2. • infection that damages
the gingiva and alveolar
bone
What is periodontitis?
1. Van Dyke et al., 2014
2. CDC, 2012 Lee, 2017
• 47.2% of the population
above 30 has some
form of periodontitis
• multistage disease
3. 2 key components:
Pathogenesis of Periodontitis
Dominy et al., 2019 Figuerdo et al., 2019
Microbial shift/Dysbiosis
Host Inflammatory pathways
4. ● essentially a “microbial shift”/dysbiosis occurs
changing a healthy oral microbiome to be
pathogenic
● changes symbiotic host-microbe relationship to
pathogenic
Pathogenesis - Dysbiosis
Dominy et al., 2019
1. Teles et al., 2013
2. Zhang et al., 2019
3. Nath & Raveendran,
2013
● The oral microbiome houses ~700 types of
microbes
● symbiotic microbe-host relationship
● dysbiosis leads to a pathogenic relationship
● reduction of gram positive aerobes and over
abundance of gram negative anaerobes
● new microbial complexes → orange complex,
red complex
Orange complex bacteria:
Prevotella intermedia
Prevotella nigrescens
Prevotella micros
Fusobacterium
Campylobacter gracilis
Campylobacter rectus
Leptotrichia bucallis
Campylobacter showae
Campylobacter ochracea
Red Complex Bacteria:
Porphyromonas gingivalis
Treponema denticola
Tannerella forsythia
Eubacterium nodatum
Eubacterium saburreum
Aggregatibacter
actinomycetemcomitans
Prevotella melaninogenica
Prevotella micra
filifactor alocis
5. Pathogenesis - Inflammatory Response
Munoz-Carillo et al., 2018
Initial lesion - polymorphonuclear
leukocytes infiltrate the gingival
sulcus, increase in fibrin
Early lesion - accumulation of T
cells and cytokine release
Established lesion - dense
infiltration of T cells and B cells,
RANKL production
Advanced lesion - further
infiltration of B cells and T cells, B
cell autoantibodies breakdown
gingival tissue
Figuerdo et al., 2019
7. What we Know So Far...
Presence of
Diabetes
Increased
incidence of
periodontitis
Exacerbates
progression of
periodontitis
WHY?
8. Question: What are the mechanisms and
factors that contribute to this increased
incidence and exacerbation of periodontitis
in diabetics?
9. Overlap Between Periodontitis and Diabetes
- dysbiosis of
the oral
microbiome
increase in red
and orange
complex
bacteria
Change in
oral
microbiome
Increase in
inflammation
Increased
incidence
of:
- nerve damage
- heart disease
- Kidney failure
Increased insulin
resistance chronic
inflammatory- immune
response
- inflammatory response
resulting in an increase in
cytokines, T cells, RANKL
etc
high glucose levels in
saliva which changes
nutrient sources for
bacteria
Diabetes Periodontitis
10. Hypothesis: Diabetes increases the
incidence of periodontitis by fostering an
oral microbiome that promotes
periodontitis pathogenesis and
exacerbates periodontitis by increasing the
stimulation of inflammatory pathways
11. Methods
• Worked with associate
librarian at UB’s
dental school
• The search resulted in
276 articles
• narrowed it down to
75
• Used only studies
using animal models
and gene sequencing
12. Is it the oral microbiome?
Hypothesis: Diabetes increases the incidence of periodontitis by fostering an oral
microbiome that promotes periodontitis pathogenesis and exacerbates
periodontitis by increasing the stimulation of inflammatory pathways
15. 1) Diabetes fosters an oral microbiome that has an
increased abundance of periodontopathogenic
bacteria in comparison to healthy individuals
2) Diabetics display less microbial diversity in the oral
microbiome
3) Those who have poorly controlled diabetes have a
more pathogenic oral microbiome than those with
well controlled diabetes
Findings:
1. Yost et al., 2015
2. Farina et al., 2019
3. Matsha et al., 2020
4. Xiao et al., 2017
5. Xiayou et al., 2020
6. Zhou et al., 2015
16. Presence of Periodontitis
Increased
incidence of
periodontitis
Exacerbates
progression of
periodontitis
WHY?
Oral
Microbiome
increased abundance of
periodontopathogenic +
greater bone loss
17. But what about the inflammatory response?
● Oral microbiome
● Inflammatory
response
18. Hypothesis: Diabetes increases the
incidence of periodontitis by fostering an
oral microbiome that promotes
periodontitis pathogenesis and
exacerbates periodontitis by increasing the
stimulation of inflammatory pathways
19. Pathogenesis - Inflammatory Response
Munoz-Carillo et al., 2018
Initial lesion - polymorphonuclear
leukocytes infiltrate the gingival
sulcus, increase in fibrin
Early lesion - accumulation of T
cells and cytokine release
Established lesion - dense
infiltration of T cells and B cells,
RANKL production
Advanced lesion - further
infiltration of B cells and T cells, B
cell autoantibodies breakdown
gingival tissue
Figuerdo et al., 2019
20. Pathogenesis - Inflammatory Response
Munoz-Carillo et al., 2018
Initial lesion - polymorphonuclear
leukocytes infiltrate the gingival
sulcus, increase in fibrin
Early lesion - accumulation of T
cells and cytokine release- IL1A,
IL6,TNF-a
Established lesion - dense
infiltration of T cells and B cells,
Advanced lesion - further
infiltration of B cells and T cells, B
cell autobodies breakdown gingival
tissue
Figuerdo et al., 2019
21. • 4 groups
Group 1:
Non-diabetic
PBS injection
Findings - AGE deposition in Periodontitis and Diabetes
Group 2:
Non-diabetic
P. gingivalis
injection
Group 3
Diabetic
PBS injection
Group 4:
Diabetic
P. gingivalis
injection
● Animal model study looked at AGE accumulation in the gingival epithelium.
● wanted to see how the presence of periodontitis, diabetes, periodontitis and diabetes impacted
AGEs
Lalla et al., 2000
22. • Used immunohistochemistry to
determine the presence of AGE in
gingival epithelium
• Found an increase in AGE to be a
unique feature of diabetic
environment
Findings - AGE deposition
Lalla et al., 2000
Non-diabetic
PBS injection
Diabetic
PBS injection
Non-diabetic
P. gingivalis
Diabetic
P. gingivalis
main takeaway: Diabetic mice had more
AGEs in gingival epithelium regardless of
periodontitis presence
23. Findings - RAGE
Lalla et al., 2000
Non diabetic
PBS injection
Non-diabetic
P.gingivalis
Diabetic
P.BS
Diabetic mice
P. gingivalis
25. In-vitro study of mouse osteocyte like cells impacted by AGE2 and P-LPS
4 groups:
Findings - Osteocyte Cells and AGE accumulation and P-
LPS
sakamoto et al., 2019
28. Presence of Diabetes
Increased
incidence of
periodontitis
Exacerbates
progression of
periodontitis
WHY?
Oral
Microbiome
Inflammatory
response
greater abudnance of
periodontopathogenic
bacteria + greater bone
loss
- increased AGE in gingival
epithelium
- increased Il-6
- increased sclerostin
- reduction in alveolar bone
loss when blocked
29. • Periodontitis and Diabetes are both life altering diseases
• Diabetes and periodontitis are both some of the most commonly diagnosed
diseases and understanding the relationship between these two is extremely
important to improve the outcomes for patients
• Open the door for new therapies
Conclusion + Impact