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Diabetes mealitus &periodontal disease

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Diabetes mealitus &periodontal disease

  1. 1. Diabetes Mealitus & PERIODONTAL DISEASE
  2. 2. Diabetes mellitus metabolism hyperglycemia) Type2 Type1 oType1 Diabetes mellitus/IDDM insulin dependent diabetes oType2 Diabetes mellitus /NIDDM non-insulin-dependent diabetes , , ,
  3. 3. Diabetes mellitus Type1 Diabetes Insulin dependent diabetes mellitus (IDDM) juvenile diabetes autoimmune Insulin deficiency)     , ,
  4. 4. Diabetes mellitus Type2 Diabetes (NIDDM) Noninsulin dependent diabetes mellitus Insulin resistance)    abdominal obesity)  , ,
  5. 5. Diabetes mellitus , ,
  6. 6. Risk Factors o o o o o Pre-Diabetes http://www.oknation.net/blog/22313/2
  7. 7. Risk Factors o Insulin HDL Pre-Diabetes) o o Metabolic Syndrome ( kg o o http://www.oknation.net/blog/22313/2
  8. 8. http://www.typefreediabetes.com/
  9. 9. Signs and Symptoms Polyuria) o Polydipsia) o o Polyphagia) o Pruritus) o Weakness) o Fatigue) , , ,
  10. 10. Complications • retinopathy) microvascular Diabetic Diabetic nephropathy) macrovascular • 2. • Coronary vascular disease) • Cerebrovascular disease) • Peripheral vascular disease) , ,
  11. 11. Complications 3. • Diabetic neuropathy) Diabetic ulcer) • • Cataract) , ,
  12. 12. Epidemiology • Severe periodontitis : Diabetic > non-diabetics. study.Taylor et al, J Perio 96) (Pima • Destructive periodontitis occurred much earlier in life in the diabetics (27% of diabetics 15-19 years old). (Pima study.Taylor et al, J Perio 96) • Higher-aged diabetic had greater periodontal attachment and bone loss than younger. (R.G. Nelson, M. Shlossman, L.M. Budding et al.Periodontal disease and NIDDM in Pima Indians. Diabetes Care 1990) •Diabetic complications increased susceptibility to periodontal disease with increased attachment loss (B.L. Mealey. Diabetes and periodontal disease: two sides of a coin.Compend
  13. 13. Epidemiology •Uncontrolled Diabetes • • • acute fulminating periodontitis attachment loss bone loss acute abscess •Control of diabetes •
  14. 14. Oral manifestation in Diabetic Patient oXerostomia fibrosis fat infiltration : Burning sensation, Caries Incidence oCheilosis oMild gingivitis to severe periodontitis oMultiple periodontal abscesses
  15. 15. Oral manifestation in Diabetic Patient oCandidiasis Candida thrush salivary bacteria oGingival enlargement channel blocker oLichen planus calcium
  16. 16. Gingivitis in a 19-year-old women with uncontrolled diabetes mellitus Robert P. Langlais, Craig Miller.THE COLOUR ATLAS OF COMMON ORAL
  17. 17. Inflamed, papulonodular hyperplasia of the gingiva in a diabetic patient Robert P. Langlais, Craig Miller.THE COLOUR ATLAS OF COMMON ORAL
  18. 18. DIABETES MELLITUS PERIODONTAL ABSCESS Robert P. Langlais, Craig Miller.THE COLOUR ATLAS OF COMMON ORAL
  19. 19. Lichen planus Lynch DP. Oral examination. http://emedicine.medscape.com/article/1080850-
  20. 20. Pseudomembranous candidiasis (thrush) Impairment of the immune system, chemotherapy, Sjögren syndrome, and diabetes mellitus can also contribute to the proliferation of C albicans. Lynch DP. Oral examination. http://emedicine.medscape.com/article/1080850-
  21. 21. Relation TO PERIODONTAL DISEASE
  22. 22. Relation of diabetes and periodontal disease •Host resistance •Vascular changes  membrane • basement collagen metabolism ◦ collagenase activity ◦ microorganism diabetic gingival crevice ◦ ◦ endotoxin protease collagenase production gingiva
