Periodontal infections and diabetes mellitus: when will the puzzle be complete?

J Clin Periodontol 2007; 34: 913–916 doi: 10.1111/j.1600-051X.2007.01140.x Division of Periodontics, Section of Oral and Diagnostic Sciences, Columbia UniversityCollege of Dental Medicine, New York, NY,USA Lalla E. Periodontal infections and diabetes mellitus: when will the puzzle becomplete? J Clin Periodontol 2007; 34: 913–916. doi: 10.1111/j.1600-051X.2007.01140.x.
The article in last month’s issue of the that diabetes increases the risk for perio- dontitis by twofold (Papapanou 1996).
the past 12 months (Engebretson et al.
including 19,245 individuals 5–78 years similar extent of periodontal diseases in et al. 2007, Lim et al. 2007, Jones et al.
a limitation of the latter report, acknowl- of studies with significant heterogeneity, i.e., very different study populations and conditions, focuses on the topic of perio- state with the opportunity of the January disease duration appear to play a role in issue Jones et al. (2007a, b) study, high- the level of risk for periodontal diseases, what are the effects of periodontitis and adults reported that the level of glycae- diabetic patients is scant, as is informa- severity and extent of periodontitis.
ades of reports regarding the association in several reports, although some studies that diabetic patients are at significantly (2001) and Mealey & Oates (2006).
r 2007 The Author. Journal compilation r 2007 Blackwell Munksgaard might affect the diabetic state, is rather (p 5 0.82)’’ without any further expla- and E-selectin (Lalla et al. 2007b).
cations (i.e., cardiovascular disease and usually have poor glycaemic control.
studying type 1 diabetes in this particu- Saremi et al. 2005, Shultis et al. 2007).
pilot studies are of importance given the cooperative with oral health-care habits) has a positive systemic effect in patients respectively, in diabetic individuals.
of other complications, this is of essence that direct infection of the vascular wall validated across all diabetic patients.
January issue of the journal (Jones et al.
spread of bacteria. Adjunctive antibiotic affected individuals and this is the rea- essential treatment strategy in both types interested in participating patients were of diabetes. Therefore, type of disease or excluded. The authors adopted this strat- egy because ‘‘it clearly left room for quantify the effects of periodontal ther- (i.e., the overall host burden). The treat- range of poor control’’. Indeed, baseline ment strategy in type 2 patients is argu- 456 patients, from 10 longitudinal perio- further substantiates the concept that in both disease types, the potential effects À 1.5, 0.7). A larger, but still not statis- requirements, lipid levels/profile, serum authors reported that ‘‘the type of con- r 2007 The Author. Journal compilation r 2007 Blackwell Munksgaard Periodontal infections and diabetes mellitus support for the concept that periodontitis Bakhshandeh, S., Murtomaa, H., Mofid, R., Vehkalahti, M. M. & Suomalainen, K.
although statistical significance was not Bodenheimer, T., Wagner, E. H. & Grumbach, Davila-Perez, C., Amano, A., Alpuche-Solis, A.
G., Patino-Marin, N., Pontigo-Loyola, A. P., the untreated subjects received increases Hamada, S. & Loyola-Rodriguez, J. P. (2007) in insulin during the 4-month period.
to real changes in clinical practice.
Distribution of genotypes of Porphyromonas gingivalis in type 2 diabetic patients with periodontitis in Mexico. Journal of Clinical Engebretson, S., Chertog, R., Nichols, A., Hey- Hadavi, J., Celenti, R. & Grbic, J. (2007) Plasma levels of tumour necrosis factor-alpha al. 2005, 2006). Dentists tend to inquire, in patients with chronic periodontitis and Engebretson, S. P., Vossughi, F., Hey-Hadavi, J., Emingil, G. & Grbic, J. T. (2006) The influence of diabetes on gingival crevicular effect size achieved in the current study fluid beta-glucuronidase and interleukin-8.
patient relations are significant predic- Iwamoto, Y., Nishimura, F., Nakagawa, M., include the fact that periodontal destruc- tors for general dentists (Kunzel et al.
deep sites were still present at 4 months.
microbial periodontal treatment on circulat- ing tumor necrosis factor-alpha and glycated reveal improved periodontal healing.
