Diabetes mellitus: a review of the literature and dental implications

Diabetes mellitus consists of a group of disorders, which are characterized by a lack of insulin production or insulin resistance. There can be various oral manifestations of diabetes, such as xerostomia and an increased incidence of dental caries. Recently, it has been suggested that periodontitis be added as the sixth complication of diabetes mellitus. It has been shown that uncontrolled or poorly controlled diabetics have a greater incidence of severe periodontal disease compared with those patients who are well controlled or have no diabetes mellitus. This has been found for both type 1 and type 2 diabetics. In addition, the diabetic patient may be predisposed to periodontal disease based on the production of advanced glycation end products, which bind to receptors on specific cells such as the monocyte. The success of periodontal treatment appears to be dependent on the control exhibited by the diabetic patient. The well-controlled diabetic will respond well to periodontal treatment, while the uncontrolled or poorly controlled will often not respond well or be stable in the long-term. Because of the large number of diabetics in the US population, dental therapists should be aware of the interactions of the patient's diabetic status, the proposed treatment, and the possible treatment outcomes as well as complications.

Influence of estrogen and osteopenia/osteoporosis on clinical periodontitis in postmenopausal women

BACKGROUND

In Western societies, more than one-third of the female population above age 65 suffers from signs and symptoms of osteoporosis, a disorder characterized by low bone mass. Estrogen deficiency is the dominant pathogenic factor for osteoporosis in women. The impact of estrogen deficiency and osteopenia/osteoporosis on periodontitis is unclear, partially due to the lack of longitudinal studies evaluating clinical signs of gingival inflammation and periodontitis progression. The purpose of this investigation was to analyze prospectively the influence of serum estradiol levels and osteopenia/osteoporosis on common clinical measurements of periodontal disease over a 2-year period.

METHODS

Fifty-nine moderate/advanced adult periodontitis patients and 16 non-periodontitis subjects, all within 5 years after menopause at baseline, completed the study. Serum estradiol levels (E2) were measured yearly by 125I radioimmunoassay, and osteopenia/osteoporosis was determined by dual energy x-ray absorptiometry of the lumbar spine. Posterior interproximal clinical measurements were obtained every 6 months for the periodontitis patients, including explorer-detectable supragingival plaque, bleeding on probing (BOP) and relative clinical attachment level (RCAL). Baseline probing depths, smoking history, and demographic data also were collected.

RESULTS

Data indicated that baseline demographic measurements and bone mineral density (BMD) of the lumbar spine were not different between E2-deficient and E2-sufficient subjects. Smoking activity (packs smoked/day, years smoked) was higher in periodontitis patients (P=0.0001). E2-sufficient periodontitis subjects had a higher frequency of supragingival plaque without increasing gingival inflammation. E2 status did not influence the percentage of sites losing RCAL for either periodontitis or non-periodontitis groups, but when non-smoking osteopenic/osteoporotic periodontitis patients were evaluated, E2-deficient subjects had more BOP (43.8% versus 24.4%, P<0.04) and a trend toward a higher frequency of > or =2.0 mm RCAL loss (3.8% versus 1.2%, P<0.1) than E2-sufficient subjects.

CONCLUSIONS

These data suggest that E2 supplementation (serum E2>40 pg/ml) is associated with reduced gingival inflammation and a reduced frequency of clinical attachment loss in osteopenic/osteoporotic women in early menopause.

The use of 2 bioabsorbable barrier membranes in the treatment of interproximal intrabony periodontal defects

BACKGROUND

The use of barrier membranes in the treatment of periodontal defects is well documented. There has been an increase in the use of bioabsorbable materials which do not require a second surgical procedure for removal. However, there are little data evaluating the efficacy of bioabsorbable membranes in the treatment of intrabony defects. The purpose of this investigation was to evaluate the regenerative potential of 2 bioabsorbable barrier membranes without the use of grafting materials in the treatment of interdental intrabony defects.

METHODS

Twenty-three 2- or 3-walled intrabony defects were treated in 19 patients with a mean age of 50.4 years. All had completed nonsurgical treatment and a period of supportive periodontal therapy. The sites were randomly chosen to receive a barrier membrane composed of type I bovine collagen (11) or a copolymer of polylactic acid (PGA/PLA;12). A pressure sensitive disc probe was used to evaluate the following criteria at baseline and re-entry: 1) occlusal surface to the apical depth of probe penetration (OS-DP); 2) occlusal surface to the gingival margin (OS-GM); 3) occlusal surface to the alveolar crest (OS-AC); and 4) occlusal surface to the base of the osseous defect (OS-BD). Full thickness mucoperiosteal flaps were reflected to expose the surgical sites. The defects were debrided of the granulomatous tissue, the root surfaces instrumented and conditioned with 4 one-minute applications of 50 mg/ml of tetracycline. The barrier membranes were adapted to cover the defects and the flaps replaced. The postsurgical healing was uneventful and similar in both treatment modalities.

RESULTS

Twenty-three sites were surgically re-entered 6 months from the time of the initial surgery. The deepest probe depth for each site was used for statistical analysis. There was a mean relative attachment gain of 2.58+/-1.90 mm for the collagen, and 2.77+/-2.13 mm for the copolymer. There was a decrease in probing depth of 3.27+/-1.91 mm and 0.69+/-1.35 mm of recession for the collagen. The PGA/PLA copolymer had 3.55+/-2.47 mm reduction in probe depth and 0.78+/-1.14 mm of recession.

