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Periodontal (or gum) disease is historically endemic in all indigenous communities in the South Pacific Region. While the disease becomes evident in mature adults the pathology becomes overt by adolescence or earlier. The initial gum inflammation progresses increasingly with age and may lead to pathological destruction of the tooth supporting tissues, tooth loosening and potential tooth loss. For most adults the disease presents as an adult-onset generalized chronic marginal-gingivitis-periodontitis-calculus complex. Microbiological components of dental plaque on tooth surfaces and dental calculus initiate the pathology. While the general clinical features are similar between adults and between communities, epidemiological studies have identified variations in disease progression. Also severity of the disease may be influenced by systemic health factors such as diabetes, known to be common in the Region. A common outcome, loss of teeth, usually becomes evident from the fourth decade onwards. Once established the plaque- gingivitis- calculus- periodontitis complex becomes increasingly difficult to reverse. Early adoption and maintenance of routine oral care actions through family, social, community and educational actions will improve long-term oral health, tooth loss, potentially adverse systemic health and in general better lifestyles.
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PMID:Periodontal health in South Pacific populations: a review. 1627 47

The periodontal diseases are highly prevalent and can affect up to 90% of the worldwide population. Gingivitis, the mildest form of periodontal disease, is caused by the bacterial biofilm (dental plaque) that accumulates on teeth adjacent to the gingiva (gums). However, gingivitis does not affect the underlying supporting structures of the teeth and is reversible. Periodontitis results in loss of connective tissue and bone support and is a major cause of tooth loss in adults. In addition to pathogenic microorganisms in the biofilm, genetic and environmental factors, especially tobacco use, contribute to the cause of these diseases. Genetic, dermatological, haematological, granulomatous, immunosuppressive, and neoplastic disorders can also have periodontal manifestations. Common forms of periodontal disease have been associated with adverse pregnancy outcomes, cardiovascular disease, stroke, pulmonary disease, and diabetes, but the causal relations have not been established. Prevention and treatment are aimed at controlling the bacterial biofilm and other risk factors, arresting progressive disease, and restoring lost tooth support.
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PMID:Periodontal diseases. 1629 20

The aim of our study was to analyze inflammatory pathology of periodontal tissues in patients with diabetes mellitus, and the relationship of this pathology with other complications caused by diabetes mellitus. In our study, we evaluated 126 people aged 16-53 years (42 males and 84 females) with diabetes mellitus admitted to the Clinic of Endocrinology of the Hospital of Kaunas University of Medicine (HKUM). The condition of periodontal tissues was evaluated according to the World Health organization (WHO) CPITN index. Oral hygiene was evaluated using a simplified oral hygiene index (OHI-S) according to Green-Vermillion. Out of 126 subjects with diabetes mellitus, periodontitis was detected in 96 patients (36 males and 60 females) (CPITN index 2-5). Gingivitis was found in 27 subjects (CPITN index 1). Only 2.4% of the studied patients had healthy periodontal tissues. The study analyzed complications of other organs (neuropathy, and nephropathy and retinopathy) caused by diabetes mellitus. The obtained findings showed that microvascular complications were diagnosed more frequently in the presence of more severe inflammatory pathology of periodontal tissues. Retinopathy was diagnosed in patients with CPITN index 2.8+/-0.1, while patients with CPITN index 1.8+/-0.3 had no retinopathy. Neuropathy was more common among patients whose CPITN index was 2.9+/-0.1, while the condition was absent in cases where the CPITN index was 1.8+/-0.2. Comparable results were yielded by the studies of nephropathies in relation with changes in periodontium. Nephropathy was diagnosed in patients whose CPITN index was 3.0+/-0.1, and was not found in patients with CPITN index 2.1+/-0.2. The generalization of the obtained study data allows for stating that a more detailed analysis of factors causing complications of diabetes mellitus will also allow for a more profound understanding of the etiopathogenetic mechanisms that cause inflammatory pathology of periodontal tissues.
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PMID:The influence of microvascular complications caused by diabetes mellitus on the inflammatory pathology of periodontal tissues. 1650 14

The problem of treatment of periodontitis remains one of the hot topics in practical stomatology. It has been established that modern adaptogenic infection is rather aggressive to whole organism of a human being. All these demands accurate approach while choosing of a conservative method of treatment for such forms as acute and chronic periodontitis. There were 27 children under observation with diabetes mellitus of type 1 (I group). Mean age was 10.5+/-0.75 years. 15 were girls and 13 boys. All patients from the I group were examined for the pathologies of oral cavity. In 100% dryness in a mouth and in 67% bleeding from the gum had been revealed. The mild form of chronic catarrhal gingivitis was revealed in 12 patients, moderate in 5, chronic hypertrophic gingivitis in 8 respectively. Studying of pH of saliva and lactate dehydrogenase (LDH) activity in children with periodontitis developed on the background of recently diagnosed type 1 diabetes mellitus has shown, that pH of saliva was equal to 5.3+/-0.18. In control group (healthy children) pH of saliva was 6.8+/-0.06. In the conclusion it should be emphasized, that we have tried to explain some aspects of multiple character of development of periodontitis at recently discovered insulin-depended diabetes mellitus. Character of changes of some properties of saliva pH and of enzyme activity of LDG promotes to carrying out medical and preventive actions, influencing the main blocks of pathogenesis of this pathological process. Besides, we consider possibility of inclusion the studied parameters of mixed saliva in the algorithm of investigation of periodontitis in children with recently diagnosed type 1 diabetes mellitus.
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PMID:[Diagnostic value of definition of lactate dehydrogenase in mixed saliva in children with periodontitis at diabetes mellitus, type I]. 1651 Sep 13

