Higher prevalence of periodontitis in patients with refractory arterial hypertension: a case-control study

Oral Diseases (2011) 17 , 560–563 Objective: The aim of this study was to assess the association of periodontitis with refractory arterial hypertension. Study design: A total of 137 patients were examined. Seventy patients (mean age of 55.2 ± 9.2 years) were included in the case group, while 67 non‐hypertensive subjects (mean age of 50.0 ± 7.2) served as a control group. Periodontal clinical examination included plaque index, bleeding on probing, probing pocket depth and clinical attachment loss (CAL). Patients with at least five sites with CAL ≥6 mm were considered as severe periodontitis, and with at least 30% of the sites with CAL ≥4 mm generalized chronic periodontitis. Results: The mean (±s.d.) number and percentage of sites with CAL ≥6 mm were 11 (±14) and 16.6 (±14) in the case group, and 5.7 (±9.5) and 5.8 (±9.7) in the control group (P < 0.05). The mean (±s.d.) percentage of sites with CAL ≥4 mm was 37 (±29.6) in the case group and 21.2 (±20) in the control group (P < 0.05). The significant associations with arterial hypertension were severe chronic periodontitis (OR = 4.04, 95% CI: 1.92; 8.49) and generalized chronic periodontitis (OR = 2.18, 95% CI: 1.04; 4.56). Conclusions: Severe and generalized chronic periodontitis seem to play a role as risk indicators for hypertensive patients.     

浅析中药对慢性牙周炎的辅助治疗作用

目的：探讨中药治疗慢性牙周炎的临床疗效。方法：20例慢性牙周炎女性患者,随机分为2组,牙周基础治疗后,实验组给予补肾清火的中药治疗,对照组不服中药,3个月后复查各项牙周指数的变化。结果：2组患者服药前,菌斑指数（PLI）、牙周探诊深度（PPD）、附着水平测定（PAL）,无显著性差异（P〉0．05）,3个月后复查,2组各项牙周指数有显著性差异（P〈0．01）。结论：中药对慢性牙周炎症有明显的改善作用。     

牙周炎伴发糖尿病的临床治疗

对牙周炎伴发糖尿病68例病人的治疗进行观察，实验组牙周炎及糖尿病同时治疗，而对照组仅治疗牙周炎，观察30天。结果为实验组中牙周炎显效34例，占91．9％，对照组牙周炎显效11例，占29．7％。x2＝32．8＞7．88，P＜0．005。结果表明，对于牙周炎伴发糖尿病病人，在治疗牙周炎的同时，治疗糖尿病，可以明显提高牙周炎的疗效。     

牙周基础治疗对Ⅱ型糖尿病伴牙周炎病人糖基化终产物的影响

目的:观察牙周基础治疗对Ⅱ型糖尿病伴慢性牙周炎病人牙周组织和血清中糖基化终产物(advanced glycation end of products,AGEs)变化的长期影响。方法:诊断为Ⅱ型糖尿病并伴有中等程度以上牙周炎的病人30例,分为进行牙周基础治疗的干预组15例(DM1组),未进行牙周基础治疗的未干预组15例(DM2组);分别在初诊和每次复诊治疗前记录2组的探诊深度(probing depth,PD)、附着丧失(attachment loss,AL)、空腹血精、AGEs指标。结果:经牙周基础治疗后,DM1组牙周临床指标均有明显改善;2组AGEs水平有不同程度升高(P<0.05);DM1组第21个月AGFs水平显著低于DM2组,有统计学意义(P<0.05)。结论:牙周基础治疗对Ⅱ型糖尿病伴慢性牙周炎病人的PD、AL、血糖水平、AGEs水平有显著的改善(P<0.05),并且有助于长期稳定。     

2型糖尿病合并牙周炎患者血清白细胞介素-1水平的检测

目的探讨2型糖尿病合并牙周炎患者血清白细胞介素-1（interleukin-1,IL-1）蛋白水平的表达。方法选择健康对照、糖尿病、重度慢性牙周炎和重度慢性牙周炎伴2型糖尿病患者各32例。用酶联免疫ELISA法测定血清IL-1α、IL-1β水平。结果 2型糖尿病合并牙周炎患者的血清IL-1β含量明显高于不伴牙周炎的糖尿病患者（P〈0.05）,牙周炎组高于健康对照组。4组中IL-1α水平无显著差异。结论 2型糖尿病合并牙周炎患者血清IL-1β水平明显升高。     