Janket, S. J., Wightman, A., Baird, A. E., Van Dyke, T. E. & Jones, J. A. (2005) Does periodontal treatment improve glycemic con- trol in diabetic patients? A meta-analysis of Jones, J. A., Miller, D. R., Wehler, C. J., Rich, S., Krall, E., Christiansen, C. L., Rothendler, J. A. & Garcia, R. I. (2007a) Study design, recruitment, and baseline characteristics: the department of veterans affairs dental diabetes study. Journal of Clinical Periodontology 34, clinical trial. As a final point, the Jones et al. study represents a major effort and Jones, J. A., Miller, D. R., Wehler, C. J., Rich, Christiansen, C. L., Rothendler, J. A. & inducing a positive effect on the diabetic Garcia, R. I. (2007b) Does periodontal care state and offers valuable information for the design of future multi-centre clinical infections–diabetes relationship is large, of veterans affairs dental diabetes study.
Journal of Clinical Periodontology 34, 46–52.
Khader, Y. S., Dauod, A. S., El-Qaderi, S. S., results from large, multi-centre clinical Alkafajei, A. & Batayha, W. Q. (2006) trials with multiple treatment modalities with nondiabetics: a meta-analysis. Journal of Diabetes Complications 20, 59–68.
r 2007 The Author. Journal compilation r 2007 Blackwell Munksgaard Kunzel, C., Lalla, E., Albert, D. A., Yin, H. & Effect of periodontitis on overt nephropathy Lamster, I. B. (2005) On the primary care pilot study. Journal of Periodontal Research and end-stage renal disease in type 2 diabetes.
frontlines: the role of the general practitioner in smoking-cessation activities and diabetes Lim, L. P., Tay, F. B., Sum, C. F. & Thai, A. C.
Taylor, G. (2001) Bi-directional interrelation- ships between diabetes and periodontal dis- Dental Associations 136, 1144–1153; quiz metabolic control and inflammation on sever- eases: an epidemiologic perspective. Annals Kunzel, C., Lalla, E. & Lamster, I. (2007) with diabetes mellitus. Journal of Clinical Taylor, G. W., Burt, B. A., Becker, M. P., Dentists’ management of the diabetic patient: Genco, R. J., Shlossman, M., Knowler, W.
contrasting generalists and specialists. Amer- Mealey, B. L. & Oates, T. W. (2006) Diabetes C. & Pettitt, D. J. (1996) Severe periodontitis ican Journal of Public Health 97, 725–730.
mellitus and periodontal diseases. Journal of and risk for poor glycemic control in patients Kunzel, C., Lalla, E. & Lamster, I. B. (2006) with non-insulin-dependent diabetes mellitus.
Navarro-Sanchez, A. B., Faria-Almeida, R. & Journal of Periodontology 67, 1085–1093.
the diabetic patient in the dental office.
Bascones-Martinez, A. (2007). Effect of non- Journal of Periodontology 77, 331–340.
Hugoson, A. (1996) Medical status and com- Lalla, E., Cheng, B., Lal, S., Kaplan, S., Soft- plications in relation to periodontal disease ness, B., Greenberg, E., Goland, R. S. & experience in insulin-dependent diabetics.
moderate periodontitis. Journal of Clinical promotes periodontal destruction in children.
Journal of Clinical Periodontology 34, 294– Papapanou, P. N. (1996) Periodontal diseases: epidemiology. Annals of Periodontology 1, Lalla, E., Kaplan, S., Chang, S. M., Roth, G. A., Celenti, R., Hinckley, K., Greenberg, E. & Saremi, A., Nelson, R. G., Tulloch-Reid, M., Papapanou, P. N. (2006) Periodontal infec- Hanson, R. L., Sievers, M. L., Taylor, G. W., tion profiles in type 1 diabetes. Journal of Shlossman, M., Bennett, P. H., Genco, R. & Clinical Periodontology 33, 855–862.
Knowler, W. C. (2005) Periodontal disease Lalla, E., Kaplan, S., Yang, J., Roth, G. A., and mortality in type 2 diabetes. Diabetes Papapanou, P. N. & Greenberg, S. (2007b) Effects of periodontal therapy on serum C- Shultis, W. A., Weil, E. J., Looker, H. C., reactive protein, sE-selectin and tumor necro- Curtis, J. M., Shlossman, M., Genco, R. J., Knowler, W. C. & Nelson, R. G. (2007) r 2007 The Author. Journal compilation r 2007 Blackwell Munksgaard


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