[Sugar intake and public health]

Tidsskr Nor Laegeforen. 2007 Sep 6;127(17):2259-62

Authors: Henriksen HB, Kolset SO

BACKGROUND: Sugar is present in simple forms such as sucrose, lactose and fructose, and in the more complex forms starch and fibre. Complex carbohydrates in foods like vegetables and less refined grain products provide energy and important additions of vitamins, minerals and fibre. We have reviewed the effects of sugars on overweight, diabetes Type 2 and caries, and the intake of carbohydrates in simple and complex forms in the Norwegian population. METHOD: Literature was found in the databases PubMed and Bibsys, and in public statistics. RESULTS AND INTERPRETATION: Sugars in beverages and candy only contribute with energy that can lead to an increased amount of fat in the body. High sugar intakes contribute to development of overweight, diabetes type 2 and caries. Glucose from sucrose and starch increase blood glucose levels and stimulate insulin secretion. Lack of insulin response after fructose intake can result in adverse effects on lipid metabolism and satiety regulation. Norway is one of the countries in the world with the highest intake of sweetened beverages. Preventive health measures aimed at decreasing sugar intake in pre-school and school children must include increased availability of fruits and vegetables, water and better canteens. The increased sugar intake among adolescents requires measures from politicians and authorities.

PMID: 17828323 [PubMed - indexed for MEDLINE]

Altered circadian rhythm of pulp sensibility in elderly diabetic and hypertensive patients.

Chin Med J (Engl). 2007 Jun 5;120(11):1024-6

Authors: Guo B, Xie SJ, Que KH, Yang F, Liu J, Wang ZR, Zhou XD

PMID: 17624275 [PubMed - indexed for MEDLINE]

Diabetes and tooth loss in a national sample of dentate adults reporting annual dental visits.

Prev Chronic Dis. 2007 Jul;4(3):A59

Authors: Kapp JM, Boren SA, Yun S, LeMaster J

INTRODUCTION: Periodontal disease has been associated with tooth loss and reported as more prevalent among people with diabetes than among those without diabetes. Having an annual dental examination is a national goal of Healthy People 2010. Our objective was to examine whether an association exists between diabetes and tooth loss among a population reporting an annual dental visit. METHODS: We used data from the 2004 Behavioral Risk Factor Surveillance System to examine the association between self-reported diabetes and tooth removal due to decay or periodontal disease among 155,280 respondents reporting a dental visit within the past year. We calculated prevalence estimates, odds ratios, and 95% confidence intervals. Multiple logistic regression allowed for adjustment. RESULTS: The overall prevalence of tooth removal among the people in the study was 38.3%. People with diabetes had a significantly higher prevalence of tooth removal. In a multivariable model adjusting for selected covariates, respondents with diabetes were 1.46 times as likely (95% CI, 1.30-1.64) to have at least one tooth removed than respondents without diabetes. A stronger association between diabetes and tooth loss was observed among people in the younger age groups than among those in the older age groups. CONCLUSION: Even among people reporting a recent dental visit, diabetes was independently associated with tooth loss. Multidisciplinary efforts are needed to raise awareness of the risk of tooth loss among younger people with diabetes. Good oral hygiene as well as annual dental examinations are important for preventing tooth loss.

PMID: 17572963 [PubMed - indexed for MEDLINE]

Diabetes and its effects on dental pulp.

J Oral Sci. 2006 Dec;48(4):195-9

Authors: Catanzaro O, Dziubecki D, Lauria LC, Ceron CM, Rodriguez RR

Uncontrolled or poorly controlled diabetes mellitus may be a risk factor for the development of oral complications. The objective of this investigation was to determine the effect of diabetes mellitus progression on inflammatory and structural components of dental pulp. Male Wistar rats were given a single injection of Streptozotocin (STZ), and induction of diabetes was confirmed 24 h later. Dental pulp tissue samples were taken from central incisors and molars of diabetic rats 30 and 90 days after the STZ treatment. Plasma glucose levels in diabetic rats 30 and 90 days after STZ treatment were significantly increased when compared to control rats (P < 0.001). Nitrite and kallikrein levels in dental pulp tissue were higher in diabetic rats 30 days after STZ treatment than in controls, while only nitrite were decreased 90 after of STZ treatment. Myeloperoxidase activity showed changes 30 and 90 days after STZ injection when compared to controls. The activity of alkaline phosphatase showed significant changes 30 and 90 days after STZ treatment. On the other hand the concentration of collagen was decreased in diabetic rats 30 and 90 days after STZ injection. These results suggest that diabetes is a critical factor that has profound effects upon oral tissues, resulting in expression of inflammatory mediators and modifications of structural components of dental pulp.

PMID: 17220616 [PubMed - indexed for MEDLINE]

Prevalence of medical conditions among patients attending dental teaching clinics in northern Jordan.

J Contemp Dent Pract. 2007 Jan 1;8(1):60-7

Authors: Khader YS, Alsaeed O, Burgan SZ, Amarin ZO

AIM: This study was conducted to estimate the prevalence of self reported medical conditions among dental patients attending dental teaching clinics in north Jordan. METHODS AND MATERIALS: A total of 1,509 patients were included, of which 46.1% were males and 53.9% were females. All age groups were included and ranged between 14 and 78 years. The findings were analyzed in relation to age and gender. RESULTS: Overall, gastrointestinal disease was most prevalent (11.9%), followed by bleeding tendencies (9.3%), renal disorders (8.7%), respiratory disease (8.3%), and hypertension (6.4%). Only 3.2% of the participants reported having antibiotics prescribed for them prior to a dental procedure for prophylactic purposes. CONCLUSION: Due to the high frequency of medical conditions, thorough evaluation of patients' medical and dental care histories should be a mandatory first step in their management.

PMID: 17211506 [PubMed - indexed for MEDLINE]

Effects of diabetes on the osseointegration of dental implants.

Med Oral Patol Oral Cir Bucal. 2007 Jan;12(1):E38-43

Authors: Mellado-Valero A, Ferrer Garc&#xED;a JC, Herrera Ballester A, Labaig Rueda C

The increased prevalence of diabetes mellitus has become a public health problem. Hyperglycaemia entails a rise in the morbidity and mortality of these patients. Although a direct relationship with periodontal disease has already been shown, little is known about the results of dental implants in diabetics. The present paper reviews the bibliography linking the effect of diabetes on the osseointegration of implants and the healing of soft tissue. In experimental models of diabetes, a reduced level of bone-implant contact has been shown, and this can be reversed by means of treatment with insulin. Compared with the general population, a higher failure rate is seen in diabetic patients. Most of these occur during the first year of functional loading, seemingly pointing to the microvascular complications of this condition as a possible causal factor. These complications also compromise the healing of soft tissues. It is necessary to take certain special considerations into account for the placement of implants in diabetic patient. A good control of plasma glycaemia, together with other measures, has been shown to improve the percentages of implant survival in these patients.

PMID: 17195826 [PubMed - indexed for MEDLINE]

Gingivitis susceptibility and its relation to periodontitis in men.

J Dent Res. 2006 Dec;85(12):1134-7

Authors: Dietrich T, Kaye EK, Nunn ME, Van Dyke T, Garcia RI

The objective of this cross-sectional study was to evaluate whether gingivitis susceptibility is associated with periodontitis. We analyzed data of 462 men in the VA Dental Longitudinal Study aged 47 to 92 years who had never smoked or had quit smoking 5+ years previously. Multiple logistic regression models, with tooth-level bleeding on probing at sites with attachment loss<or=2 mm as the dependent variable, were derived with adjustment for plaque, calculus, crown coverage, age, income, education, marital status, body mass index, diabetes, and vitamin C intake, and stratification by age (<65, 65+ years). Periodontitis and mean attachment loss were positively associated with bleeding on probing, with stronger associations among men<65 years old (for periodontitis, OR 2.1; 95% CI 1.5, 3.1) than men 65+ years of age (OR 1.2; 95% CI 0.9, 1.6). Our results suggest that among never and former smokers, gingivitis susceptibility is higher among men with periodontitis compared with that in men without periodontitis.

