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IMPACT OF PERIODONTAL INFECTION ON
PERIODONTAL DISEASE AND DIABETES
DEPARTMENT OF PERIODONTICS
By Dr Sachin Rathod
Pathobiology of periodontitis
Focal infection theory revisited
Periodontal disease & diabetes mellitus
•Periodontal disease is an infectious disease but
environmental ,physical, social & host stresses
may affect & modify disease expression
•Evidences has also shed light on converse sides
of relationship between systemic health & oral
health that is ,the potential effect of periodontal
disease on a wide range of organ system
• Periodontitis is associated with small number of
predominantly gram negative micro organism existing in
• Pathogenic bacteria are necessary to cause disease
but they are not susceptible alone, a susceptible host is
• Difference in host susceptibility makes not all individual
equally vulnerable to destructive effects of periodontal
pathogens so response to treatment may vary
• Periodontal infection may enhance the risk for certain
PATHOBIOLOGY OF PERIODONTITIS
•WILLIAM HUNTER , a british physician developed idea of oral
micro organism being responsible for wide range of systemic
•He claimed the restorations of carious teeth instead of extraction
resulted in trapping of infectious agents under restorations.
•He believed teeth are liable to infection primarily because of their
relationship to alveolar bone & structures
Therefore he advocated extraction of teeth to eliminate source of
•In 1940s & 1950s hunter and other advocates fell into disrepute
when widespread extraction failed to reduce or eliminate systemic
FOCAL INFECTION THEORY REVISITED
PERIODONTAL DISEASE AND DIABETES
“ Diabetes mellitus is a complex metabolic disorder characterized by
Diminished insulin production
Impaired insulin action
Or a combination of both
Results in the inability of glucose to be transported from the
bloodstream into the tissues, which results in high blood glucose
level and excretion of sugar in the urine. Lipid and protein
metabolism is altered in diabetes as well.
Greater loss of attachment
Increased bleeding on probing
Reduction in defense mechanisms
Increased susceptibility to infections which leads
to destructive periodontal disease
The glucose content of gingival fluid and blood is higher.
This leads to change in environment of microflora.
This induces qualitative changes in bacteria.
The sub gingival flora is composed mainly of –
The increased susceptibility of diabetic patients to
infection is due to polymorphonuclear leukocyte
deficiencies resulting in
This results in diminished primary defense against
periodontal pathogens and bacterial proliferation is
ALTERED COLLAGEN METABOLISM
Increased collagenase activity and decreased collagen
synthesis is found in individuals with poorly controlled
Decreased collagen synthesis, osteoporosis and
reduction in height of alveolar bone occurs in diabetes.
Inhyperglycemic state, numerous proteins and matrix
molecules undergo a nonenzymatic glycosylation
resulting in accumulated glycation end products(AGE’s).
AGE’s play a significant role in the progression of
priodontal disease. It renders the periodontal tissues
more susceptible to destruction.
Collagen in tissues of diabetic patients is
aged and more susceptible to breakdown.
The cumulative effects of altered cellular
response to local factors, impaired tissue
integrity and altered collagen metabolism
patients to infection and destructive
PERIODONTAL INFECTION ASSOCIATED WITH
GLYCEMIC CONTROL IN DIABETES
Acute bacterial and viral infections have shown to
increase insulin and aggravate glycemic control.
Systemic infection increases tissue resistance to
insulin, preventing glucose level and requiring
increased pancreatic insulin production to maintain
In patient with periodontitis, persistent systemic
challenge with periodontopathic bacteria and their
products may act in a way similar to well recognized
TREATMENT OF PERIODONTITIS IN
Type-I:- Scaling and root planing, surgery, selected tooth
extraction and systemic antibiotics resulted in decreased
Also scaling and root planing combined with systemic
doxycycline therapy for 2 weeks had shown significant
Type-II:- Scaling and root planing combined with systemic
doxycycline therapy for 2 weeks had shown reduced
probing depth and bleeding on probing.
a)Periodontal treatment in patient with uncontrolled diabetes is
b)If suspected to be a diabetic following procedure should be
1)Consult the patient ‘s physician.
2)Analyze laboratory test , glucose tolerance test ,post prandial
blood glucose . Glycated hemoglobin ,glucose tolerance test
3)If there is a periodontal condition that requires immediate care
prophylactic antibiotics should be given.
4)If patient is brittle diabetic optimal periodontal health is necessity.
Glucose level should be continuosly monitored and periodontal
treatment should be performed when a disease is in a well
controlled state. Prophylactic antibiotics should be started two
days preoperatively, penicillin is a drug of first choice.
• 1.Clinician should make certain that the prescribed
insulin has been taken , followed by a meal. Morning
appointments are ideal , after breakfast because of
optimal insulin levels.
• 2.After any surgical procedures, post operative insulin
dose should be altered.
• 3.Tissues should be handled as atraumatically and as
minimally as possible for anxious patients ,if pre-
operative sedation is required , epinephrine
concentration should not be greater than 1:1,00,000
• 4.Diet recommendation should be made.
• 5.Antibiotic prophylaxis is recommended for
• 6.Recall appointments and fastidious home oral
care should be stressed.
SUMMARY AND CONCLUSION
• 1. Periodontal infections is one of many potential
risk factors for the number of systemic
• 2. The emerging field of periodontal medicine
offers new insights into the concept of oral cavity
as one system interconnected with the whole
• 3. For many years dental profession as
recognized the effect of systemic condition.