effect of β-anhydroicaritin on the expression levels of tumor necrosis factor (TNF)-α and matrix metalloproteinase (MMP)-3, and the pathological changes in the periodontal tissue of diabetic rats. Male Wistar rats (n=40; three months old) were randomly divided into four groups: Normal control group, diabetes group, diabetes + β-anhydroicaritin group and diabetes + urate group, (n=10 in each group). Following an overnight fast, diabetes was induced by intraperitoneal injection of streptozocin. The rats were maintained for 12 weeks and the blood sugar, urine sugar and body weight were assessed in week 12. Histological changes of the periodontal tissues were observed by hematoxylin and eosin staining, and the expression levels of TNF-α and MMP-3 were observed by immunohistochemistry. Following 12 weeks, the TNF-α grey value in the diabetes group was significantly lower compared with that in the control group (P<0.05), while no significant difference was observed between TNF-α levels in the diabetes + β-anhydroicaritin group, diabetes + urate group and the control group (P>0.05). However, TNF-α levels in the diabetes + β-anhdroicaritin group and diabetes + urate group were significantly higher compared with those in the diabetes group (P<0.05), and those in the diabetes + β-anhydroicaritin group were lower compared with those in the diabetes + urate group (P<0.05). The MMP-3 grey value in the diabetes group was significantly lower compared with that in the control group (P<0.05), while no significant difference was observed between MMP-3 levels in the diabetes + β-anhydroicaritin group, diabetes + urate group and the control group (P>0.05). However, MMP-3 levels the diabetes + β-anhydroicaritin group and diabetes + urate group were significantly higher compared with those in the diabetes group (P<0.05), and those in the diabetes + β-anhydroicaritin group were lower compared with those in the diabetes + urate group (P<0.01). β-anhydroicaritin normalized the expression levels of TNF-α and MMP-3 in the periodontal tissue of diabetic rats and led to the recovery of the changes in the morphological structure of the periodontal tissue.

Influence of Glycemic Control on Peri-Implant Bone Healing: 12-Month Outcomes of Local Release of Bone-Related Factors and Implant Stabilization in Type 2 Diabetics

BACKGROUND

The poor glycemic status seems to be an important factor affecting implant complication rates, including peri-implant bone loss.

PURPOSE

This trial evaluated the influence of glycemic control of type 2 diabetes mellitus (T2DM) patients on implant stabilization and on the levels of bone markers in peri-implant fluid during the healing.

MATERIALS AND METHODS

Systemically healthy patients (SH,n = 19), better-controlled T2DM (BCDM,n = 16), and poorly controlled T2DM (PCDM,n = 16) indicated for implant therapy were recruited. The implant stability quotient (ISQ) was determined at implant placement, 3, 6, and 12 months. Levels of transforming growth factor- β (TGF-β), fibroblast growth factor (FGF), osteopontin (OPN), osteocalcin (OC), and osteoprotegerin (OPG) in the peri-implant fluid were quantified at 15 days, and 3, 6, and 12 months, using the Luminex assay.

RESULTS

OPG and OPN levels were higher in SH at 12 months than at15 days (p < .05), whereas OC and TGF-β were lower in PCDM at 12 months compared with the 15-day and 3-month follow-ups, respectively (p < .05). Inter-group analyses showed lower OPN levels in PCDM compared with SH at 12 months (p < .05). The ISQ was higher at 12 months when compared with baseline and 3 months in SH (p < .05), whereas no differences were observed during follow-up in diabetics, regardless of glycemic control (p > .05). No difference in ISQ was observed among groups over time (p > .05).

CONCLUSION

Poor glycemic control negatively modulated the bone factors during healing, although T2DM, regardless of glycemic status, had no effect on implant stabilization.

Blood profile and histology in oral infections associated with diabetes

INTRODUCTION

We aimed to investigate the relationship between blood profile and histologic findings in both apical periodontitis (AP) and periodontal disease (PD) associated with diabetes.