PMID: 17122168 [PubMed - indexed for MEDLINE]

Diabetes as a risk factor for periodontal disease: current status and future considerations.

Ann Acad Med Singapore. 2006 Aug;35(8):571-81

Authors: Tan WC, Tay FB, Lim LP

INTRODUCTION: Over the past decade, there has been an emerging interest in the interrelationship between systemic conditions and oral health. Diabetes is perhaps one of the best documented conditions that have been closely linked with periodontal disease. This paper reviews the role of diabetes as a risk factor in periodontal disease. The treatment implications in the management of periodontal disease as an integral component of diabetes care is also discussed in light of the current understanding of the pathogenesis of these 2 chronic conditions. MATERIALS AND METHODS: Epidemiological, clinical and laboratory studies examining the relationship between diabetes and periodontal diseases were selected from both medical and dental journals. RESULTS: The severity of periodontal destruction has been shown to be related to the direct and indirect effects of glycaemic control, with other factors also being implicated. Although some studies have pointed towards a bi-directional relationship between glycaemic control and periodontal health, it is still not clear if improvement in periodontal health could lead to improved metabolic control. CONCLUSION: Diabetes and periodontal disease are closely related in many ways, though the effect of periodontal disease on diabetes control remain to be determined, with larger intervention studies. In light of the increasing evidence of the relationship between diabetes and periodontal disease, management of oral health should form an integral part of diabetes management.

PMID: 17006586 [PubMed - indexed for MEDLINE]

[Study on the frequency of caries and associated factors in type 1 diabetes mellitus]

Arq Bras Endocrinol Metabol. 2006 Jun;50(3):515-22

Authors: do Amaral FM, Ramos PG, Ferreira SR

Subjects with diabetes mellitus (DM) are more prone to certain disturbances of oral cavity but there are controversies concerning caries. This cross-sectional study investigated the frequency of caries and associated factors, in a sample of population with or without type 1 DM, including non-diabetic (53 women, 31 men) and 30 diabetic subjects (19 women, 11 men) aged 17-28 years. Diagnosis of dental caries was based on the DMF-T index (D= decay; M= miss; F= fill; T= teeth); in addition, a plaque control record (PCR) was obtained. A preponderance of female sex was found within the groups studied but such proportions did not differ when comparing diabetic and non-diabetic groups. Mean ages were 21.0 +/- 2.2 and 19.5+/-1.8 years, respectively for subjects without and with DM (p< 0.05). Education level was higher in the non-diabetic group as well as the DMF-T index (10.5 +/-5.8 vs. 6.7+/-5.7, p< 0.01). Linear regression analysis (n= 114) showed significant associations of DMF-T with age, sucrose intake, daily frequency of tooth brushing, of dental floss use, PCR and of visits to the dentist. By ANOVA model with age as a covariate the non-diabetic condition (p= 0.047), sucrose index and PCR (r(2)= 0.820) were independently associated with the DMF-T. In the diabetic-specific model, with only the diabetic subjects included and sucrose index as a covariate, DM duration, fundus abnormality and PCR were significantly associated with the presence of caries (r(2)= 0.816). The sample of type 1 diabetic subjects suggest that they are less prone to caries than non-diabetics, despite having a higher frequency of meals, less tooth brushing and dental floss use. We speculate that DM duration may contribute to the occurrence of caries and restricted sucrose consumption to lower frequency of caries in diabetic subjects.

PMID: 16936993 [PubMed - indexed for MEDLINE]

Systemic conditions, oral findings and dental management of chronic renal failure patients: general considerations and case report.

Braz Dent J. 2006;17(2):166-70

Authors: Hamid MJ, Dummer CD, Pinto LS

Chronic renal failure is a relatively common systemic disease. Systemic abnormalities such as anemia, platelet disorders and hypertension as well as oral manifestations including xerostomia, uremic stomatitis, periodontal disease and maxillary and mandibular radiographic alterations can be observed in individuals with chronic renal disease. In view of its frequent occurrence and the need of knowledge by dentists dealing with this condition, this paper discusses the most important issues regarding chronic renal failure, addressing its systemic and oral manifestations and the dental management of chronic renal patients. A case report is presented.

PMID: 16924347 [PubMed - indexed for MEDLINE]

An examination of periodontal treatment and per member per month (PMPM) medical costs in an insured population.

BMC Health Serv Res. 2006;6:103

Authors: Albert DA, Sadowsky D, Papapanou P, Conicella ML, Ward A

BACKGROUND: Chronic medical conditions have been associated with periodontal disease. This study examined if periodontal treatment can contribute to changes in overall risk and medical expenditures for three chronic conditions [Diabetes Mellitus (DM), Coronary Artery Disease (CAD), and Cerebrovascular Disease (CVD)]. METHODS: 116,306 enrollees participating in a preferred provider organization (PPO) insurance plan with continuous dental and medical coverage between January 1, 2001 and December 30, 2002, exhibiting one of three chronic conditions (DM, CAD, or CVD) were examined. This study was a population-based retrospective cohort study. Aggregate costs for medical services were used as a proxy for overall disease burden. The cost for medical care was measured in Per Member Per Month (PMPM) dollars by aggregating all medical expenditures by diagnoses that corresponded to the International Classification of Diseases, 9th Edition, (ICD-9) codebook. To control for differences in the overall disease burden of each group, a previously calculated retrospective risk score utilizing Symmetry Health Data Systems, Inc. Episode Risk Groups (ERGs) were utilized for DM, CAD or CVD diagnosis groups within distinct dental services groups including; periodontal treatment (periodontitis or gingivitis), dental maintenance services (DMS), other dental services, or to a no dental services group. The differences between group means were tested for statistical significance using log-transformed values of the individual total paid amounts. RESULTS: The DM, CAD and CVD condition groups who received periodontitis treatment incurred significantly higher PMPM medical costs than enrollees who received gingivitis treatment, DMS, other dental services, or no dental services (p < .001). DM, CAD, and CVD condition groups who received periodontitis treatment had significantly lower retrospective risk scores (ERGs) than enrollees who received gingivitis treatment, DMS, other dental services, or no dental services (p < .001). CONCLUSION: This two-year retrospective examination of a large insurance company database revealed a possible association between periodontal treatment and PMPM medical costs. The findings suggest that periodontitis treatment (a proxy for the presence of periodontitis) has an impact on the PMPM medical costs for the three chronic conditions (DM, CAD, and CVD). Additional studies are indicated to examine if this relationship is maintained after adjusting for confounding factors such as smoking and SES.

PMID: 16914052 [PubMed - indexed for MEDLINE]

Factors associated with periodontal diseases in Jordan: principal component and factor analysis approach.

J Oral Sci. 2006 Jun;48(2):77-84

Authors: Khader YS

This study was conducted to identify factors associated with periodontal disease in a Jordanian population using principal component and factor analysis techniques. Subjects were 603 dentate patients aged 15-65 years attending dental teaching clinics at the Jordan University of Science and Technology. Their oral hygiene and periodontal status were assessed using plaque index, gingival index, probing pocket depth, clinical attachment level, gingival recession, and number of missing teeth. Factor and principal component analysis and binary logistic regression were conducted to identify factors related to periodontal disease. Probing pocket depth, clinical attachment level, gingival recession, and number of missing teeth were sorted as the same factor and could be combined in one scale to measure the severity of periodontal disease. On the other hand, plaque index and gingival index were sorted as another factor and could be combined in another scale to correlate between oral hygiene and gingival status. The results demonstrated that increased age, low level of education, increased plaque index score, not brushing teeth, smoking more than 15 pack-years, and having diabetes were significantly associated with increased severity of periodontal disease. In conclusion, it was possible to form a standard scale, based on linear combinations of periodontal indices and parameters, to measure the severity of periodontal disease and determine its risk indicators.