Ⅱ型糖尿病病人牙周附着水平的调查

目的:了解Ⅱ型糖尿病病人的牙周附着水平。方法:调查1 503名Ⅱ型糖尿病病人和819名健康志愿者的牙周附着水平,按年龄分组,用SPSS 16.0软件包对结果进行分析。结果:同一年龄组内,Ⅱ型糖尿病病人和健康对照组年龄构成相似,差异无统计学意义(P>0.05),除≥75岁组外,同一年龄组内Ⅱ型糖尿病病人牙周附着丧失程度明显较正常对照组严重,差异具有统计学意义(P<0.01)。结论:Ⅱ型糖尿病病人牙周附着丧失程度较正常人群明显严重,倡导早期对糖尿病病人进行口腔卫生保健指导,预防牙周炎的发生。     

Cytokines and bone-related factors in systemically healthy patients with chronic periodontitis and patients with type 2 diabetes and chronic periodontitis

Background: This study compares the levels of cytokines and bone‐related factors in the gingival crevicular fluid (GCF) of systemically healthy patients with chronic periodontitis (CP); and better‐controlled, and poorly controlled patients with type 2 diabetes and CP. Methods: Thirty‐seven patients with type 2 diabetes and CP and 20 systemically healthy patients with CP were enrolled in this study. The patients with diabetes mellitus were categorized as better‐controlled (n = 17; HbA_1c levels ≤8%) or poorly controlled (n = 20; glycated hemoglobin values >8%). Levels of tumor necrosis factor‐α, interleukin (IL)‐4, interferon (IFN)‐γ, IL‐23, IL‐17, soluble receptor activator of nuclear factor‐kappa B ligand (sRANKL), and osteoprotegerin (OPG) in GCF of diseased sites were analyzed by enzyme‐linked immunosorbent assay. Results: Type 2 diabetes mellitus, as a whole, upregulates the levels of OPG, sRANKL, IFN‐γ, IL‐17, and IL‐23 and downregulates the production of IL‐4 in sites with CP (P <0.05). Better‐controlled individuals exhibited the highest levels of IFN‐γ, whereas poorly controlled patients presented the highest levels of IL‐17 (P <0.05). There were no differences in the levels of tumor necrosis factor‐α, OPG, and IL‐23 among systemically healthy, better‐controlled, and poorly controlled patients with diabetes (P >0.05). Conclusions: Increased levels of proinflammatory cytokines and RANKL were observed in the GCF of patients with type 2 diabetes with CP, compared to patients without diabetes. In addition, poor or good glycemic status seems to modulate osteo‐immunoinflammatory mediators in a different manner.     

A novel intraoral diabetes screening approach in periodontal patients: results of a pilot study

Background: This pilot study examines whether a novel diabetes screening approach using gingival crevicular blood (GCB) could be used to test for hemoglobin A1c (HbA1c) during periodontal visits. Methods: Finger‐stick blood (FSB) samples from 120 patients and GCB samples from those patients with adequate bleeding on probing (BOP) were collected on special blood collection cards and analyzed for HbA1c levels in a laboratory. The Pearson correlation coefficient was used to measure correlation between FSB and GCB HbA1c values for 75 paired FSB and GCB samples. A receiver–operator characteristic curve (ROC) analysis was performed to determine an optimal GCB HbA1c criterion value for a positive diabetes screen. Results: For the 75 paired samples, the Pearson correlation coefficient was 0.842. The ROC analysis identified a criterion value of 6.3% for the GCB HbA1c test with high sensitivity (0.933) and high specificity (0.900), corresponding to FSB HbA1c values ≥6.5% (in the diabetes range). Using this GCB HbA1c criterion value for 27 additional paired samples, in which there was an unidentified component observed to coelute within the elution window of GCB HbA1c in the laboratory, there was agreement between FSB and GCB values for 24 of the pairs according to whether both were within or outside of the diabetes range. Conclusion: Using a criterion value of 6.3%, GCB samples are acceptable for HbA1c testing to screen for diabetes in most persons with BOP at the GCB collection site.     

