Update on diabetes mellitus and related oral diseases

Diabetes mellitus (DM) is a group of complex multisystem metabolic disorders characterized by a relative or absolute insufficiency of insulin secretion and/or concomitant resistance to the metabolic action of insulin on target tissues. The chronic hyperglycaemia of diabetes is associated with long-term systemic dysfunction. The present article summarizes current knowledge of DM and details the oral and dental implications of this common endocrine disorder.     

Dental and oral symptoms of diabetes mellitus

Dental and oral examinations of 1360 patients with diabetes mellitus showed higher DMFT mean values with fewer carious teeth and more filled and extracted teeth than the controls. PI mean values were higher in diabetics than in the controls, the difference being statistically significant, and showed a positive correlation with age, but no correlation with the length of time since the disease was established. No correlation was found between the severity of gingivitis and changes in blood glucose levels. The sucrose-free diet of diabetics does not seem to reduce caries prevalence. The increased DMFT index is explained by the fact that, due to periodontitis, diabetics lose more teeth sooner than do healthy people.     

The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus

OBJECTIVES: The aim of the present study was to investigate the effect of improved periodontal health on metabolic control in type 2 diabetes mellitus (DM) patients. MATERIAL AND METHODS: Fourty-four patients with type 2 DM were selected. Subjects were randomly assigned into two groups. Data collection: Plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment levels (CALs), gingival recession (GR) and bleeding on probing (BOP) were recorded at baseline at 1st and 3rd months. Fasting plasma glucose (FPG), 2-h post-prandial glucose (PPG), glycated haemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), HDL-cholesterol, LDL-cholesterol and microalbuminure were analysed at baseline, 3 months following the periodontal therapy. The treatment group received full-mouth scaling and root planing whereas the control group received no periodontal treatment. RESULTS: A statistically significant effect could be demonstrated for PI, GI, PPD, CAL and BOP for the treatment group. HbA1c levels in the treatment group decreased significantly whereas the control group showed a slight but insignificant increase for this parameter. CONCLUSIONS: The results of our study showed that non-surgical periodontal treatment is associated with improved glycaemic control in type 2 patients and could be undertaken along with the standard measures for the diabetic patient care.     

Root caries and diabetes: risk assessing to improve oral and systemic health outcomes

This report reviews the current understanding of the relationship between diabetes and root caries, and investigates the evidence for dental chairside testing of gingival crevicular blood (GCB) glucose levels to assess risk for type 2 diabetes mellitus. Diabetes is linked with the progression of periodontal disease and a greater number of exposed root surfaces at risk for root caries. The rapidly increasing prevalence of type 2 diabetes coupled with a general trend towards retention of teeth means that the number of patients with increased risk for root caries is expanding significantly. Many patients with diabetes or abnormal blood glucose levels are unaware of their condition or that they are at increased risk for oral disease. Systemic blood glucose concentrations are comparable to those found in GCB and therefore may be a useful adjunctive clinical aid in determining appropriate care for patients and providing timely referrals to general medical practitioners. Use of GCB testing within the dental clinic is described. It is proposed that future studies be undertaken to provide clinicians with improved risk assessment strategies and to evaluate GCB glucose screening models.     

数字光处理打印牙科氧化锆的微观结构和机械性能研究

目的 研究数字光处理技术(DLP)打印牙科氧化锆的微观结构特征和机械性能,探究其临床应用前景.方法 以DLP技术制备氧化锆为实验组(DLP组),数控切削技术制备氧化锆为对照组(MILL组),测定其密度、晶粒尺寸及晶相构成以研究微观结构特征,采用三点弯曲试验测量挠曲强度,硬度计测量维氏硬度,单边V槽横梁法测量断裂韧度.结...     

Oral health of patients with insulin-dependent diabetes mellitus

Abstract — Oral health, the amount of salivary Streptococcus mutans and lactobacilli, and the flow rate, pH and buffer capacity of paraffin-stimulated whole saliva were analyzed in 35 adult diabetic patients and their age- and sex-matched non-diabetic, clinically healthy controls. All patients had insulin-dependent diabetes (IDDM) with a mean (± SD) duration of 14.0 ± 9.1 yr. The prevalence of dental caries was as high in the diabetic group as in the controls but the past caries experience was remarkably lower in those individuals whose diabetes had started at a very early age (= 7 yr). In agreement with the clinical data, the salivary levels of cariogenic microorganisms were of the same order of magnitude in both study groups. However, the relative proportion of S. mutans from the total cultivable aerobic microflora was significantly higher ( P <0.01) in diabetics compared to the controls. The other studied salivary parameters did not differ between the groups. Remarkable individual differences were observed in the correlation between glucose levels of blood and whole saliva among diabetics. In spite of the noncariogenic dietary habits, the adult diabetic patients seem to be at least as susceptible to dental caries as non-diabetics, probably due to the leakage of glucose from blood into the oral cavity.     