PMID: 16858136 [PubMed - indexed for MEDLINE]

Structural and functional salivary disorders in type 2 diabetic patients.

Med Oral Patol Oral Cir Bucal. 2006 Jul;11(4):E309-14

Authors: Carda C, Mosquera-Lloreda N, Salom L, Gomez de Ferraris ME, Peydr&#xF3; A

Diabetes mellitus type 2 is the most common metabolic disorder and it causes an important morbimortality. The structural modifications in the parotid gland (sialosis) had already been described in these patients and could result in variations in the salivary composition, as well as an increase in periodontal and dental pathology. OBJECTIVES: To compare the biochemical findings in the saliva and to correlate these biochemical disturbances with the morphologic findings previously described. PATIENTS AND METHODS: Clinical information were gathered about 33 patients, 17 had type 2 diabetes. Samples of whole saliva were obtained for biochemical analysis and serum samples to determine metabolic control. RESULTS: In the diabetics saliva we found urea and total proteins increased and reduced levels of microalbumina. Salivary glucose was only augmented in patients with poor metabolic control. Clinical symptoms of xerostomia were present in 76,4% and dental and periodontal disease in 100%. The parotid gland was characterised by the presence of small acini, lipid intracytoplasmic droplets, as well as adipose stroma infiltration. The acinar cytoqueratins expression was heterogeneous and very positive in the hyperplasic ducts. CONCLUSIONS: These biochemical disorders in the saliva of the type 2 diabetic patients would be related with the structural changes previously observed in parotid glands.

PMID: 16816810 [PubMed - indexed for MEDLINE]

Dental caries in type 1 diabetics: influence of systemic factors of the disease upon the development of dental caries.

Med Oral Patol Oral Cir Bucal. 2006 May;11(3):E256-60

Authors: Miralles L, Silvestre FJ, Hernández-Mijares A, Bautista D, Llambes F, Grau D

OBJECTIVES: Diabetes mellitus is one of the most common chronic diseases in the general population. A study is made of the presence of caries in type 1 diabetic patients. The specific aim was to determine whether such patients present a greater incidence of dental caries than non-diabetic individuals. An evaluation was also made of the relationship of caries to salivary flow and to factors inherent to the disease such as the degree of metabolic control, the duration of diabetes, and the existence of chronic complications. STUDY DESIGN: The study comprised 90 type 1 diabetics between 18 and 50 years of age, and a group of non-diabetic controls matched for age and sex. Visual and tactile exploration of the dentition was carried out in all cases. Oral hygiene was rated based on the O'Leary plaque index, and basal (unstimulated) and stimulated salivary flow were evaluated in both groups. In the diabetic group, correlations were established with disease control based on the mean glycosylated hemoglobin (HbA1c) value corresponding to the two years prior to examination; evolution of the disease in years; and the existence of complications such as diabetic neuropathy or retinopathy. RESULTS: Under similar conditions of oral hygiene and salivary flow, the diabetic group showed a higher incidence of caries than the control group (p<0.05). Likewise, on specifically analyzing the diabetic group, metabolic control of the disease, the duration of diabetes, and the existence of complications of the disease exerted an influence upon the development of dental caries. CONCLUSIONS: Qualitative salivary studies are advised to better account for this increased incidence of caries in the diabetic population.

PMID: 16648764 [PubMed - indexed for MEDLINE]

For the dental patient...healthy mouth, healthy body.

J Am Dent Assoc. 2006 Apr;137(4):563

Authors:

PMID: 16637487 [PubMed - indexed for MEDLINE]

Periodontal treatment and glycemic control in diabetic patients: the problem of a possible Hawthorne effect.

J Dent Res. 2006 Apr;85(4):294; author reply 294-5

Authors: Watts T

PMID: 16567546 [PubMed - indexed for MEDLINE]

Diabetes: It is all about the numbers.

J Am Dent Assoc. 2006 Jan;137(1):12, 14

Authors: Glick M

PMID: 16456991 [PubMed - indexed for MEDLINE]

Periodontal changes in children and adolescents with diabetes: a case-control study.

Diabetes Care. 2006 Feb;29(2):295-9

Authors: Lalla E, Cheng B, Lal S, Tucker S, Greenberg E, Goland R, Lamster IB

OBJECTIVE: To evaluate the level of oral disease in children and adolescents with diabetes. RESEARCH DESIGN AND METHODS: Dental caries and periodontal disease were clinically assessed in 182 children and adolescents (6-18 years of age) with diabetes and 160 nondiabetic control subjects. RESULTS: There were no differences between case and control subjects with respect to dental caries. Children with diabetes had significantly higher plaque and gingival inflammation levels compared with control subjects. The number of teeth with evidence of attachment loss (the hallmark of periodontal disease) was significantly greater in children with diabetes (5.79 +/- 5.34 vs. 1.53 +/- 3.05 in control subjects, unadjusted P < 0.001). When controlling for age, sex, ethnicity, gingival bleeding, and frequency of dental visits, diabetes remained a highly significant correlate of periodontitis, especially in the 12- to 18-year-old subgroup. In the case group, BMI was significantly correlated with destruction of connective tissue attachment and bone, but duration of diabetes and mean HbA(1c) were not. CONCLUSIONS: Our findings suggest that periodontal destruction can start very early in life in diabetes and becomes more prominent as children become adolescents. Programs designed to promote periodontal disease prevention and treatment should be provided to young patients with diabetes.

PMID: 16443876 [PubMed - indexed for MEDLINE]

Managing diabetes.

J Am Dent Assoc. 2005 Nov;136(11):1510, 1512

Authors: Friedlander AH

PMID: 16329410 [PubMed - indexed for MEDLINE]

Dental visits among dentate adults with diabetes--United States, 1999 and 2004.

MMWR Morb Mortal Wkly Rep. 2005 Nov 25;54(46):1181-3

Authors:

One of the major complications of diabetes is periodontal disease, a chronic infection of tissues supporting the teeth and a major cause of tooth loss. Adults with diabetes have both a higher prevalence of periodontal disease and more severe forms of the disease, contributing to impaired quality of life and substantial oral functional disability. In addition, periodontal disease has been associated with development of glucose intolerance and poor glycemic control among adults with diabetes. Regular dental visits provide opportunities for prevention, early detection, and treatment of periodontal disease among dentate adults (i.e., those having one or more teeth); moreover, regular dental cleaning improves glycemic control in patients with poorly controlled diabetic conditions. One of the national health objectives for 2010 is to increase the proportion of persons with diabetes who have an annual dental examination to 71% (revised objective 5-15). To estimate the percentage of dentate U.S. adults aged > or =18 years with diabetes who visited a dentist within the preceding 12 months, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys for 1999 and 2004. This report describes the results of that analysis, which indicated that, in 2004, age-adjusted estimates in only seven states exceeded 71% and estimated percentages for four states and District of Columbia (DC) increased significantly from their levels in 1999. The findings underscore the need to increase awareness and support for oral health care among adults with diabetes, including support for national and state diabetes care management programs.

PMID: 16304554 [PubMed - indexed for MEDLINE]

Oral health status in a population of Nigerian diabetics.