糖尿病患者牙周炎牙列缺损和牙列缺失的情况调查

目的：了解分析卫辉市部分老年糖尿病患者牙周炎、牙列缺损和牙列缺失情况。方法：对近3年来就诊于新乡医学院第一附属医院口腔科的60岁以上老年糖尿病患者的牙周炎患病率、牙列缺损及牙列缺失情况进行调查,并与对照组进行对比分析。结果：老年糖尿病患者的牙周病患病率为70.02%,牙列缺损率为66.36%,牙列缺失率为18.26%,均明显高于对照组,具有显著性差异（P〈0.01）。结论：该人群口腔健康水平较低,我们应该加强口腔卫生服务及健康宣传工作。     

Long-term control of diabetes mellitus and periodontitis

Abstract The purpose of this study was to evaluate the association between long-term control of diabetes mellitus (DM) and periodontitis, A total of 75 diabetics (Type I or II) aged 20–70 years with long-term records of their diabetic control were selected for the study. The following periodontal variables were recorded in a randomized half-mouth examination: plaque, calculus (+/?), probing depth (pd) and attachment loss (al). The mean of glycosylated hemoglobin measurements (IIbAlc) over the past 2–5 years was used to indicate the long-term control of DM. The study participants were divided into well-, moderately- and poorly-controlled diabetics. An increase in the prevalence, severity and extent of periodontitis with poorer control of diabetes was observed. The extent of calculus also increased with poorer control. In a multiple regression analysis, calculus and long-term control of diabetes were significant variables when pd≥4 mm was used as the dependent variable. Age was a significant predictor for al > 3 mm but not for pd ≥4 mm. Sex, duration and type of DM were not significant variables in the regression models. Less than 2% of sites with no calculus demonstrated pd≥4mm. When calculus was present, the frequency of pd ≥4 mm increased from 6% in the well-controlled diabetics to 16% in the poorly-controlled ones. We conclude that periodontitis in diabetics is associated with long-term metabolic control and presence of calculus. Therefore, regular maintenance care, including patient motivation and instruction as well as professional calculus removal, is important for diabetic patients.     

A population-based study of periodontal care among those with and without diabetes

Background: Our objectives were to describe the prevalence of periodontal care (a marker of periodontitis) among persons with and without diabetes and to examine the association between periodontal care and diabetes. Methods: We conducted a cross‐sectional analysis, using 5 years of electronic data from a population‐based cohort (N = 46,132), aged 40 to 70 years, with dental and medical insurance, and ≥1 dental and ≥1 medical visit. Periodontal care (yes/no) was defined by dental claims codes for procedures used to manage periodontitis. The association between periodontal care and diabetes was determined using logistic regression adjusted for and stratified by age, sex, insurance type, smoking status, body mass index (BMI) (in kilograms per square meter), and resource utilization band (RUB) (a measure of expected health care utilization attributable to comorbidity). Results: Overall, 11.2% (5,153 of 46,132) met diabetes criteria. The age‐adjusted prevalence of periodontal care among those with and without diabetes was 39.1% and 32.5%, respectively (P <0.0001). The association between diabetes and periodontal care decreased with increasing age (interaction, P <0.0001), adjusting for BMI and RUB. The aged‐stratified, adjusted odds ratio (OR) for periodontal care associated with diabetes was highest among those aged 40 to 44 years [OR, 1.6; confidence interval (CI), 1.30 to 1.97] and lowest among those aged 60 to 64 years (OR, 0.97; CI, 0.81 to 1.15) and was significant only among those aged 40 to 54 years. Conclusion: We found that the prevalence of periodontal care was significantly higher among those with diabetes compared to those without diabetes and that the magnitude of this association decreased with increasing age.     

Recovery of Candida dubliniensis and other Candida species from the oral cavity of subjects with periodontitis who had well‐controlled and poorly controlled type 2 diabetes: a pilot study

The goal of this study was to determine the prevalence of Candida dubliniensis and other Candida species from saliva samples and from subgingival plaque samples at periodontally healthy and periodontally diseased sites in subjects who had type 2 diabetes and periodontitis. Saliva and subgingival samples were obtained from 30 subjects with periodontitis: 15 with poorly controlled and 15 with well‐controlled type 2 diabetes. Samples were analyzed for the presence of C. dubliniensis and other Candida species. Among subjects with poorly controlled diabetes, 53% were positive for C. albicans, 20% for C. glabrata, 6% for C. tropicalis, and 6% for C. parapsilosis. Among well‐controlled subjects, 33% were positive for C. albicans and 13% for C. glabrata; none had C. tropicalis or C. parapsilosis. No samples were positive for C. dubliniensis in either group of subjects.