1

UNIVERSITY OF BASRAH
‫جامعـــة البصرة‬
‫كليـة طـب االسنـــان‬ COLLEGE OF DENTISTRY

‫فرع امراض وجراحه ما حول‬ PERIODONTIC DEPARTMENT

‫االسنان‬
FOURTH STAGE
ACADEMIC YEAR: 2019-2020

SCIENTIFIC REPORT
REPORT TITLE:

Diabetes and periodontal disease: a two-way

relationship

Under supervision:- Dr. Reham Adnan Radhi

Dr. Hoda Jassim

Student’s name :-

Student's Mark
18
 2

UNIVERSITY OF BASRAH
‫جامعـــة البصرة‬
‫كليـة طـب االسنـــان‬ COLLEGE OF DENTISTRY

‫فرع امراض وجراحه ما حول‬ PERIODONTIC DEPARTMENT

‫االسنان‬
INTRODUCTION
Periodontitis and diabetes are both highly prevalent conditions, and the association
between these two common diseases has been recognized by dental professionals
for many years. Epidemiological studies have clearly identified that diabetes is a
major risk factor for periodontitis, increasing the risk approximately three-fold
compared to non-diabetic individuals, particularly if glycemic control is poor. In
recent years, the precise relationship between periodontitis and diabetes has been
the subject of much interest, given that both conditions are highly prevalent, and also
because it has become increasingly clear that there are interactions between the two
diseases that have important clinical implications for dental professionals, physicians
.and, most importantly, patients

PERIODONTAL DISEASE
Periodontal disease, also known as gum disease, is a set of inflammatory conditions
affecting the tissue surrounding the teeth . In its early stage, called gingivitis, the gums
become swollen, red, and may bleed In its more serious form called periodontitis, the
gums can pull away from the tooth , bone can be lost, and the teeth may loosen or fall
out , Bad breath may also occur . The main cause of periodontal disease is bacterial
.plaque, a sticky, colorless film that constantly forms on teeth
 3

UNIVERSITY OF BASRAH
‫جامعـــة البصرة‬
‫كليـة طـب االسنـــان‬ COLLEGE OF DENTISTRY

‫فرع امراض وجراحه ما حول‬ PERIODONTIC DEPARTMENT

‫االسنان‬

Diabetes Mellitus

Diabetes is a group of metabolic disorders characterized by hyperglycemia (elevated

blood sugar). The main types of diabetes are type 1 diabetes, type 2 diabetes and
gestational diabetes .

Type 1 diabetes ( insulin-dependent diabetes mellitus ) is due to absolute insulin

deficiency and is usually an autoimmune disease leading to the destruction of the
insulin-secreting beta cells in the pancreas. In some cases the cause of destruction of
the beta cells is not known.

Type 2 ( non-insulin dependent diabetes mellitus) results from relative insulin

deficiency that may be associated with varying degrees of insulin action defects
known collectively as insulin resistance.

Gestational diabetes is a form of diabetes that occurs in pregnant women without a

previous history of diabetes who develop hyperglycemia during their pregnancy. It is
characterized by reduced insulin secretion as well as insulin resistance, and usually
improves after pregnancy

THE EFFECTS OF DIABETES ON PERIODONTAL DISEASE

 Red, swollen, tender gums.

 Bleeding while brushing, flossing, or both.

 Receding gums.
 4

UNIVERSITY OF BASRAH
‫جامعـــة البصرة‬
‫كليـة طـب االسنـــان‬ COLLEGE OF DENTISTRY

‫فرع امراض وجراحه ما حول‬ PERIODONTIC DEPARTMENT

‫االسنان‬
 diminished salivary flow.

 xerostomia (Dry mouth can make tasting, chewing, and swallowing food
difficult)

 burning mouth .

 altered taste ( neuropathy ) .

 Candida albicans , hemolytic streptococci, and staphylococci.

 increase caries rate.

 progressive periodontitis.

 increase risk of gingivitis and periodontitis.

 extensive bone loss .

 increased tooth mobility.

 widening of periodontal ligament space .

 suppuration and abscess formation .