J Contemp Dent Pract. 2005 Nov 15;6(4):75-84

Authors: Ogunbodede EO, Fatusi OA, Akintomide A, Kolawole K, Ajayi A

Oral manifestations of diabetes mellitus have been documented, but the effect of glycemic control on the oral tissues has been scantily reported. The oral health status of 65 metabolically controlled adult diabetic patients attending the Diabetes Clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, was prospectively assessed over six months and compared with that of 54 non-diabetic acting as controls. The mean duration of diabetes was 100.5+/-85.1 months. The difference in periodontal status of the patients and control, assessed using the Community Periodontal Index of Treatment Needs (CPITN), was not statistically significant (p=0.07). The degree of hyposalivation between the two groups was, however, statiscally significant (p<0.05). No significant difference was observed in the altered taste, burning mouth sensation, angular cheilitis, glossitis, and stomatitis status of the two groups. We conclude, with adequate metabolic control, the oral health status of a diabetic may not be significantly different from that of a non-diabetic except for xerostomia. A good understanding of the interactions between systemic diseases and oral health is imperative for physicians and dental practitioners. The need for early detection and closer linkages between the dental and medical professions in managing diabetic patients is emphasized.

PMID: 16299609 [PubMed - indexed for MEDLINE]

On the primary care frontlines: the role of the general practitioner in smoking-cessation activities and diabetes management.

J Am Dent Assoc. 2005 Aug;136(8):1144-53; quiz 1167

Authors: Kunzel C, Lalla E, Albert DA, Yin H, Lamster IB

BACKGROUND: Advances in understanding the relationship between oral disease and systemic conditions need to be translated into clinical practice. Relevant here is assessing dentists' active involvement in in-office smoking-cessation activities and management of the patient with type 1 or type 2 diabetes. METHODS: The authors mailed a survey to a net sample of 132 active general practitioners (GPs) in the northeastern United States during fall 2002. They drew a random sample of GPs listed in the designated states from the 2001 American Dental Association directory. They received 105 responses, for a response rate of 80 percent. RESULTS: With regard to smoking-cessation activities and management of diabetic patients, a majority of GPs reported having a lack of knowledge, viewed such activities as peripheral to their role and disagreed that colleagues and/or patients expected them to perform such activities. More GPs performed both activities on an assessing/advising basis than on an active management basis. CONCLUSION: Results suggest that approaches to changing dentists' behavior should aim not only at increasing knowledge but at overcoming attitudes and orientations associated with actively managing patients who smoke and patients who have diabetes. PRACTICE IMPLICATIONS: The profession's growing evidence base supports an increased primary and preventive care role for dentists. This role affords them opportunities to expand the bounds of dental practice, improve therapeutic outcomes and promote patients' overall health.

PMID: 16161371 [PubMed - indexed for MEDLINE]

The National Institute of Dental and Craniofacial Research: research for the practicing dentist.

J Am Dent Assoc. 2005 Jun;136(6):728-37

Authors: Pihlstrom BL, Tabak L

BACKGROUND AND OVERVIEW: Established in 1948, the National Institute of Dental and Craniofacial Research (NIDCR) has helped transform dentistry into a profession that is based firmly in prevention and technological innovation. This article introduces the new NIDCR initiative in general dentistry practice-based research. It also highlights research supported by the NIDCR and its implications for dental practice in restorative dentistry, oral and systemic disease, stem cell research, salivary diagnostics, gene transfer therapy and pain. CLINICAL IMPLICATIONS: The NIDCR supports research that will help guide the practitioner in the delivery of patient care and have a direct impact on the practice of dentistry.

PMID: 16022037 [PubMed - indexed for MEDLINE]

Addressing oral health disparities in settings without a research-intensive dental school: collaborative strategies.

Ethn Dis. 2005;15(2):187-90

Authors: Easa D, Harrigan R, Hammatt Z, Greer M, Kuba C, Davis J, Beck JD, Offenbacher S

Research suggests that oral health is linked to systemic health, and those with poor oral health are potentially at greater risk for important diseases, including cardiovascular disease, stroke, diabetes mellitus, and adverse pregnancy outcomes. Asians and Pacific Islanders (APIs) in Hawaii have high rates of many such diseases. Studies in children in Hawaii have revealed disparities in dental health; for example, API children have significantly higher rates of cavities than other groups. Hence, conducting further study is vital in adults, particularly APIs, to assess oral health and its correlation to overall health outcomes. Given the lack of a dental school and the lack of fluoridated water in the state, the University of Hawaii's John A. Burns School of Medicine (ABSOM) has identified the need to assume a leadership role in creating effective community-based oral health research and treatment programs. With the support of the National Institute of Dental and Craniofacial Research, JABSOM fostered a collaborative relationship with the University of North Carolina at Chapel Hill School of Dentistry, a premiere research-intensive dental school, the Waimanalo Health Center, and the Hawaii State Department of Health. This partnership has worked together to implement a community-based approach to performing research designed to illuminate disparities and develop innovative strategies to promote oral health in Hawaii's diverse populations. We hope that this collaborative, culturally competent approach may serve as a model for use in other settings without a research-intensive dental school.

PMID: 15825963 [PubMed - indexed for MEDLINE]

Histomorphometric evaluation of new bone formation in diabetic rats submitted to insertion of temporary implants.

Braz Dent J. 2004;15(2):87-92

Authors: Ottoni CE, Chopard RP

This study aimed to quantify new bone formation in the femurs of diabetic Wistar rats. Over an eight-week period, MTI-MP implants were evaluated in control rats and in diabetic rats. At several points during this period, various markers for bone deposit were introduced. The material was observed under fluorescent light microscopy. New bone formation in periosteal and cortical regions linked to the implant did not vary significantly between the groups. However, there were significant differences in total new bone formation in the medullar canal and in bone/implant contact area in the medullar portion. Bone deposits attached to the surface of the temporary implants demonstrated that they are biocompatible and capable of osseointegration.

PMID: 15776188 [PubMed - indexed for MEDLINE]

Systemic conditions associated with periodontitis in childhood and adolescence. A review of diagnostic possibilities.

Med Oral Patol Oral Cir Bucal. 2005 Mar-Apr;10(2):142-50

Authors: Sollecito TP, Sullivan KE, Pinto A, Stewart J, Korostoff J

The term periodontitis is used to describe a group of multifactorial diseases that result in the progressive destruction of the structures that support the teeth within the jaws, the so-called attachment apparatus, which includes the periodontal ligament, cementum and alveolar bone. If left untreated, this process can ultimately lead to tooth loss. The pathogenesis of these diseases involves the initial colonization of the gingival microenvironment of a susceptible host by pathogenic bacteria found in dental plaque. Subsequently, much of the tissue destruction characteristic of periodontitis is a , by-product, of the host response directed against these organisms. One of the major factors that appear to modulate disease severity is systemic health. Severe periodontitis in young individuals can therefore be a manifestation of an underlying systemic disease. In this review we will discuss the most important systemic diseases that should be considered in a differential diagnosis when evaluating a pediatric patient presenting with periodontitis.

PMID: 15735547 [PubMed - indexed for MEDLINE]

[Study of the oral manifestations in diabetic children and their correlation variables]

Arq Bras Endocrinol Metabol. 2004 Jun;48(3):374-8

Authors: Costa CC, Resende GB, Souza JM, Tavares SS, Almeida IC, Filho LC

Because children with type 1 diabetes (DM) are prone to diseases of the buccal cavity, in this transversal study we investigate the prevalence of dental caries, gingivitis and buccal alterations in 26 patients (16F/10M; average age: 10.3 years) from the Diabetic Children's Group at the Federal University Hospital of Santa Catarina, to verify possible correlations among the following variables: index of decayed, missing or filled permanent or deciduous teeth [DMFT or dmft], index of visible plaque [IVP], index of gum bleeding [IGB], dental calculi, gum recession, tongue abnormalities, xerostomia, burning sensation of the mucosa, age at DM diagnosis, administration of insulin; occurrence of DM-related complications; glycemia and glycosilated hemoglobin [GH]. The most frequent alterations were dental calculi (42.3%), xerostomia (38.5%), burning sensation (11.5%), and gum recession (7.7%). The median indices for DMFT/dmft, IVP and IGB were 2.0, 27.21% and 10.91%, respectively. Only age and the level of GH were significantly correlated to IVP (r2 = 0.61), whereas the IVP and hypoglycemia correlated to IGB (r2 = 0.63). We conclude that the older the patient and the higher the GH level, the higher the IVP; whereas the higher the IVP and the less frequent the crisis of mild hypoglycemia, the higher the IGB.