METHODS

Wistar rats (N = 80) were assigned to the following 8 groups: control, AP, PD, AP associated with PD, diabetes, diabetes with AP, diabetes with PD, and diabetes with AP and PD. Diabetes mellitus (DM) was induced with streptozotocin, AP was induced by exposure to the oral environment, and PD was induced using periodontal ligature. After 30 days, blood samples were collected, and the rats were euthanized. Subsequently, the maxillae were processed for light microscopy. Hematologic examinations were conducted to determine the total number of erythrocytes and leukocytes, erythrocyte constant, and blood glucose level. One-way analysis of variance and Kruskal-Wallis tests were used for statistical analysis, and the significance was set at P < .05.

RESULTS

A significant correlation was found between the histologic findings and blood parameters.

CONCLUSIONS

In conclusion, diabetes accelerated the development and progression of AP and PD in the rats and caused an increase in the average erythrocyte volume as well as the leukocyte and neutrophil counts. Oral infections increase the total number of leukocytes, the number of neutrophils and lymphocytes, and blood glucose concentrations in DM rats.

Periodontal disease associated with blood glucose levels in urban Koreans aged 50 years and older: the Dong-gu study

OBJECTIVE

To investigate the association of periodontal disease and the number of teeth present with the risk of prediabetes and diabetes as well as with blood glucose and HbA1c levels in adult Koreans.

BACKGROUND

The relationship between periodontal disease and diabetes has not been fully elucidated.

MATERIALS AND METHODS

Cross-sectional data from 5535 participants aged ≥50 years were obtained from 2008 to 2010. Periodontal status was measured as pocket depth (PD), clinical attachment loss (CAL) and bleeding on probing (BOP) recorded. The percentage of sites with a PD ≥4 mm, CAL ≥4 mm (CAL4) and BOP (BOP%) were recorded. Participants were divided into three groups according to PD4, CAL4 and BOP% measurements. Number of teeth present was divided into four groups. Participants were classified as normoglycaemic, prediabetic or diabetic based on HbA1c and fasting glucose levels.

RESULTS

After full adjustment, the highest tertile of CAL4 (OR: 1.47, 95% CI: 1.18-2.02, p < 0.001), PD4 (OR: 1.58, 95% CI: 1.26-1.97, p < 0.001) and BOP% (OR: 1.37, 95% CI: 1.07-1.75, p = 0.012) had significantly increased odds of diabetes. The number of teeth present was inversely related to diabetes (p < 0.001) and prediabetes (p = 0.032) risk. Periodontal disease severity was positively associated with HbA1c and glucose levels. The number of teeth present was positively associated with HbA1c, but not glucose, levels.

CONCLUSION

Periodontal disease and the number of teeth present are associated with an increased risk of diabetes and increased blood glucose and HbA1c levels in Koreans aged ≥50 years.

Occurrence of red complex microorganisms and Aggregatibacter actinomycetemcomitans in patients with diabetes

AIM

The aim of the present study was to analyze the occurrence of Porphyromonas gingivalis (P. gingivalis), Tannerella forsythia (T. forsythia), Treponema denticola (T. denticola), and Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) in patients with diabetes.

METHODS

Periodontal and diabetic parameters and subgingival biofilm samples were obtained from 60 patients with diabetes and 62 patients without diabetes. By using polymerase chain reaction, the prevalence of red complex microorganisms (P. gingivalis, T. forsythia, and T. denticola) and A. actinomycetemcomitans were determined. Descriptive and non-parametric statistical analyses between groups were performed (Kruskal-Wallis, Mann-Whitney U-test, and Fisher's exact test).

RESULTS

Patients with diabetes presented significantly higher periodontal attachment loss levels compared to patients without diabetes. Red complex microorganisms were detected in lower frequencies in patients with diabetes. The detection of A. actinomycetemcomitans was higher in patients with diabetes and periodontitis compared to systemically-healthy patients without periodontitis (P < 0.05). P. gingivalis was associated with periodontitis in non-diabetic patients (P < 0.05), whereas A. actinomycetemcomitans was associated with periodontitis in diabetic patients (P < 0.05).