Root surface and coronal caries in adults with type 2 diabetes mellitus

OBJECTIVES: To determine the effect of type 2 diabetes mellitus (DM) on coronal and root surface caries and to investigate some factors suspected of being related to or interacting with DM, that may be associated with coronal and root surface caries. METHODS: A stratified cross-sectional study was conducted in 105 type 2 diabetic patients and 103 non-diabetic subjects of the same age and gender. Coronal and root surface caries, exposed root surfaces, periodontal status, stimulated salivary functions, oral hygiene status, oral health behaviors, and counts of mutans streptococci and lactobacilli were measured. RESULTS: Type 2 diabetic patients compared with non-diabetic subjects had a higher prevalence of root surface caries (40.0% versus 18.5%; P = 0.001), a higher number of decayed/filled root surfaces (1.2 +/- 0.2 versus 0.5 +/- 0.1; P < 0.01) and a higher percentage of generalized periodontitis (98.1% versus 87.4%; P < 0.01); but the prevalence and decayed/filled surface of coronal caries was not significantly different (83.8% versus 72.8% and 8.0 +/- 9.4 versus 6.3 +/- 7.5 respectively). The factors associated with root surface caries included type 2 DM, a low saliva buffer capacity, more missing teeth, and existing coronal caries; whereas wearing removable dentures, more missing teeth, a high number of lactobacilli, and a low saliva buffer capacity were associated with coronal caries. CONCLUSION: Type 2 DM is a significant risk factor for root surface, but not for coronal caries. Periodontal disease should be treated early in type 2 diabetic subjects to reduce the risk of subsequent root surface caries.     

Caries, oral hygiene and periodontal disease in handicapped adults

Caries, periodontal disease, oral hygiene and treatment needs were assessed in a group of handicapped adults. The study group comprised 199 individuals aged 17-64 yr, most of whom were mentally subnormal. The mean DMFT values ranged from 17.4 in the 17-24-yr-old age group to 26.9 in the 55-64-yr-old age group. Tooth loss increased rapidly with advancing age. In all age groups the F component was less than 20% and high numbers of untreated carious lesions were found. Of the group studied, 90% needed some conservative treatment. Oral hygiene was poor and a high prevalence of periodontal disease was found. Of the dentulous persons, 49% needed scaling and 34% complex periodontal treatment. The percentage of study group patients requiring dental treatment was very high, so that it can be concluded that dental care for the handicapped is insufficient. This situation must be improved and a suitable system for the delivery of preventive measures must be devised for this group of the population.     

Anti-plaque agents in the prevention of biofilm-associated oral diseases

The prevention of dental caries and periodontal diseases is targeted at the control of dental plaque. In this context, chemical agents could represent a valuable complement to mechanical plaque control. The active agents should prevent biofilm formation without affecting the biological equilibrium within the oral cavity. Depending on the goals of the preventive measures, various strategies may be considered. Anti-plaque agents with properties other than bactericidal or bacteriostatic activities may be used in primary prevention. In this approach, a modest anti-plaque effect may be sufficient or even desirable, as it would decrease the side effects of the active agent. Antimicrobial agents are best indicated in secondary and tertiary prevention, as the objectives are to restore health and to prevent disease recurrence. The rational is to prevent or delay subgingival recolonization by pathogenic micro-organisms. The development of in vitro oral biofilm models certainly represents a major advance for studying and testing oral anti-plaque agents in recent years. The results of these studies have shown that chlorhexidine, hexetidine, delmopinol, amine fluoride/stannous fluoride, triclosan, phenolic compounds, among others, may inhibit biofilm development and maturation as well as affect bacterial metabolism.     