PMID: 15640899 [PubMed - indexed for MEDLINE]

Periodontal disease and mortality in type 2 diabetes.

Diabetes Care. 2005 Jan;28(1):27-32

Authors: Saremi A, Nelson RG, Tulloch-Reid M, Hanson RL, Sievers ML, Taylor GW, Shlossman M, Bennett PH, Genco R, Knowler WC

OBJECTIVE: Periodontal disease may contribute to the increased mortality associated with diabetes. RESEARCH DESIGN AND METHODS: In a prospective longitudinal study of 628 subjects aged > or =35 years, we examined the effect of periodontal disease on overall and cardiovascular disease mortality in Pima Indians with type 2 diabetes. Periodontal abnormality was classified as no or mild, moderate, and severe, based on panoramic radiographs and clinical dental examinations. RESULTS: During a median follow-up of 11 years (range 0.3-16), 204 subjects died. The age- and sex-adjusted death rates for all natural causes expressed as the number of deaths per 1,000 person-years of follow-up were 3.7 (95% CI 0.7-6.6) for no or mild periodontal disease, 19.6 (10.7-28.5) for moderate periodontal disease, and 28.4 (22.3-34.6) for severe periodontal disease. Periodontal disease predicted deaths from ischemic heart disease (IHD) (P trend = 0.04) and diabetic nephropathy (P trend < 0.01). Death rates from other causes were not associated with periodontal disease. After adjustment for age, sex, duration of diabetes, HbA1c, macroalbuminuria, BMI, serum cholesterol concentration, hypertension, electrocardiographic abnormalities, and current smoking in a proportional hazards model, subjects with severe periodontal disease had 3.2 times the risk (95% CI 1.1-9.3) of cardiorenal mortality (IHD and diabetic nephropathy combined) compared with the reference group (no or mild periodontal disease and moderate periodontal disease combined). CONCLUSIONS: Periodontal disease is a strong predictor of mortality from IHD and diabetic nephropathy in Pima Indians with type 2 diabetes. The effect of periodontal disease is in addition to the effects of traditional risk factors for these diseases.

PMID: 15616229 [PubMed - indexed for MEDLINE]

Periodontal diseases: microbiological considerations.

Med Oral Patol Oral Cir Bucal. 2004;9 Suppl:82-91; 75-82

Authors: Li&#xE9;bana J, Castillo AM, Alvarez M

The location of plaque-associated gingivitis at the gingival portion of the tooth plays an essential role in its genesis. However, at times local and other host response modifying factors also have an influence. The pathogeny of periodontitis is more complex. The microorganisms that comprise subgingival plaque are capable of acting directly on periodontal tissues or of modifying the host response, whereas the participation of the plaque per se (normal, decreased, or increased) is as decisive as the action of the bacteria themselves in the emergence of the disease. Different types of periodontitis are associated with specific microorganisms. The most periodontopathogenic are A. actinomycetemcomitans, P. gingivalis, and T. forsythensis. Periodontitis as a whole, represent the source of complications such as root caries, endoperiodontal processes and periodontal abscesses. They are associated with various illnesses such as atherosclerosis, diabetes, and respiratory infections, amongst others, as well as pathological oral halitosis. The different modalities of PCR are particularly important in the microbiological diagnosis of periodontitis, although on the negative side of things, it must be pointed out that in vitro sensitivity studies cannot be performed using this technique. First line antibiotic treatment of periodontitis includes amoxicillin/ clavulanic acid, metronidazole (associated or not with amoxicillin) and clindamycin.

PMID: 15580139 [PubMed - indexed for MEDLINE]

Facial cellulitis associated with Pseudomonas aeruginosa complicating ophthalmic herpes zoster.

Dermatol Online J. 2004;10(2):20

Authors: Atzori L, Ferreli C, Zucca M, Fanni D, Aste N

Cellulitis is a rare and severe soft-tissue infection characterized by acute, diffuse, spreading inflammation, often associated with systemic symptoms such as malaise and fever. Surgery of the head and neck, dental infections, sinusitis, upper respiratory tract infections, and trauma are the most common portal of entry for pathogens in facial cellulitis. A very unusual case complicating an ophthalmic herpes zoster in a 74-year-old woman was observed at the department of dermatology, Cagliari University (Italy). Culture of skin swabs showed growth of numerous Gram-negative bacilli, further identified as Pseudomonas aeruginosa. Therapy with intravenous ciprofloxacin was promptly instituted on the basis of the culture and sensitivity report. She was initially treated with daily drainage and twice-daily topical fusidic acid. The lesion completely resolved in 4 weeks, and no general complications or recurrence have been observed for 6 months. Early recognition and management of facial cellulitis is mandatory to avoid serious and generalized complications. Pseudomonas aeruginosa is rarely reported in facial cellulitis; there are apparently no reports of this infection occurring as a complication of ophthalmic herpes zoster. Herpetic damage of the anatomic barrier as well as impairment of defense mechanisms because of decompensated diabetes mellitus may have facilitated the colonization and proliferation of this opportunistic pathogen in our patient.

PMID: 15530310 [PubMed - indexed for MEDLINE]

[Dental implants in patients with Type 2 diabetes mellitus: a clinical study.]

Shanghai Kou Qiang Yi Xue. 2004 Oct;13(5):441-3

Authors: Huang JS, Zhou L, Song GB

PURPOSE: The oral rehabilitation by dental implants in patients with diabetes remains a controversial issue.The aim of this study was to investigate the clinical results of implantation in patients with Type 2 diabetes mellitus. METHODS: This study group consisted of 21 patients with Type 2 diabetes mellitus who received 52 implants. RESULTS: There were 5 failures.The success rate was 90.4% with a follow up period of 12 to 37 months. CONCLUSIONS: The clinical outcome of dental implants in selected group of patients with well-controlled type 2 diabetes mellitus is satisfying and encouraging.Further investigations and clinical trials over a longer period of time are needed to determine the long-term survival of implants in diverse of patients with diabetes mellitus.

PMID: 15514877 [PubMed - in process]

[Dental management of diabetic patient]

Med Oral. 2003 Aug-Oct;8(4):308

Authors: Miralles-Jord&#xE1; L

PMID: 15328628 [PubMed - indexed for MEDLINE]

Tuberculosis and diabetes in southern Mexico.

Diabetes Care. 2004 Jul;27(7):1584-90

Authors: Ponce-De-Leon A, Garcia-Garcia Md Mde L, Garcia-Sancho MC, Gomez-Perez FJ, Valdespino-Gomez JL, Olaiz-Fernandez G, Rojas R, Ferreyra-Reyes L, Cano-Arellano B, Bobadilla M, Small PM, Sifuentes-Osornio J

OBJECTIVE: To determine the impact of diabetes on the rates of tuberculosis in a region where both diseases are prevalent. RESEARCH DESIGN AND METHODS: Data from a population-based cohort of patients with pulmonary tuberculosis undergoing clinical and mycobacteriologic evaluation (isolation, identification, drug-susceptibility testing, and IS6110-based genotyping and spoligotyping) were linked to the 2000 National Health Survey (ENSA2000), a national probabilistic, polystage, stratified, cluster household survey of the civilian, noninstitutionalized population of Mexico. RESULTS: From March 1995 to March 2003, 581 patients with Mycobacterium tuberculosis culture and fingerprint were diagnosed, 29.6% of whom had been diagnosed previously with diabetes by a physician. According to the ENSA2000, the estimated prevalence of diabetes in the study area was 5.3% (95% CI 4.1-6.5). The estimated rates of tuberculosis for the study area were greater for patients with diabetes than for nondiabetic individuals (209.5 vs. 30.7 per 100000 person-years, P < 0.0001). CONCLUSIONS: In this setting, the rate of tuberculosis was increased 6.8-fold (95% CI 5.7-8.2, P < 0.0001) in patients with diabetes due to increases in both reactivated and recently transmitted infection. Comorbidity with diabetes may increase tuberculosis rates as much as coinfection with human immunodeficiency virus (HIV), with important implications for the allocation of health care resources.

