Diabetes &. Periodontal Health: A Two-way relationship. Francesco D'Aiuto. DMD , MClinDent, PhD, MRD RCS(Eng) RCPS (Glasg). HEFCE Senior Clinical. There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the. periodontitis, while periodontal infection is associated with worsening glycemic control in diabetic patients. This two-way relationship points to a.
Currently there is a large amount of data in epidemiological, clinical and laboratory studies that strongly correlate the role of periodontal pathogens on systemic organs by producing pro-inflammatory cytokines, chemokines and inflammatory mediators. Although the relationship between periodontal disease, inflammation and overall health has been suspected, numerous studies are providing more comprehensive evidence for this link.
In this context, diabetes predisposes oral tissues to greater periodontal destruction but several studies have now identified that periodontal disease leads to poor glycemic control.
Periodontitis and diabetes: a two-way relationship
It was hence predicted that there exists a two-way relationship between periodontal disease and diabetes mellitus. The regular use of Dental Air Force home dental cleaning system as an oral hygiene device is optimal for suppressing both periodontal infection and associated systemic diseases Diabetes as compared to conventional tooth brushing.The Perio Link, gum disease and diabetes connection.
A Microbial Infection The oral cavity has the potential to harbor at least different bacterial species, and in any given patient, more than species may be present, surfaces of tooth can have as many as a billion bacteria in its attached bacterial plaque and good oral hygiene is the fundamental for oral integrity as it greatly affects the quality of life.
Periodontal diseases are recognized as infectious processes that require bacterial presence and a host response and are further affected and modified by other local, environmental and genetic factors. Bacteria in a biofilm have a physiology different from that of planktonic cells and live under nutrient limitation and often in a dormant state, thus a biofilm is organized to maximize energy, spatial arrangements and movement of nutrients and byproducts with advantages which includes a broader habitat range for growth, an enhanced resistance to antimicrobial agents and host defense and an enhanced ability to cause disease.
A Complex Linkage Association of periodontal infection with organ systems such as cardiovascular system, endocrine system, reproductive system, and respiratory system makes periodontal infection a complex multiphase disease.
Periodontitis initiates systemic inflammation and can be monitored by inflammatory markers like C-reactive protein or fibrinogen levels. Bacteria and byproducts from the oral cavity are commonly introduced into the bloodstream; the extent of the pathogenic bacterial migration depends on the severity of the gingival inflammation.
Oral bacteria have been found in arteries, lungs, the brain, amniotic fluid and pancreas.
Diabetes and periodontal disease: a two-way relationship.
The vibrant effect of dental plaque- host immune reaction leading to adverse influence on systemic health is illustrated in Fig. Periodontitis and Systemic health Linkage. DM is a metabolic disorder characterized by impaired action, secretion of insulin or both, resulting in hyperglycemia presents with the classical triad of symptoms: Polydypsia, polyuria and polyphagia which are often accompanied by chronic fatigue and loss of weight. Frequently this metabolic disarrangement is associated with alterations in adipocyte metabolism.
Diabetes is a syndrome and it is now recognized that chronic hyperglycemia leads to long-term damage to different organs including the heart, eyes, kidneys, nerves, and vascular system. There are several etiologies for diabetes and although establishing the type of diabetes for each patient is important, understanding the pathophysiology of the various forms of the disease is the key to appropriate treatment.
Clinical Presentation of Diabetes Type 1 diabetes The onset of type 1 diabetes is usually rather abrupt when compared to that of type2.
The classic signs and symptoms of diabetes are polyuria, polydipsia, and polyphagia; however, others may be present.
This increased urination causes a loss of glucose, free water, and electrolytes in the urine, with consequent polydipsia. Postural hypotension may be present secondary to decreased plasma volume, and weakness can occur as a result of potassium wasting and catabolism of muscle proteins. Blurred vision is a consequence of the exposure of the lens and retina to the hyperosmolar state.
If the insulin deficiency is acute, as often occurs in type 1 diabetes, these signs and symptoms develop abruptly.
When ketoacidosis is present, greater hyperosmolarity and dehydration are present causing nausea, vomiting, and anorexia with various levels of altered consciousness.
Type 1 diabetes mellitus encompasses diabetes resulting primarily from destruction of the beta-cells in the islets of Langerhans of the pancreas and this condition often leads to absolute insulin deficiency. The cause may be idiopathic or due to a disturbance in the autoimmune process. The onset of the disease is often abrupt, and patients with this type of diabetes are more prone to ketoacidosis and wide fluctuations in plasma glucose levels. Type 2 diabetes Patients with type 2 diabetes can be initially asymptomatic or may have symptoms of polyuria and polydipsia.
Diabetes and Periodontitis: A Two Way Relationship | Open Access Journals
Others may present initially with pruritis or evidence of chronic or acute skin and mucosal infections such as candidal vulvovaginitis or intertrigo. Typically, type 2 diabetic patients are obese and may present with neuropathic or cardiovascular complications, hypertension, or microalbuminuria. Because type 2 diabetes can remain undiagnosed for many years, these patients may have significant diabetic complications even at the time of initial diagnosis. The causes of type 2 diabetes mellitus range from insulin resistance with relative insulin deficiency to a predominantly secretory defect accompanied by insulin resistance.
