Because the prevalence of both chronic periodontics and diabetes increases with age, establishing a relationship between them in the older age groups in extremely difficult. Recent studies in which the age relationship of periodontal diseases show that periodontal diseases is more severe and more prevalent than in non-diabetics of comparable age. However, it is generally accepted that adults whose diabetes is well-controlled do not have more gingivitis or destructive periodontics that non-diabetics.
Diabetics have elevated glucose levels in oral fluids when blood glucose is high, and these glucose elevations can influence the microbial flora, the composition of bacterial plaque, and the mixture of organisms at the bottoms of the periodontal pockets. Elevated glucose levels may in particular encourage the growth of candida albicans, the causative agent in thrush, and oral C. albicans counts have been reported to be higher in diabetics than non-diabetics
In addition to elevated glucose levels, other pathological changes in diabetics may predispose the diabetic to periodontal disease. These changes include decreases in leukocyte chemotaxis, phagocytes, and bactericidal activity, as well as decreased cellular immunity.
Other factors contributing to periodontal diseases in diabetics may be vascular changes, including stasis in the micro circulation and altered collagen metabolism.
Dental infections themselves may worsen the diabetic state. As in other infections, dental infections result in hypoglycemia, mobilization of fatty acids, and acidosis. Exacerbation of dental infections may undermine good control that has been achieved in diabetes, and initial control may be difficult or impossible in a newly diagnosed diabetic with active dental infection.
Periodontitis can be arrested by treatment aimed at plaque and calculus removal and improved oral hygiene, all of which are directed towards eradicating pathogenic bacteria that causes periodontal diseases.
Detection and Monitoring
Dry mouth and thirst are classic symptoms of diabetes mellitus, and an increases incidence of thrush is considered a complication of diabetes.
Bleeding gums may be a sign of infection, and diabetics who notice this or other unusual lesions in the mouth should see a dentist
If you are a health professional and want more information, you may be interested to know.....
People with chronic periodontal disease have increased serum levels of CRP, hyper-fibrinogenemia, moderate leukocytes,as well as increased serum levels of IL-1 and IL-6 when compared with unaffected control populations (Kweider et al., 1993; Ebersole et al., 1997;Loos et al., 2000; Slade et al., 2000, 2003; Hutter et al., 2001).Furthermore, in periodontics patients, elevated serum CRP is associated with high levels of infection with periodontal pathogens (Noack et al., 2001).
Support for the hypothesis that periodontists-driven inflammatory responses are of significance for otherwise healthy individuals is at least three-fold: (i) Periodontists has been associated with increased odds of cardiovascular events (Genco et al.,2002; Joshipura et al., 2003), of delivering pre-term low-birth weight babies (Offenbacher et al., 1996), and of having sub-optimal control of type II diabetes (Grossi and Genco, 1998); (ii) the strength of association between periodontitis or other chronic infections and cardiovascular events seems to be of similar magnitude (Danesh, 1999); and (iii) experimental pre-clinical models have indicated that chronic infection with periodontal pathogens leads to thickening of the carotid intima (Li et al.,2002) and to fetal growth restriction (Collins et al., 1994).
Independently of the underlying mechanism(s), systemic inflammation seems to be central for explaining the nature of the link between chronic infections and atherosclerosis (Ridkeret al., 1997;Danesh, 1999; Ross, 1999; Libby et al., 2002; Pearson et al.,2003). Within this context, CRP represents an emerging and reliable marker of the acute phase response to infectious burdens and/inflammation. As a consequence of its kinetics, it best describes the inflammatory status of the individual (de Maat and Kluft, 2001).CRP hepatic production is usually elicited by an inflammatory stimulus and mediated through a complex network of cytokines(mainly IL-6) (Ablij and Meinders, 2002). CRP has also assumed significant role as a predictor for future coronary events in healthy populations (Blake and Ridker, 2002).