Type 1 diabetes mellitus and oral health: assessment of coronal and root caries

OBJECTIVES: The oral health of a large cohort of adult insulin-dependent diabetic patients (Type 1), diagnosed 24 years previously with juvenile onset, was comprehensively assessed. This paper describes the prevalence of coronal and root caries in this adult Type 1 diabetic population and evaluates demographic, dietary, behavioral, physiologic, salivary and medical variables associated with decayed and filled surfaces in the crown (DFS) or root (RDFS). METHODS: Type 1 diabetes mellitus subjects participating in this oral health evaluation had been monitored for 6-8 years as participants in the University of Pittsburgh, Department of Epidemiology, longitudinal study of medical complications associated with diabetes. Four hundred and six diabetic subjects received a comprehensive oral health examination during one of their regularly scheduled medical visits. Oral assessments included coronal and root caries, missing teeth, edentulism, periodontal status, soft tissue pathologies, salivary function and health behaviors. Sixteen diabetic subjects and one control subject were edentulous. Coronal and root caries data from the remaining 390 dentate diabetic subjects were compared with 202 dentate nondiabetic control subjects. RESULTS: The adult Type 1 diabetic subjects were not found to have significantly higher DFS rates as compared with our control subjects or published age-adjusted NHANES III findings. Both control and diabetic subjects had low decayed to filled tooth surface ratios. A linear regression model evaluated possible associations with coronal decayed and filled tooth surfaces (DFS) within the diabetic population. Significant factors included older age, women, fewer missing teeth, more frequent use of dental floss, more frequent visits to the dentist during the last 12 months, and diabetic nephropathy. The prevalence of RDFS was higher in the diabetic subjects as compared to recruited control subjects. Neither dietary behaviors nor glycemic control were found to contribute to coronal or root caries. CONCLUSIONS: Factors associated with presence of coronal and root caries and fillings are discussed. Possible causes and implications for the association between DFS and diabetic nephropathy are provided.     

Single-blind studies of the effects of improved periodontal health on metabolic control in Type 1 diabetes mellitus

Abstract Uncontrolled studies have suggested a beneficial effect of periodontal treatment on metabolic control of insulin-dependent diabetes mellitus (IDDM). We therefore conducted controlled single-blind studies, using current metabolic status indicators in IDDM subjects free of significant complications other than periodontal diseases. In the 1st study, 41 IDDM subjects with gingivitis and early periodontitis were randomly assigned to treatment (oral hygiene and scaling) or control groups. The study was completed by 16 experimental and 15 control subjects. Reassessment after 2 months showed a Hawthorne effect in the control group, and no difference between groups. However, further analysis showed a relationship between individual metabolic control variation and gingival inflammation. A 2nd study enrolled 23 IDDM subjects with advanced periodontitis, who were randomised to treatment (full initial therapy including root planing) or control groups. Only 1 subject failed to complete the study, owing to illness. In this study, a significant response to periodontal treatment was not accompanied by any improvement in metabolic control. These results support the concept that the effect of metabolic control may be predominant in the relationship between IDDM and periodontal health.     

A longitudinal study on insulin-dependent diabetes mellitus and periodontal disease

Abstract In the present two-year longitudinal investigation, the progression of periodontal disease was assessed after 1 year from the baseline examination in 38 dentate subjects and after 2 years in 22 dentate subjects with a mean duration of 18 years of insulin-dependent diabetes mellitus. The diabetics, aged 35 to 56 years at baseline, were under medical treatment at the outpatient clinic of the III Department of Medicine, University Central Hospital of Helsinki and at 2 diabetic clinics of the Helsinki Health Centre. Based upon their long-term medical records, 26 subjects were at baseline identified as having poorly controlled insulin-dependent diabetes (PIDD) with a mean blood glucose level of 12.5 mmol/1 and a mean glycosylated hemoglobin (HBA₁) level of 10.1%. 12 subjects were classified as having controlled insulin-dependent diabetes (CIDD) with a mean blood glucose level of 6.7 mmol/1 and a mean HBA, level of 9.2% at baseline. For each individual, recordings were made at baseline and after 1 and 2 years from the baseline for the plaque index, gingival index, pocket depth, loss of attachment, bleeding after probing, gingival recession, and radiographic loss of alveolar bone. At baseline and 2 years after the baseline examination, the PIDD subjects had similar plaque conditions as the CIDD subjects. At baseline and after 1 and 2 years from baseline the PIDD subjects had more gingivitis and bleeding after probing (P<0.05, χtest) than the CIDD subjects. Both at baseline and at the 1-year and 2-year examinations, the long-term PIDD subjects had lost more tooth attachment and approximal bone than the corresponding CIDD subjects (P<0.01, χ-test). At all 3 examinations, the PIDD subjects also exhibited more gingival recession than the CIDD subjects (P<0.05, χ-test).     

