The effect of diabetes mellitus on periodontium

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A Literature Review Submitted to the Council of the College of Dentistry at Hawler Medical University in partial Fulfillment of the Requirement for the B.D.S. degree in Degree

Transcript of The effect of diabetes mellitus on periodontium

  • 1. By: Zanyar Mohammad Kareem 5th stage Supervised by: Dr.Chenar A. Mohammad B.D.S., M.Sc., Ph.D.

2. Introduction : Diabetes mellitus Periodontium Bidirectional relationship 3. Diabetes mellitus Type 1 diabetes -cell destruction Type 2 diabetes insulin resistance Gestational diabetes mellitus (GDM) Other specific types of diabetes Genetic defects in -cell function, insulin action Diseases of the exocrine pancreas Drug- or chemical-induced Others .. 4. Oral manifestation and complications of diabetes mellitus enlarged gingiva, sessile or pedunculated gingival polyp, polypoid gingival proliferations, abscess. cheilosis, diminished salivary flow, mucosal drying, and cracking, burning mouth and tongue, and with greater predominance of candida albicans, hemolytic streptococci, and staphylococci. 5. increased rate of dental caries peripheral diabetic neuropathy may be a risk factor for severe TMJ dysfunction. Geographic and fissured tongue lichen planus, recurrent aphthous stomatitis, and oral fungal infections 6. Mechanisms of interaction between diabetes and periodontal tissues Bacterial pathogens in diabetes mellitus: Capnocytophaga species , A. actinomycetumcomitans, C. rectus, C. species, E. corrodens, F. nucleatum, P. gingivalis, and P. intermedia. glycemic control and alterations in microflora may increase the susceptibility of diabetics to periodontal disease. 7. Polymorphonuclear leukocyte function in diabetes mellitus polymorphonuclear leukocyte deficiencies resulting in impaired chemotaxis, defective phagocytosis, or impaired adherence . Function of polymorphonuclear leukocytes (PMNs) impaired. (GCF) collagenase concentration is higher in diabetics and it is primarily derived from PMNs. related to poor glycemic control . 8. Monocytes, macrophages and cytokines in diabetes mellitus Higher concentration IL-1, PGE2, and TNF- have been detected in GCF. The release of these cytokines in response to bacterial lipopolysaccharides (LPS) by monocytes is significantly higher. This hyperinflammatory is due to (AGE-RAGE interaction) dysregulation of macrophages cytokine production, tissue destruction and alveolar bone loss. alter the function of macrophages and delay the wound healing 9. Altered collagen metabolism in diabetes mellitus increase collagenasae activity, decreased collagen synthesis, maturation, and maintenance of collagen. In the hyperglycemic state, numerous proteins and matrix molecules undergo a nonenzymatic glycosylation, resulting in accumulated advanced glycation end products (AGEs) collagen is cross-linked by AGE formation, making it less soluble and less likely to be normally repaired or replaced biologic effect of AGEs is mediated by the receptor for AGEs (RAGE) causing precoagulatory changes, thrombus formation and thickening of basement membrane of microvasculature 10. Altered wound healing in diabetes mellitus the primary reparative cell in the periodontium is the fibroblast, which does not function properly in high-glucose environments The collagen that is produced by these fibroblasts is susceptible to rapid degradation by matrix metalloproteinase enzymes Gingival microangiopathy, Increased collagen degradation, and Glycolysation 11. The mechanisms in which periodontal diseases may affect the diabetic state Chronic periodontal diseases have the potential to exacerbate insulin resistance and worsen glycemic control hyperinflammatory immune cells can exacerbate the elevated production of proinflammatory cytokines, this has the potential to increase insulin resistance and make it more difficult for the patient to control diabetes 12. The relationship between diabetes and periodontitis The severity of periodontitis was significantly higher in diabetic patients compared to non- diabetic patients Poorly controlled diabetics had three fold increases in risk of having periodontitis compared to non-diabetics this bidirectional relationship between periodontal disease and diabetes mellitus makes diabetes a disorder of importance to dentists and dental hygienists and to patients seen in the dental office.