CONCLUSIONS

The data indicated the bioabsorbable collagen and copolymer membranes resulted in comparable results. A larger sample size would be necessary to determine if one membrane was superior to the other.

Complications associated with diabetes mellitus after guided tissue regeneration: case report

Dental practitioners need to be aware of the complications that can arise in the management and treatment of patients with diabetes mellitus. Patients with diabetes, and patients with a family history of diabetes, are at-risk dental patients. They are more likely to develop periodontal disease, and the periodontitis is more likely to be severe. Diabetes influences the progression and severity of periodontitis through changes in the small blood vessels, decreased collagen formation, and impairment of the host's defense mechanisms. Furthermore, complications associated with diabetes, such as impaired wound healing, can affect the patient's response to periodontal therapies like guided tissue regeneration (GTR). The case report in this article discusses the postsurgical complications that occurred during GTR treatment of a patient with non-insulin-dependent diabetes. The diabetic's susceptibility to periodontal disease and impaired wound healing can affect the progression of the disease and its treatment. Dental patients with diabetes require close supervision and frequent monitoring of their medical and dental health by the dental clinician.

Case report. Use of an argon laser to treat drug-induced gingival overgrowth

This article explores the use of an argon laser to treat severe drug-induced gingival overgrowth. The patient was being treated with phenytoin (Dilantin, Parke-Davis), cyclosporine and a calcium channel blocker. He had undergone a kidney transplantation and had insulin-dependent diabetes mellitus. He had severe gingival overgrowth, which prevented him from wearing his removable prostheses, and a superimposed Candida albicans infection. An argon laser was used to excise the gingival overgrowth so new maxillary and mandibular prostheses could be fabricated.

Placement and restoration of implants by predoctoral students: the Creighton experience

Teaching of implant dentistry in the predoctoral dental curriculum has evolved dramatically over the past 20 years. In 1974, only one third of American dental schools addressed the topic of implants. Today, 48 of the 54 American dental schools have predoctoral curricula. The Creighton University experience offers some unique and instructive insights into a 10-year process of developing and implementing a predoctoral implant dentistry curriculum. All interested students may perform both the surgical placement and restoration of implant prostheses. Clinical instruction involves all restorative and surgical faculty members. Favorable 3-year (91%) and 5-year (87%) surgical success rates have been maintained. This article presents one university's program for examination and discussion.

Treatment of intrabony defects with collagen membrane barriers. Case reports

Two separate investigations were undertaken to assess the clinical characteristics and the safety, and to determine whether an absorbable type 1 bovine collagen barrier membrane would result in the improvement of clinical parameters during guided tissue regeneration in humans. The collagen membrane barrier was placed over a total of 21 interdental intrabony periodontal defects in 18 patients. The surgical procedures and postsurgical regimen were similar in both components of the investigation. Sulcular incisions were used and the sites were surgically exposed by reflection of full thickness mucoperiosteal flaps. The intrabony defects were debrided and the root surfaces prepared with automatic scalers and curets. Four 1-minute applications of tetracycline HCl 50 mg/ml were applied to the root surface. The collagen membrane barrier was hydrated in sterile saline until pliable, then trimmed so it covered the osseous defect and extended 2 to 3 mm beyond the defect. In both investigations, the collagen barrier membrane was not sutured, but retained by "pouching" or undermining the flap. Healing occurred without complications. There were no untoward or adverse reactions to the material in either phase of the study. In the initial investigation, 13 intrabony defects with probing depths of > or = 5 mm were treated in 9 patients having a mean age of 50.6 years. No controls defects were treated. Soft and hard tissue measurements were taken at the time of initial surgery and at 2, 4, and 6 months. In the second phase, 9 patients were enrolled with a mean age of 49.7 years. They had similar bilateral interdental intrabony defects with probing depths > or = 6 mm. One defect received the collagen membrane barrier, while the other was treated by flap debridement alone. The collagen membrane had undergone modification since the initial investigation, and was more highly cross-linked to retard absorption. After initial therapy, and prior to the surgical procedure, a series of 3 dermal patch tests were used to determine whether the patient would elicit a reaction to the collagen. Venous blood was drawn at baseline, 7 to 10 days, 18 to 21 days and at 8 weeks for analysis by ELISA for comparison of test and control sites relative to baseline. There were no allergic response to the dermal tests, and the ELISA tests indicated no significant differences between test and control sites. An automated probe was used to record soft and hard tissue measurements. These included the probing depths and clinical attachment levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute myelomonocytic leukemia with oral manifestations: report of case

A patient seeking dental care was diagnosed with acute myelomonocytic leukemia and referred to a hematologic-oncologic service for confirmation and treatment. The typical oral findings and a discussion of the disease process of acute leukemia are presented.

Enhanced protein adsorption at the solid-solution interface: dependence on surface charge

By the use of infrared internal reflection spectroelectrochemistry, it has been possible to observe an enhanced adsorption of porcine fibrinogen onto a germanium surface at potentials more positive than -200 millivolts relative to a saturated calomel electrode. The enhanced adsorption was observed directly at the interface between the solid and the aqueous solution.