Periodontitis as a risk factor for Diabetes mellitus and Pre-term low birth weight risk factor diabetes pre-term low birth weight AGE

1. Periodontitis as a risk factor for Diabetes
mellitus and Pre-term low birth weight
Department of Periodontology and Oral implantology
Presented by :
Sushant Pandey
653
Resource faculties :
Dr. Shivalal Sharma
Dr. Khushboo Goel
Dr. Sajeev Shrestha
Dr. Pujan Acharya

2. Objectives :
1. Bi-directional relationship between periodontitis
and diabetes
2. Relationship between periodontitis and pre-term
low birth weight

3. Introduction :
Risk factors : They are environmental, behavioral, or biologic
factors that, when present, increase the likelihood that an
individual will develop the disease.
Risk factors for periodontal disease are
• Tobacco smoking
• Diabetes
• Pathogenic bacteria
• Microbial tooth deposits

4. International Diabetes Federation (IDF) describes diabetes
as a chronic disease that arises when the pancreas does not
produce enough insulin, or when the body cannot effectively
use the insulin it produces.
Types :
1. Type I diabetes (due to autoimmune β-cell destruction,
usually leading to absolute insulin deficiency)
2. Type 2 diabetes (due to a progressive loss of β-cell insulin
secretion frequently on the background of insulin
resistance)
3. Gestational diabetes mellitus
4. Diabetes due to other causes

5. In 2017,
• Approximately 425 million adults (20-79 years) were living with
diabetes
• The proportion of people with type 2 diabetes is increasing in most
countries
• 79% of adults with diabetes were living in low- and middle-income
countries
• 1 in 2 (212 million) people with diabetes were undiagnosed
• Diabetes caused 4 million deaths
• More than 1,106,500 children were living with type 1 diabetes
Source : International Diabetes Federation (IDF)
Facts and Figures

6. Diabetes mellitus :

7. 1. Retinopathy
2. Neuropathy
3. Nephropathy
4. Cardiovascular diseases
5. Impaired wound healing
6. Periodontal disease
Complications of Diabetes :
Susceptibility to periodontitis is increased by approximately
three folds in people with diabetes.

8. Effects of diabetes on periodontium :
• Enlarged gingiva
• Sessile or pedunculated gingival polyps
• Polypoid gingival proliferations
• Abscess formation
• Periodontitis
• Loosened teeth

11. Mechanisms by which diabetes
influence the periodontium

12. Bacterial pathogens
• Increased glucose in gingival fluid changes the
microflora.
• Patients with diabetes have a subgingival flora of
Capnocytophaga, anaerobic vibrios,
Actinomyces species, P.gingivalis
Interaction of any of these bacterial products with phagocytic
cells results in activation of a catabolic inflammatory cascade,
with synthesis and secretion of mediators including primarily
IL-lß, PGE2, TNF-α, and IL-6.

13. Polymorphonuclear leukocyte function
• Impaired chemotaxis & adherence
• Defective Phagocytosis
Diminished primary defense against periodontal
pathogens.

14. Altered Collagen Metabolism
Increased collagenase activity and decreased
collagen synthesis is seen in individuals with poorly
controlled diabetes.
Production of advanced glycation end products
(AGEs).

15. ADVANCED GLYCATION END PRODUCTS (AGEs)
AGEs are formed by the
non-enzymatic glycation
(addition of hexoses) to
proteins or lipids under
hyperglycaemic conditions.

16. AGEs
Plays central role in diabetic complications
Collagen is crosslinked by AGE, making it less soluble and
less likely to be replaced or repaired.
Cellular migration through crosslinked is impeded.
Binding of the AGE to macrophage receptor
(RAGE) initiates a cycle of cytokine upregulation,
with synthesis mostly of IL-1 and TNFα.

18. Effects of periodontal diseases on the
diabetic state
The presence of periodontitis increases the risk of worsening
of glycemic control over time.
Incidences of macroalbuminuria and end-stage renal disease are
increased twofold and threefold, respectively, in diabetic individuals who
also have severe periodontitis compared to diabetic individuals without
severe periodontitis. Furthermore, the risk of cardiorenal mortality
(ischaemic heart disease and diabetic nephropathy combined) is three
times higher in diabetic people with severe periodontitis than in diabetic
people without severe periodontitis.

19. Bacterial infection causes increased secretion of
TNF-α and IL-lβ which in turn induce insulin
resistance and decrease insulin action.

20. Mechanisms by which periodontal diseases
may influence diabetes

21. Two way relationship

22. Effect of periodontal treatment on diabetes
Limited evidence.
Meta-analyses indicate that HbA1c reductions of around
0.4% can be anticipated following effective periodontal
therapy.

23. Periodontitis as a Risk Factor for
Preterm Low Birth Weight(LBW)

24. • Preterm birth is the birth of a baby of less than 37
weeks gestational age.
• Low birth weight refers to infants who weigh less
than 2500 gm at birth.
• Low birth babies are 40 times more likely to die
in neonatal period than normal-birth weight
babies

25. The primary cause of LBW is preterm labor.
Women with preterm labor have culture-positive
amniotic fluid and bacteria most often isolated are
Fusobacterium nucleatum and Capnocytophaga.
These species are rarely found in female
reproductive tract but are common in oral cavity.
Spread of Infection is via hematogenous route

26. These bacteria stimulate cytokine production like IL-1
and TNFα and increase prostaglandin production in
amnion which leads to preterm delivery.

29. Summary
People with poorly controlled diabetes (both type 1 and type 2 diabetes
mellitus, both adults and children) must be considered at risk for
periodontitis, and people with diabetes should be informed of this risk.
Early diagnosis and prevention are of fundamental importance to avoid the
largely irreversible tissue loss that occurs in periodontitis.
Healthy periodontium is a must during pregnancy.

30. References :
1. Caranza’s clinical periodontology 12th edition
2. Periodontal Disease and Diabetes Mellitus: A Two-Way Relationship,
Sara G. Grossi and Robert J. Genco
3. Periodontitis and diabetes: a two-way relationship : P. M. Preshaw &
A. L. Alba & D. Herrera & S. Jepsen & A. Konstantinidis & K.
Makrilakis & R. Taylor
4. Associations between periodontal diseases and systemic diseases: A
review of the inter-relationships and interactions with diabetes,
respiratory diseases, cardiovascular diseases and osteoporosis : Lan-
Chen Kuo, Alan M. Polson, Taeheon Kang

31. Questions ?