PMID: 15220232 [PubMed - indexed for MEDLINE]

The comparison of the thickness of the cementum layer in Type 2 diabetic and non-diabetic patients.

J Contemp Dent Pract. 2004 May 15;5(2):124-33

Authors: Gokhan K, Keklikoglu N, Buyukertan M

It has been suggested diabetes plays an important role in tooth loss. Studies examining the periodontal structures and the alveolar bone architecture in diabetics have revealed some alterations. However, mechanisms responsible for these alterations have not been elucidated completely. Established relationships between the cementum layer, which is resistant to resorption, and diabetes are few in number. The aim of this study was to compare the thickness of the cementum layer in Type 2 diabetic and non-diabetic subjects in order to improve the understanding of dental mobility in Type 2 diabetes and its effect on tooth loss. A total of 46 male patients with a mean age of 61.72 +/- 5.45 yr. were included in this study (Type 2 diabetics, n=23; non-diabetics, n=23); undecayed. Single rooted premolar teeth extracted from 46 male patients were used to assess the alterations in the cementum layer in Type 2 diabetics. Histological preparations from extracted teeth were examined under light microscopy. In each tooth, the thickness of the cementum layer was measured by an oculometer in 4 different sites on the specimen with the largest pulp space including the pulp chamber and root canals. Statistical analyses were performed with student's t test. The average thickness of the cementum layer in the decalcified teeth extracted from non-diabetic patients was compared to the average thickness of the cementum layer in Type 2 diabetic patients. A significant difference was observed in every site of measurement between Type 2 diabetic and non-diabetic patients with regard to the thickness of the cementum layer (p < 0.05). The cementum layer was thicker at the apical part of the root and at the midpoint of the apical half, and thinner at the central part of the root and at the midpoint of the coronal half in Type 2 diabetic patients.

PMID: 15150640 [PubMed - indexed for MEDLINE]

Oral disease burden in Northern Manhattan patients with diabetes mellitus.

Am J Public Health. 2004 May;94(5):755-8

Authors: Lalla E, Park DB, Papapanou PN, Lamster IB

OBJECTIVES: We explored the association between diabetes mellitus and oral disease in a low-socioeconomic-status urban population. METHODS: Dental records of 150 adults with diabetes and 150 nondiabetic controls from the dental clinic at Columbia University in Northern Manhattan matched by age and gender were studied. RESULTS: There was a 50% increase in alveolar bone loss in diabetic patients compared with nondiabetic controls. Diabetes, increasing age, male gender, and use of tobacco products had a statistically significant effect on bone loss. CONCLUSIONS: Our findings provide evidence that diabetes is an added risk for oral disease in this low-income, underserved population of Northern Manhattan. Oral disease prevention and treatment programs may need to be part of the standards of continuing care for patients with diabetes

PMID: 15117696 [PubMed - indexed for MEDLINE]

Influence of diazepam on blood glucose levels in nondiabetic and non-insulin-dependent diabetic subjects under dental treatment with local anesthesia.

Anesth Prog. 2004;51(1):14-8

Authors: Schaira VR, Ranali J, Saad MJ, de Oliveira PC, Ambrosano GM, Volpato MC

The effect of diazepam on blood glucose concentration (BGC) was investigated in a double-blind cross-over study in 10 healthy and 10 non-insulin-dependent diabetic subjects taking oral hypoglycemic drugs. In the first session, fasting blood samples were taken for blood glucose and glycosylated hemoglobin estimation and at 60, 80, 95, 125, and 155 minutes thereafter for glucose estimation. In another 2 sessions, a venous sample was taken immediately before premedication (5 mg diazepam or placebo randomly given during breakfast). One hour later a blood sample was taken, and the volunteers were submitted to periodontal treatment after injection of 1.8 mL of 2% mepivacaine with 1:100,000 adrenaline. Venous blood samples were taken at 15, 30, 60, and 90 minutes after injection. The changes in BGC were analyzed using analysis of variance (ANOVA) for repeated measures; the means were compared using Tukey test (P = .05). Statistically significant differences in the BGC were observed between diabetic and nondiabetic groups (P = .00003). However, there were no significant differences among the sessions of the same group (P = .29). The results of this study show that a single dose of 5 mg diazepam before dental treatment does not influence BGC in nondiabetic and non-insulin-dependent diabetic subjects.

PMID: 15106685 [PubMed - indexed for MEDLINE]

Diabetic patients who smoke: are they different?

Ann Fam Med. 2004 Jan-Feb;2(1):26-32

Authors: Solberg LI, Desai JR, O'Connor PJ, Bishop DB, Devlin HM

BACKGROUND: We wanted to identify differences between diabetic patients who smoke and those who do not smoke to design more effective strategies to improve their diabetes care and encourage smoking cessation. METHODS: A random sample of adult health plan members with diabetes were mailed a survey questionnaire, with telephone follow-up, asking about their attitudes and behaviors regarding diabetes care and smoking. Among the 1,352 respondents (response rate 82.4%), we found 188 current smokers whose answers we compared with those of 1,264 nonsmokers, with statistical adjustment for demographic characteristics and duration of diabetes. RESULTS: Smokers with diabetes were more likely to report fair or poor health (odds ratio [OR] = 1.5, P = .03) and often feeling depressed (OR = 1.7, P = .004). Relative to nonsmokers, smokers had lower rates of checking blood glucose levels, were less physically active, and had fewer diabetes care visits, glycated hemoglobin (A1c) tests, foot examinations, eye examinations, and dental checkups (P < or = .01). Smokers also reported receiving and desiring less support from family and friends for specific diabetic self-management activities and had lower readiness to quit smoking than has been observed in other population groups. CONCLUSIONS: Clinicians should be aware that diabetic patients who smoke are more likely to report often feeling depressed and, even after adjusting for depression, are less likely to be active in self-care or to comply with diabetes care recommendations. Diabetic patients who smoke are special clinical challenges and are likely to require more creative and consistent clinical interventions and support.

PMID: 15053280 [PubMed - indexed for MEDLINE]

Establishment of an animal model using recombinant NOD.B10.D2 mice to study initial adhesion of oral streptococci.

Clin Diagn Lab Immunol. 2004 Mar;11(2):379-86

Authors: Abdus Salam M, Matsumoto N, Matin K, Tsuha Y, Nakao R, Hanada N, Senpuku H

An oral biofilm is a community of surface-attached microorganisms that coats the oral cavity, including the teeth, and provides a protective reservoir for oral microbial pathogens, which are the primary cause of persistent and chronic infectious diseases in patients with dry mouth or Sj&#xF6;gren's syndrome (SS). The purpose of this study was to establish an animal model for studying the initial adhesion of oral streptococci that cause biofilm formation in patients with dry mouth and SS in an attempt to decrease the influence of cariogenic organisms and their substrates. In nonobese diabetogenic (NOD) mice that spontaneously develop insulin-dependent diabetes mellitus (IDDM) and SS, we replaced major histocompatibility complex (MHC) class II (A(g7) E(g7)) and class I D(b) with MHC class II (A(d) E(d)) and class I D(d) from nondiabetic B10.D2 mice to produce an animal model that inhibited IDDM without affecting SS. The adhesion of oral streptococci, including Streptococcus mutans, onto tooth surfaces was then investigated and quantified in homologous recombinant N5 (NOD.B10.D2) and N9 (NOD.B10.D2) mice. We found that a higher number of oral streptococci adhered to the tooth surfaces of N5 (NOD.B10.D2) and N9 (NOD.B10.D2) mice than to those of the control C57BL/6 and B10.D2 mice. On the basis of our observation, we concluded that these mouse models might be useful as animal models of dry mouth and SS for in vivo biological studies of oral biofilm formation on the tooth surfaces.

