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Page 1: The effect of diabetes mellitus on periodontium

The effect of diabetes mellitus on periodontal tissues

By:Zanyar Mohammad Kareem5th stageSupervised by:Dr.Chenar A. MohammadB.D.S., M.Sc., Ph.D.

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Introduction :

• Diabetes mellitus• Periodontium • Bidirectional relationship

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Periodontium

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Diabetes mellitus

• Type 1 diabetes– β-cell destruction

• Type 2 diabetes– insulin resistance

• Gestational diabetes mellitus (GDM)• Other specific types of diabetes

– Genetic defects in β-cell function, insulin action

– Diseases of the exocrine pancreas

– Drug- or chemical-induced

– Others ..

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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.

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• 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

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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.

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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 .

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Monocytes, macrophages and cytokines in diabetes mellitus• Higher concentration IL-1β, PGE2, and TNF-α 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

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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

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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

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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

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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.

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