  23. 23. Relation of diabetes and periodontal disease Hyperglycemia (Ren, Fu, Deng, Qi, & Jin, 2009) • • (AGEs) • factor advanced glycation end products Periodontitis biologic mechanism diabetes gingivitisperiodontitis •
  24. 24. Relation of diabetes and periodontitis clinical patterns epidemiologic sulcular oxygen crevicular fluid selective effect periodontal pocket microflora o glucose hyperglycemia ketoacidosis uncontrolled diabetes activity subgingival gram negative anaerobes host defense o o tissue microorganism collagen metabolism periodontal
  25. 25. DM and Periodontitis - The 2 Way Relationship
  26. 26. DM and Periodontitis - The 2 Way Relationship
  27. 27. Modification OF THE HOST/BACTERIA IN DIABETES
  28. 28. Effect of DM on  Microorganism  Host response
  29. 29. Salivary flux reduction High glucose concentration in salivary and GCF Development of periodontogenic flora
  30. 30. Generally in periodontal patients is noticed the presence of ◦ Porphyromonas gingivalis ◦ Tannerella forsythia ◦ Actinobacillus actinomycetemcomitans Sometime, other bacteria, such as ◦ Treponema denticola ◦ Treponema socranskii L. MARIGO, R. CERRETO, M. GIULIANI, F. SOMMA, C. LAJOLO, M. CORDARO,
  31. 31. DM patients ◦ Candida albicans In type 1 DM patients ◦ Capnocytophaga spp :most frequent bacteria ◦ Porphyromonas gingivalis ◦ Prevotella intermedia L. MARIGO, R. CERRETO, M. GIULIANI, F. SOMMA, C. LAJOLO, M. CORDARO,
  32. 32. In type 2 DM patients ◦ Capnocytophaga spp. : most frequent bacteria ◦ Prevotella intermedia ◦ Campylobacter rectus ◦ Porphyromonas gingivalis ◦ Actinobacillus actinomycetemcomitans. L. MARIGO, R. CERRETO, M. GIULIANI, F. SOMMA, C. LAJOLO, M. CORDARO,
  33. 33. Effect of DM on  Microorganism  Host response
  34. 34. (Andersen et al. 2007).
  35. 35. neutrophil Hyperglycemia Macrophage/Monocyte Fibroblast (Andersen et al. 2007).
  36. 36. Cell Function ◦ Neutrophils : adherence chemotaxis : ◦ Monocyte and Macrophage : bacteria antigen proinflammatory cytonkine : GCF AGE-RAGE monocyte Proinflammatory American Academy of Periodontology,2006 : NF-kB
  37. 37. Cell Function Fibroblast ◦ Collagen ◦ Collagen GAGs Enzyme ◦ Collagenase American Academy of Periodontology,2006
  38. 38. Vascular alteration Hyperglycemia AGE Vascular alteration
  39. 39. Vascular alteration AGE-Collagen : enzyme degradation ◦ Thickening of blood vessel decreased Lumen ◦ Basement membrane Endothelium ◦ LDL ◦ VEGF atherosclerosis American Academy of Periodontology,2006
  40. 40. Vascular alteration AGE-RAGE Endothelium ◦ Permeability ◦ thrombosis American Academy of Periodontology,2006
  41. 41. Cytokines Hyperglycemia Cell AGE
  42. 42. Attachment and Bone Loss AGE-Bone : Bone metabolism Bone turnover : cellular , structural , functional characteristic American Academy of Periodontology,2006
  43. 43. Attachment and Bone Loss Attachment and Bone loss ◦ tissue metabolism ◦ Bone healing Bone Turnover rate ◦ proliferation of Osteoblast ◦ collagen ◦ apoptosis fibroblast Osteoblast attachment and bone loss American Academy of Periodontology,2006
  44. 44. Impaired Wound Healing Fibroblast Hyperglycemia Impaired Wound Healing Glucose in GCF
  45. 45. : www.docstoc.com
  46. 46. Impaired Wound Healing Plasma Glucose ◦ Glucose GCF Gingival sulcus Periodontal Pocket ◦ Pocket Bacteria wound healing ◦ Glucose Healing ◦ attachment fibroblast ◦ fibroblast American Academy of Periodontology,2006
  47. 47. Glycation Oxidative stress