PMID: 15013991 [PubMed - indexed for MEDLINE]

Medical health and medication use in elderly dental patients.

J Contemp Dent Pract. 2004 Feb 15;5(1):31-41

Authors: Jainkittivong A, Aneksuk V, Langlais RP

The objectives of this study were to obtain information on the medical conditions and medications used among elderly Thai dental patients and to investigate the relationship between the findings in relation to age and sex. The information regarding medical conditions and medication use was obtained from interviews of 510 dental patients aged 60 years and older. The incidence of medical conditions was 82.5%; women had a significantly higher incidence of medical conditions (86.5%) than men (76.5%). The incidence of medical conditions did not differ among the three age groups. Overall, cardiovascular disease was the leading problem (33.7%) with hypertension being the major component (26.1%). The prevalent problems were bone/joint disorders (32.4%), allergies (18.2%), diabetes mellitus (14.5%), and eye and ear problems (14.3%). In our sample, 65.5% reported taking medications, with an average of 1.5 drug groups per person. The average number of medications taken increased as age increased. Women took medications more frequently than men (70% vs. 58.5%). The four most prevalent drugs were cardiovascular agents (32%), endocrinologic drugs (14.5%), nutritional therapeutics (12.9%), and drugs acting on the musculoskeletal system (11.4%). The present study supports the findings of previous reports in that the presence of medical conditions is high in the elderly and the incidence of medication use increases with advancing age.

PMID: 14973558 [PubMed - indexed for MEDLINE]

The impact of periodontal infection on systemic diseases.

Med Sci Monit. 2003 Dec;9(12):RA291-9

Authors: Amar S, Han X

Systemic health is often closely linked to the state of the oral cavity: many systemic diseases and conditions have oral manifestations. Likewise, oral microbiological infections may also affect one's general health status. Indeed, animal and population-based studies now suggest that periodontal diseases may be linked with systemic diseases and conditions including cardiovascular diseases, diabetes, respiratory diseases, adverse pregnancy outcomes, and osteoporosis. Better understanding of this correlation will help both dental and medical professionals to determine the best approach to patient care. This review will focus on the current knowledge linking periodontal infections to a set of systemic diseases. While a number of interactions have been identified, additional research will be required to determine whether these associations are causal or coincidental, and to evaluate disease pathogenesis and potential therapeutic interventions. These findings place oral health in the perspective of systemic health, and they suggest that the dental and medical professions should develop even closer ties in the future.

PMID: 14646984 [PubMed - indexed for MEDLINE]

Sugar revisited -- again.

Bull World Health Organ. 2003;81(8):552

Authors: Mann J

PMID: 14576885 [PubMed - indexed for MEDLINE]

Enamel hypoplasia in a litter of rats with alloxan-induced diabetes mellitus.

Braz Dent J. 2003;14(2):87-93

Authors: Silva-Sousa YT, Peres LC, Foss MC

Enamel hypoplasia is an important clinical problem commonly seen in children born to diabetic women. We aimed to characterize the enamel hypoplasia in Wistar rats born to alloxan-induced diabetes mellitus rats. Groups consisted of pregnant rats supplemented (ISDR) or not (NISDR) with insulin and controls, in which sterile saline solution was administered instead of alloxan or insulin. The mandibular incisors of one-month-old rats born to these mothers were analyzed. Whitish defective enamel was found macroscopically in both experimental groups (ISDR = 37.5%, NISDR = 33.3%) but not in the control group. Mild to severe enamel hypoplasia was observed by scanning electron microscopy (ISDR = 93.8%; NISDR = 100%, control = 4.2%). The severity of hypoplasia correlated positively with the maternal level of blood glucose. In conclusion, the intensity of enamel hypoplasia in the teeth of the litter born to alloxan-induced diabetic rats was variable and was dependent on the glycemic level of the pregnant rat.

PMID: 12964650 [PubMed - indexed for MEDLINE]

Oral health indicators poorly predict coronary heart disease deaths.

J Dent Res. 2003 Sep;82(9):713-8

Authors: Tuominen R, Reunanen A, Paunio M, Paunio I, Aromaa A

Several earlier studies have suggested that development of coronary heart disease (CHD) is causally related to oral infections. The aim of this study was to investigate the association between oral health indicators and CHD deaths. Out of a nationally representative sample, 6527 men and women aged 30-69 years participated in the health examination with a dental check. Detailed oral health data included caries, periodontal and dental plaque status, presence of remaining teeth, and various types of dentures. Over a mean 12-year follow-up, persons dying of CHD were older and more often smoked, had hypertension, hypercholesterolemia, diabetes, and only a basic education compared with other persons. In univariate analyses, several oral health indicators were associated with CHD deaths. Adjustment for the established CHD risk factors reduced all these associations to statistical non-significance. The associations between oral health indicators and CHD are mostly explained by confounding factors, particularly those relating to health behavior.

PMID: 12939356 [PubMed - indexed for MEDLINE]

The effect of oral hygiene instructions on diabetic type 2 male patients with periodontal diseases.

J Contemp Dent Pract. 2003 Aug 15;4(3):24-35

Authors: Almas K, Al-Lazzam S, Al-Quadairi A

Periodontal disease and diabetes are two common chronic diseases affecting humans. The aim of this study was to assess the effect of oral hygiene instructions on periodontal disease among type 2 male diabetic Saudi subjects. Sixty subjects completed the study and were divided into three groups of 20: healthy (non-diabetic) with periodontal disease, type 2 diabetic with early or moderate periodontal disease, and type 2 diabetic with advanced periodontitis. The age ranged from 24-64 (42 +/- 13.60) years. The subjects were examined at King Saud University, College of Dentistry, Riyadh, Saudi Arabia. Oral hygiene practices and smoking habits were recorded. Oral hygiene instructions given to patients were to use an Oral B medium toothbrush and brush three times daily for 7 days using the by Bass technique for 2 minutes. Fasting blood glucose level (FBGL), gingival crevicular fluid (GCF), community periodontal index of treatment needs (CPITN), and plaque index (Pll) were used to assess patients' profiles at baseline and at recall visit after 7 days. The results showed there was a significant overall decrease in FBGL, baseline 172.67 mg/dl (+/-64.69) to recall visit 162.20 (+/-58.78) P = 0.000, and GCF volume decreased from.4041 micro l (+/-.1260) to .3698 micro l (+/-.1164) P = 0.000. There was a significant reduction in subjects' CPITN mean scores (from 13.98 (+/-8.24) to 13.32 (+/-8.97) P = 0.000), but there was no significant difference in Group 3 with advanced periodontitis, i.e., 22.25 (+/-1.37) to 22.30 (+/-1.38). There was more than a 47% reduction in the overall percentage of plaque scores. The decrease ranged from 82.27 (+/-19.34) to 34.45 (+/-17.04) at baseline and recall visit respectively. It is concluded oral hygiene instructions (a standardized regimen) has an effect on FBGL, GCF, CPITN, and PlI. It is also concluded CPITN is not very sensitive to assess change in periodontal status over a 7 days period. Further studies are needed among diabetic and healthy subjects with a larger sample size and over a longer period of time.

PMID: 12937594 [PubMed - indexed for MEDLINE]

Dental problems in patients with diabetes mellitus (II): gingival index and periodontal disease.