The onset is generally more gradual than for type 1, and this condition is often associated with obesity. In addition, the risk of type 2 diabetes increases with age and lack of physical activity, and this form of diabetes is more prevalent among people with hypertension or dyslipidemia. Gestational diabetes mellitus GDM Is glucose intolerance that begins during pregnancy. The children of mothers with GDM are at greater risk of experiencing obesity and diabetes as young adults.
Diabetes and Periodontitis: A Two Way Relationship
A Two Way Relationship Although the relationship between periodontal disease, inflammation and overall health has been suspected, numerous studies are providing more comprehensive evidence for this link. These pro-inflammatory cytokines such as Interleukin-6 impair the glucose stimulated release of insulin from the pancreas. In fact, periodontal disease has been considered as the sixth complication of diabetes. People with type 1 diabetes are at greater risk of developing gingivitis.
Both children and adults with poor metabolic control show a tendency toward higher gingivitis scores. The prevalence of gingivitis in children and adolescents is nearly twice that observed in populations of children and adolescents without diabetes.
- Periodontitis and diabetes: a two-way relationship
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Studies indicate that the severity and extent of gingivitis are significantly increased in young patients with diabetes. The association of diabetes with gingivitis in children and adolescents is so widely accepted that diabetes mellitus—associated gingivitis is included as a specific entity in the most recent classification of periodontal diseases.
In adolescence, periodontitis does occur, but the extent of attachment loss is usually minimal.
The prevalence of periodontal disease in juveniles with type 1 diabetes has been reported to be 9. Periodontal disease may have a significant impact on the metabolic state of diabetes. The presence of PD increases the risk of worsening glycemic control in time.
Taylor [ 12 ], in a cohort study of patients with diabetes with severe PD for two years, found a relative risk six times more the probability of worsening glycemic control in comparison to periodontally healthy diabetics. Inflammation has been suggested to cause increased insulin resistance. Different biologic mechanisms have been proposed to explain the basis of this relationship.
Bioinformatics can play a central role in the analysis and interpretation of genomic and proteomic data.
The first proposes a direct causal or modifying relationship in which the consequent hyperglycemia and hyperlipidemia of diabetes result in metabolic alterations which may then exacerbate the bacteria-induced inflammatory periodontitis.
The second hypothesis proposes that an unfortunate combination of genes gene sets could result in a host who, under the influence of a variety of environmental stressors, could develop both periodontitis and diabetes. This view is supported by the observation of common immune mechanisms involved in the pathogenesis of both diabetes and periodontitis; their genetic association with the HLA region of chromosome 6, where a number of genes involved in the immune response are situated; and the bidirectional association indicating that, not only is the prevalence of periodontitis higher in diabetics than in non-diabetics, but also that the prevalence of diabetes is higher in persons with periodontitis than in controls.
It is of course possible that the two mechanisms proposed in the hypotheses are not independent but that they can function together in what is obviously a complicated set of events. Periodontitis is recognized as the sixth major complication of diabetes, having increased prevalence and severity in patients with diabetes. Early diagnosis of diabetes in patients with periodontitis can lead to the prevention of major morbidity and mortality associated with the disease. Therapy for diabetes may also lead to the improvement of periodontitis.
In this review, we are presenting the current knowledge of the interplay and interaction between these two entities and the available data regarding treatment of the two entities together. Oral health in diabetes, Periodontitis and diabetes, periodontitis How to cite this article: Agarwal R, Baid R.
A bidirectional, cyclical relationship - A brief review. Acta Med Int ;4: Diabetes is associated with an increased susceptibility to infections, poor wound healing, and is hailed as a major risk factor for more severe and progressive periodontitis, leading to the destruction of tissues and supporting bone that forms the attachment around the tooth.
Effect of Diabetes on Periodontium The influence that diabetes exerts on oral health has been extensively studied. Aggressive periodontitis was found as the sixth serious complication of diabetes as early as The risk of periodontitis is increased by threefold in patients with diabetes compared to nondiabetics.
Thus, while poor control of diabetes clearly increases the risk of diabetes complications including periodontitis, not all patients with poor glycemic control develop major complications. Conversely, some well-controlled diabetics may as well suffer some major diabetic complications. Many well-controlled patients with diabetes have excellent periodontal health, others do not.
Most certified diabetes educators agree that there is a link between oral and systemic health and that collaboration with the dental profession would be a positive outcome for patients.
In general, how diabetes adversely affects outcomes of periodontal disease has not been a much-researched topic. Most studies evaluating such are old, done in the s. Well-controlled patients with diabetes have a similar response to the standard response protocol SRP like that of nondiabetics. However, those with poor control have a rapid recurrence of deep pockets and a poorer long-term prognosis.
Considering the role of poor glycemic control in severe periodontal disease, and the fact that periodontal disease tends to act like other complications of diabetes, it would only be logical to assume that poor glycemic control might portend poorer prognosis of the periodontal disease.