  48. 48. Glycation Hyperglycemia Non-enzymatic glucose metabolism Advance glycation end products (AGEs) : http://en.wikipedia.org/wiki/Glycation
  49. 49. Glycation AGEs WBC RAGE Phagocyt e IL-6 , TNF alpha MMPs Osteocla st : http://www.dentalcouncil.or.th/content/prnews/detail.php?id=411&type=2
  50. 50. Oxidative stress DNA,Protein,Lipid,etc. Advance Lipoxition End Products RBC RBC disfunction : http://www.gpo.or.th/rdi/html/oxidative_stress.html http://www.rsu.ac.th/medtech/files/%E0%B9%80%E0%B8%AD%E0%B8%81%E
  51. 51. Treatment
  52. 52. Diabetes Mealitus 1. 2. Agents Enhancing the Effectiveness of Insulin • Metformin • Troglitazone Agents Augmentating the supply of Insulin • Sulfonylurea 3. Insulin : http://www.pharmacy.mahidol.ac.th/thai/knowledgeinfo.php?id=27
  53. 53. Insulin o o o o o o o o : http://www.siamhealth.net/public_html/Disease/endocrine/DM/insulin.htm#.URcVFKXG9
  54. 54. Periodontitis DM Non insulin dependent patient Insulincontrolled patient Uncontrolled : http://www.dentalcouncil.or.th/content/prnews/detail.php?id=411&type=2
  55. 55. Periodontitis (mechanical debridement)   Tetracycline Doxycycline ◦ Poorly uncontrolled : http://www.dentalcouncil.or.th/content/prnews/detail.php?id=411&type=2
  56. 56. Dental management
  57. 57. Uncontrolled patient and Poorly control patient Only emergency care antibiotic therapy oral infection Terry D. Rees. Periodontal management of the patient with diabetes mellitus.
  58. 58. Well-controlled patient complete periodontal therapy surgical procedures the presence of medical complications associated with diabetes mellitus should be carefully evaluated and considered in any periodontal therapeutic decision Terry D. Rees. Periodontal management of the patient with diabetes mellitus.
  59. 59. Periodontal therapy o o o o conscious sedation) atraumatic) o o epinephrine insulin epinephrine insulin preoperative : http://www.dentalcouncil.or.th/content/prnews/detail.php?id=411&type=2
  60. 60. Management of diabetic emergencies o Hyperglycemic o Hypoglycemic
  61. 61. Hyperglycemic •breathing may become rapid and deep (Kussmaul’s respiration) •hot and dry skin •‘‘acetone’’ breath may be evident. •Severe hypotension •coma may follow. Coma is usually associated with plasma glucose levels of between 300 and 600 mg/dl. Terry D. Rees. Periodontal management of the patient with diabetes mellitus.
  62. 62. conscious hyperglycemic hospital emergency room basic life support procedures unconscious open airway administration of 100% oxygen non-glucose-containing intravenous fluids should be administered to prevent vascular collapse. Terry D. Rees. Periodontal management of the patient with diabetes mellitus.
  63. 63. Hypoglycemic shock plasma glucose levels drop below 40 mg/dl. ◦ exercise ◦ diabetes mellitus drug overdose, ◦ stress or failure by the patient to properly control his or her dietary Intake. Terry D. Rees. Periodontal management of the patient with diabetes mellitus.
  64. 64. Hypoglycemic shock oTachycardia oHypotension oHypothermia oloss of consciousness oseizures and even death Terry D. Rees. Periodontal management of the patient with diabetes mellitus.
  65. 65. orange juice administration of oral carbohydrates candy Early treatment soft drinks Treatment patient remains unresponsive hospital emergency room Terry D. Rees. Periodontal management of the patient with diabetes mellitus.
  66. 66. 5410810004 5410810014 5410810024 5410810034 5410810044 5410810054

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