Med Oral. 2003 Aug-Oct;8(4):233-47

Authors: Arrieta-Blanco JJ, Bartolom&#xE9;-Villar B, Jiménez-Martinez E, Saavedra-Vallejo P, Arrieta-Blanco FJ

Among the late complications associated to the diabetes mellitus, periodontal disease has been highlighted, and it can be more severe and refractory to treatment than in healthy subjects. OBJECTIVES: Determine the prevalence of gingivitis and periodontitis as well as the Community Periodontal Index of Need of Treatment (CPITN) in diabetic population compared with a control one. Analyze the histological characteristics in the gingiva of diabetic patients. STUDY DESIGN: The study sample was made up of 74 control subjects and 70 diabetics. We evaluated the following parameters: gingival status according to the Löe and Silness criterion, probe depth, loss of insertion, gingival recession and Community Periodontal Index of Need of Treatment. We also performed gingival biopsies in 42 diabetic patients and 29 controls for histological studies. RESULTS: We found a statistically higher gingivitis index, loss of insertion and gingival recession in diabetic patients compared to the control population, the same not occurring with the probe depth. We did not find significant differences in the CPITN according to the type of diabetes mellitus, metabolic control or disease duration. The biopsy study did not show significant changes in the gingiva of the diabetic patients compared to the control population. CONCLUSIONS: The gingivitis index was higher in the diabetic population. After examination of the treatment needs, we observed how the diabetic patients required more complex treatment.

PMID: 12937385 [PubMed - indexed for MEDLINE]

Implants in the medically compromised patient.

Crit Rev Oral Biol Med. 2003;14(4):305-16

Authors: Beikler T, Flemmig TF

Dental clinicians are confronted with an increasing number of medically compromised patients who require implant surgery for their oral rehabilitation. However, there are few guidelines on dental implant therapy in this patient category, so that numerous issues regarding pre- and post-operative management remain unclear to the dental clinician. Therefore, the aim of the present review is to offer a critical evaluation of the literature and to provide the clinician with scientifically based data for implant therapy in the medically compromised patient. This review presents the current knowledge regarding the influence of the most common systemic and local diseases on the outcome of dental implant therapy, e.g., abnormalities in bone metabolism, diabetes mellitus, xerostomia, and ectodermal dysplasias. Specific pathophysiologic aspects of the above-mentioned diseases as well as their potential implications for implant success are critically appraised. In line with these implications, guidelines for pre- and post-operative management that may assist in the successful implant-supported rehabilitation of this patient category are proposed.

PMID: 12907698 [PubMed - indexed for MEDLINE]

Relationship between periodontal disease and C-reactive protein among adults in the Atherosclerosis Risk in Communities study.

Arch Intern Med. 2003 May 26;163(10):1172-9

Authors: Slade GD, Ghezzi EM, Heiss G, Beck JD, Riche E, Offenbacher S

BACKGROUND: Moderately elevated serum C-reactive protein (CRP) concentration is a systemic marker of inflammation and a documented risk factor for cardiovascular disease in otherwise healthy persons. Unrecognized infections, such as periodontal disease, may induce an acute-phase response, elevating CRP levels. We evaluated the association between periodontal disease and CRP levels in adults in the Atherosclerosis Risk in Communities study. METHODS: Oral examinations were conducted between January 1, 1996, and December 31, 1998, on 5552 ARIC participants (aged 52-74 years) from 4 US communities. Periodontal disease was quantified as the percentage of periodontal sites with pocket depth of 4 mm or more. Serum CRP concentration was quantified in milligrams per liter using an enzyme-linked immunosorbent assay. RESULTS: Mean (SE) CRP level was 7.6 (0.6) mg/L among people with extensive periodontal pockets (>30% of sites with pocket depth > or =4 mm), approximately one-third greater than that for people with less extensive periodontal pockets (5.7 [0.1] mg/L). In a multivariable linear regression model that controlled for age, sex, diabetes mellitus, cigarette use, and nonsteroidal anti-inflammatory drug use, the association of extensive periodontal pockets with CRP concentration was modified by body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters). For people with a BMI of 20, the model predicted a 2-fold difference in mean CRP concentration between periodontal pocket groups (7.5 vs 3.6 mg/L), but the difference decreased with increasing BMI and was negligible when BMI equaled 35. CONCLUSIONS: Extensive periodontal disease and BMI are jointly associated with increased CRP levels in otherwise healthy, middle-aged adults, suggesting the need for medical and dental diagnoses when evaluating sources of acute-phase response in some patients.

PMID: 12767953 [PubMed - indexed for MEDLINE]

Diabetes mellitus as a modulating factor of endodontic infections.

J Dent Educ. 2003 Apr;67(4):459-67

Authors: Fouad AF

Diabetes mellitus is a chronic disease with serious health consequences. The association between diabetes and periodontal disease is well documented. However, the progression and healing of endodontic infections in diabetic patients has not been adequately studied. In this review, diabetes mellitus is explored as a potential modulating factor of endodontic pathosis. Recent data on the relationship between the clinical presentation of pulpal and periradicular disease, as well as the outcome of endodontic treatment in diabetic and nondiabetic patients, are presented. Diabetics who present for endodontic treatment, particularly those with periradicular pathosis, may have increased perioperative symptoms. Cases with preoperative periradicular lesions are less likely to be determined successful two years or longer postoperatively if the patient reports a history of diabetes. Studies examining the pathogenesis of periradicular lesions in mouse models with uncontrolled type 1 diabetes suggest that the lesion size may be increased and the animals have increased serious sequelae. Preliminary findings suggest that some bacterial species may be more prevalent in necrotic pulp of diabetic than nondiabetic patients. More studies are needed to further explore the microbiology of endodontic infections and to determine effective treatment strategies in both diabetic and nondiabetic patients.

PMID: 12749575 [PubMed - indexed for MEDLINE]

Salivary characteristics of diabetic children.

Braz Dent J. 2003;14(1):26-31

Authors: L&#xF3;pez ME, Colloca ME, Páez RG, Schallmach JN, Koss MA, Chervonagura A

Salivary components may suffer variations that can be detected by chemical determinations. The aim of this work was to determine physical and biochemical characteristics of the saliva of a group of diabetic children compared to those of a control group. Relation to oral health indices was also determined. Twenty diabetic children (3-15-years-old) and 21 control children (5-12-years-old) were included in this study. Total proteins, sugars and calcium were determined by colorimetric methods, and glucose, urea, alpha-amylase and acid phosphatase by enzymatic methods. Our results demonstrated that acidic pH, diminished salivary flow rate and excess foam are usually present in saliva of diabetic children. Total sugars, glucose, urea and total proteins were greater in diabetic patients than controls, while calcium values were decreased. These differences were confirmed by the discrimination test. Diabetic children have higher DMFT-dmft-deft and DMFS-dmfs-defs values compared to those of the control children despite their lower sugar intake. Some salivary components in addition to the diminished flow rate could be involved in the characterization of the oral health state of diabetic children.

PMID: 12656461 [PubMed - indexed for MEDLINE]

The effect of high sugar intake on the development of periradicular lesions in rats with type 2 diabetes.

J Dent Res. 2003 Apr;82(4):322-5

Authors: Iwama A, Nishigaki N, Nakamura K, Imaizumi I, Shibata N, Yamasaki M, Nakamura H, Kameyama Y, Kapila Y

Diabetes mellitus is associated with depression of natural defenses against infection and increases the risk of periodontal disease. However, the effects of diabetes on periradicular tissue, which differs structurally from periodontal tissue, are not known. In this study, we evaluated the effects of type 2 diabetes on the development of periradicular lesions after exposure of the pulp in the left mandibular first molar through the occlusal surface in rats. GK rats with spontaneous non-insulin-dependent diabetes mellitus and Wistar rats (controls) received a normal laboratory diet and either water or a 30% sucrose solution. At both 2 and 4 weeks after pulp exposure, histologic analysis showed that alveolar bone resorption was most severe and the periradicular lesions were largest in diabetic rats given the sucrose solution. These results suggest that the metabolic conditions produced by type 2 diabetes enhance the development of periradicular lesions in rats.

PMID: 12651940 [PubMed - indexed for MEDLINE]