Prevalence of oral lichen planus in diabetes mellitus according to the type of diabetes

The purpose of the present study was to determine the prevalence of oral lichen planus (OLP) in a population of patients with diabetes mellitus (DM) as compared with a control population. DESIGN: A clinicopathologic study. SUBJECTS AND METHODS: One hundred and thirty-nine patients with type I DM, 353 patients with type II DM and 274 controls were examined for clinical evidence of OLP. The clinical evidence of OLP in the diabetic and control patients was confirmed by histopathological examination. RESULTS: The prevalence of OLP in type I diabetic patients was 5.76%, in type II 2.83%, and 1.82% in the controls. The prevalence of OLP was significantly higher in patients with type I DM and slightly higher in patients with type II DM in comparison to the prevalence in the control sample. CONCLUSIONS: The above findings and the fact that type I diabetes and OLP are characterized by autoimmune phenomena and T cell immune responses respectively, suggest that the immune system may play a critical role in the appearance of OLP in patients with type I DM.     

Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population

OBJECTIVE: We investigated the association between glycemic control of type 2 diabetes mellitus (type 2 DM) and severe periodontal disease in the US adult population ages 45 years and older. METHODS: Data on 4343 persons ages 45-90 years from the National Health and Nutrition Examination Study III were analyzed using weighted multivariable logistic regression. Severe periodontal disease was defined as 2 + sites with 6 + mm loss of attachment and at least one site with probing pocket depth of 5 + mm. Individuals with fasting plasma glucose > 126 mg/dL were classified as having diabetes; those with poorly controlled diabetes (PCDM) had glycosylated hemoglobin > 9% and those with better-controlled diabetes (BCDM) had glycosylated hemoglobin 相似文献   

牙周病与妊娠期糖尿病关系的临床研究

目的 研究牙周病与妊娠期糖尿病的相关性,探讨牙周炎对妊娠期糖尿病血清C-反应蛋白的影响.方法 选择24～28周孕妇中,患有妊娠期糖尿病孕妇100例纳入试验组,身体健康孕妇100例作为对照组,检查其牙周健康指数,其中包括牙龈指数、龈沟出血指数、附着丧失水平、牙周袋探诊深度,统计分析两组差别.同时在试验组孕妇中选取伴牙周炎和牙周健康的孕妇各30例,检测其血清C-反应蛋白的含量,进行统计学分析.结果 除牙周探诊深度外,两组孕妇的其他牙周健康指数均的差异有统计学意义(P＜0.05),试验组牙周炎孕妇的血清C-反应蛋白水平显著高于同组牙周健康的孕妇(P＜0.05).结论 牙周病与妊娠期糖尿病具有相关性,牙周炎症可能是妊娠期糖尿病的危险因素之一.     

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。     

Periodontal treatment and HbA1c levels in subjects with diabetes mellitus

It has earlier been reported that individuals with poorly controlled diabetes have severe periodontal disease (PD) compared to well‐controlled diabetes. This longitudinal interventional study compared periodontal treatment outcomes with HbA1c level changes in four groups of diabetic and non‐diabetic patients with or without PD, respectively. HbA1c, bleeding on probing (BOP), plaque index and periodontal pocket depth (PPD) 4 < 6 mm and ≥6 mm were recorded at baseline to 3 months after non‐surgical treatment and 3–6 months for surgical treatment in subjects with or without T2D, and with or without PD. A total of 129 patients were followed from baseline to 6 months. Diabetics with PD and without PD showed reductions in HbA1c levels with a mean value of 0·3% after 3 months and mean values of 1% and 0·8%, respectively, after 6 months. Diabetics with PD showed higher levels of BOP versus non‐diabetics without PD (P < 0·01) and versus diabetics without PD (P < 0·05) at baseline. After 6 months, diabetics with PD showed higher number of PPD 4 < 6 mm versus diabetics without PD (P < 0·01) and non‐diabetics with PD (P < 0·01). Diabetics without PD showed higher levels of PPD 4 < 6 mm versus non‐diabetics without PD (P < 0·01). Surgical and non‐surgical periodontal treatment in all groups improved periodontal inflammatory conditions with a decrease in HbA1c levels in a period of three and 6 months. No change was seen in the number of pockets PPD 4 < 6 mm in diabetic subjects with PD after non‐surgical and surgical treatment.