CONCLUSIONS

The findings of the present study indicate that there might be differences in the subgingival microbiota between diabetic and non-diabetic patients. In addition, P. gingivalis and A. actinomycetemcomitans were associated with periodontitis in patients without diabetes and patients with diabetes, respectively.

Is there any relationship between recurrent oral aphthous stomatitis and prediabetes?

Periodontal disease has been associated with glycaemia. Recurrent aphthous stomatitis (RAS) is one of the most common oral lesions and is characterized by painful recurrent oral ulcers. However, the exact cause and treatment of RAS is not yet well-known. Furthermore, there is still unknown the relationship between RAS and glycaemia. Prediabetes has shown to have role on worse metabolic profile. However, there is still no data on the relationship between prediabetes and clinical RAS. Therefore, the purpose of this hypothesis is to assess whether the prediabetes aggravate RAS.

Diabetes mellitus and periodontal diseases

A bidirectional relationship between diabetes mellitus (DM) and periodontal diseases (PDs) has been established. It is estimated that patients with poorly controlled DM are 3 times more likely to develop chronic PD compared with normoglycemic individuals despite similar composition in subgingival biofilms. Furthermore, these patients present with increased severity and rapid progression of attachment loss around teeth resulting in edentulism. Treatment of PD results in a modest but significant improvement in glycemic control in patients with DM reflected by a 0.4 % reduction in HbA1c-glycated hemoglobin levels. Compelling evidence from in vitro and animal studies supports a plausible biological explanation for the relationship between the 2 conditions centered on systemic low-grade inflammation. However, the limited number of comparable large randomized clinical trials is reflected in the limited specific guidelines offered by the international organizations for DM and PD regarding the management of the 2 diseases in an individual.

Effects of periodontal non-surgical therapy plus azithromycin on glycemic control in patients with diabetes: a randomized clinical trial

BACKGROUND AND OBJECTIVE

Periodontitis may alter the systemic condition in patients with diabetes and hence interfere with glycemic control. The objective of this study was to determine the quantifiable changes in glycated hemoglobin (HbA1C) after periodontal non-surgical therapy plus azithromycin in a mixed population of patients with poorly controlled diabetes.

MATERIALS AND METHODS

One hundred and five patients were randomized to receive non-surgical therapy plus azythromycin (AZ-Sca =33), non-surgical therapy plus placebo (PB-Sca = 37) and supragingival prophylaxis plus azithromycin (AZ-Pro = 35). Glycated hemoglobin, glycemia and periodontal parameters were measured at baseline, 3, 6 and 9 mo after treatment.

RESULTS

Periodontal parameters were improved in the AZ-Sca and PB-Sca groups as compared to the AZ-Pro group. A greater reduction in probing depth was observed in the AZ-Sca as compared to the PB-Sca group. Improvement in clinical attachment level was similar between AZ-Sca and PB-Sca groups. A reduction from 8.0% to 7.2% (∆0.8%; p < 0.05) in HbA1C was observed in the AZ-Sca at 9 mo as compared to the PB-Sca group in which the reduction was from 7.9% to 7.6% (∆0.3%). There was no decrease in HbA1C in the AZ-Pro group over time. Mean glycemia values decreased from 195 mg/dL to 159.2 mg/dL (∆35.8 mg/dL; p < 0.05) in the AZ-Sca group whereas a decrease from 194 mg/dL to 174.8 mg/dL (∆19.2 mg/dL) in the PB-Sca group at 9 mo was observed. There were no differences between the AZ-Sca and PB-Sca groups for glycemic parameters. No improvement in glycemic values in the AZ-Pro group was observed.

CONCLUSIONS

A modest improvement in glycemic control was detected with a trend towards the use of non-surgical therapy plus AZ as compared to the placebo.