PATHOGENESIS OF DIABETES ON PERIODONTAL DISEASE

 5

UNIVERSITY OF BASRAH
‫جامعـــة البصرة‬
‫كليـة طـب االسنـــان‬ COLLEGE OF DENTISTRY

‫فرع امراض وجراحه ما حول‬ PERIODONTIC DEPARTMENT

‫االسنان‬
Pathogenesis

There are several factors that increased prevalence of periodontal disease in patient
-: with diabetes mellitus These factors

Vascular changes: Changes include thickening and hyalinization of vascular walls, -

PAS-positive, diastase- resistant thickening of capillary basement membranes,
swelling and occasional proliferation of the endothelial cells, and splitting of capillary
basement membrane. Diabetic-induced changes in the capillary basement membrane
may have an inhibitory effect on the transport of oxygen, white blood cells, immune
.factors and waste products, all of which could affect tissue repair and regeneration

PMNL’s function: Impairment of PMN function is a feature of diabetes mellitus. -

Disorders include reduced phagocytosis and intracellular killing, impaired adherence
and impaired chemotactic response. Suggested causes include inhibition of the
glycolytic pathway with the PMNL’s, abnormal cyclic nucleotide metabolism, which
disrupts the organization of microtubules and microfilaments, or a reduction in
.leukocyte membrane receptors

Biochemistry of crevicular fluid: Alterations in the constituents and flow rate of -

crevicular fluid have been shown to be associated with diabetes. Cyclic AMP levels
.seems to be reduced in the diabetes group when compared with control

- Changes in plaque microflora: Studies have indicated that proteolytic activity has
not been altered but hyaluronidase activity is lower in plaque from diabetes.
 6

UNIVERSITY OF BASRAH
‫جامعـــة البصرة‬
‫كليـة طـب االسنـــان‬ COLLEGE OF DENTISTRY

‫فرع امراض وجراحه ما حول‬ PERIODONTIC DEPARTMENT

‫االسنان‬

Figure:
Potential
mechanistic
links in the
bidirectional

interrelationship between diabetes and periodontal disease

treatment of diabetes patient with periodontal disease

.Periodontal treatment in patient with uncontrolled- diabetes is contraindicated -

:If suspected to be a diabetic, following procedures should be performed -

.a- Consult the patient’s physician

b- Analyze laboratory tests, fasting blood glucose, post-prandial blood glucose,

, .glycated hemoglobin glucose tolerance test (GTT), urinary glucose
 7

UNIVERSITY OF BASRAH
‫جامعـــة البصرة‬
‫كليـة طـب االسنـــان‬ COLLEGE OF DENTISTRY

‫فرع امراض وجراحه ما حول‬ PERIODONTIC DEPARTMENT

‫االسنان‬
c- If there is periodontal condition that requires immediate care, prophylactic
.antibiotics should be given

d- If patient is a ‘brittle’ diabetic, optimal periodontal health is a necessity. Glucose

levels should be continuously monitored and periodontal treatment should be
performed when the disease is in a well- controlled state. Prophylactic antibiotics
.should be started 2 days preoperatively; Penicillin is the drug of first choice

-: Guideline
 8

UNIVERSITY OF BASRAH
‫جامعـــة البصرة‬
‫كليـة طـب االسنـــان‬ COLLEGE OF DENTISTRY

‫فرع امراض وجراحه ما حول‬ PERIODONTIC DEPARTMENT

‫االسنان‬

References:-
 9

UNIVERSITY OF BASRAH
‫جامعـــة البصرة‬
‫كليـة طـب االسنـــان‬ COLLEGE OF DENTISTRY

‫فرع امراض وجراحه ما حول‬ PERIODONTIC DEPARTMENT

‫االسنان‬
- Newman , Takie ,klokkevold , Carranza ( 2006 ) : “ Carranza’s
Clinical Periodontology “ ,
10th Edition , Saunders Elsevier, P 576 , 577.

- Shantipriya Reddy ( 2011 ) : “ Essential of Clinical Periodontology

and Periodontics “
3rd Edition , Jaypee, P 106 .

- Shalu Bathla ( 2011 ) : “ periodontics Revisited “ 1st Edition ,

Jaypee , P 101 .

- ABC of diabetes (Tim holt and Sudhesh kumar) 6th edition.

Thank you