Periodontitis as a Risk Factor for Diabetes Complications
A. introduction periodontal disease and complications of diabetes. Studies show that there is a two-way relationship between diabetes and periodontal disease
1. First, it is clear that diabetes increases the risk and severity of periodontal disease [72,73]. The American diabetes Association, the standard of care 2008 includes obtaining history in the past and in the present tooth infection as part of a doctor's examination [74,75].
2. Secondly, can lead to an aggravation of periodontal disease diabetes significantly worsening glycemic control with time .
B. summary of the study. Periodontal disease may have effects on glycemic control, but the mechanism by which this occurs is not clear, . Further research is needed to clarify relationships periodontal disease and diabetes.
C. Possible Biological Explanation. As Periodontits complications associated with diabetes?
1. Overview of glycemic control
a. Glycemic control is the medical term for typical levels of blood sugar (glucose) in people with diabetes.
1) optimal control implies that people with diabetes can measure and record your own levels of glucose in the blood.
2) long and increased levels of glucose in the blood, which left unchecked and untreated, over time, result in serious complications of diabetes, sensitive, and sometimes even death.
B. The blood sugar level is measured using a glucose meter, arising out of or in mg/DL (milligrams per deciliter in the United States) or mmol/l (millimoles per litre in Canada and Europe) of blood.
1) the average normal person should have the glucose level of about 4.5 to 7.0mmol/l (80 to 125mg/DL).
2) in diabetic patients before eating less than 6.1 mmol/l (<110mg/DL) and 2 hours after the start eating less than 7.8 mmol/l (<140mg/DL)is acceptable.
c. Poor glycemic control means persistently high content in the blood glucose and glycosylated hemoglobin, which can vary from 200 to 500 mg/DL (11 to 28 mmol/l) 9% 15% or higher in the months and years before you experience severe complications.
2. The proposed biological ways
a. Periodontal disease can serve as initiators of insulin resistance, thereby exacerbating glycemic control (Fig. 18-6).
B. In recent years a growing interest in the possible inflammatory basis for the treatment of diabetes and its complications (box 18-4).
1) for the most part is devoted to study of C-reactive protein (CRP) as a measure of circulating inflammatory biomarkers.
a. CRP concentrations in persons with long-term diabetes of 1st type is significantly higher than in healthy people . These results show that the inflammatory process can play an important role in the long-term development of type 1 diabetes.
B. Increases in inflammatory markers found in practically healthy persons who then to proceed to the development of type 2 diabetes [78,79].
2) further research is needed to confirm the role of inflammation in the field of diabetes and what role, if any, periodontitis, as a source of inflammation, which triggers the production of CRP can play in the disease process.
D. implications for dental hygiene. Of dental hygienists must guide the patients with diabetes about the possible consequences of periodontal infection on glycemic control and encourage diseases of the oral cavity prevention services and treatment.