Increasing evidence points to smoking as a major risk factor for periodontitis, affecting the prevalence, extent and severity of disease. The aim of our study was to asses due to clinical and statistical methods the progress of periodontal disease according to general health status and smoking. 123 persons with periodontitis were divided into 4 groups: healthy, diabetes, heart and vessels diseases and osteopenia. Oral hygiene status was established acc. to O Larry Hygiene Index, Gingival status acc to SBI Index, the gingival pocket depth and attachment loss were measured in milimeters. The monitoring took place from 1996 to 2002. In statistical analysis the Friedman and Kruskal-Wallis test were used. The development of inflammation in response to plaque accumulation is reduced in smokers compared with nonsmokers. Smoking promotes chronic gingivitis and attachment loss.
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PMID:[Tobacco smoking and periodontitis]. 1652 38

The objective of this cross-sectional study was to evaluate whether gingivitis susceptibility is associated with periodontitis. We analyzed data of 462 men in the VA Dental Longitudinal Study aged 47 to 92 years who had never smoked or had quit smoking 5+ years previously. Multiple logistic regression models, with tooth-level bleeding on probing at sites with attachment loss<or=2 mm as the dependent variable, were derived with adjustment for plaque, calculus, crown coverage, age, income, education, marital status, body mass index, diabetes, and vitamin C intake, and stratification by age (<65, 65+ years). Periodontitis and mean attachment loss were positively associated with bleeding on probing, with stronger associations among men<65 years old (for periodontitis, OR 2.1; 95% CI 1.5, 3.1) than men 65+ years of age (OR 1.2; 95% CI 0.9, 1.6). Our results suggest that among never and former smokers, gingivitis susceptibility is higher among men with periodontitis compared with that in men without periodontitis.
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PMID:Gingivitis susceptibility and its relation to periodontitis in men. 1849 87

Management of oral biofilms allows dentists to help control the pathogens responsible for periodontal disease and decay. Increasing evidence indicates that the oral system is a portal for pathogenic microorganisms. This is a cumulative situation with systemic effects that can overcome an individual's resistance threshold, culminating in systemic sequela. New evidence indicates that controlling these oral pathogens has systemic benefits, as oral pathology is related to cardiovascular and respiratory disease, diabetes, and systemic inflammatory responses, as well as low birth weight and pre-term deliveries. Some insurance companies now cover periodontal scaling for gingivitis and periodontal disease for pregnant women and patients at risk for pregnancy.
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PMID:Oral periopathogens and systemic effects. 1751 62

Oral conditions such as gingivitis and chronic periodontitis are found worldwide and are among the most prevalent microbial diseases of mankind. The cause of these common inflammatory conditions is the complex microbiota found as dental plaque, a complex microbial biofilm. Despite 3000 years of history demonstrating the influence of oral status on general health, it is only in recent decades that the association between periodontal diseases and systemic conditions such as coronary heart disease and stroke, and a higher risk of preterm low birth-weight babies, has been realised. Similarly, recognition of the threats posed by periodontal diseases to individuals with chronic diseases such as diabetes, respiratory diseases and osteoporosis is relatively recent. Despite these epidemiological associations, the mechanisms for the various relationships remain unknown. Nevertheless, a number of hypotheses have been postulated, including common susceptibility, systemic inflammation with increased circulating cytokines and mediators, direct infection and cross-reactivity or molecular mimicry between bacterial antigens and self-antigens. With respect to the latter, cross-reactive antibodies and T-cells between self heat-shock proteins (HSPs) and Porphyromonas gingivalis GroEL have been demonstrated in the peripheral blood of patients with atherosclerosis as well as in the atherosclerotic plaques themselves. In addition, P. gingivalis infection has been shown to enhance the development and progression of atherosclerosis in apoE-deficient mice. From these data, it is clear that oral infection may represent a significant risk-factor for systemic diseases, and hence the control of oral disease is essential in the prevention and management of these systemic conditions.
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PMID:Relationship between periodontal infections and systemic disease. 1771 90

The interrelation between diabetes mellitus and inflammatory periodontal disease has been intensively studied for more than 50 years, a real bidirectional influence existing between patient's glycemic level disorder and periodontal territories alteration. Several studies developed in this direction emerged to the evidences that reveal a general increase of prevalence, extent and severity of gingivitis and periodontitis. Inflammation plays an important role in this interrelation, orchestrating both the periodontal disease and diabetes mellitus pathogeny and complications. Conversely, periodontal disease--infectious disease characterized by a significant inflammatory component--can seriously impair metabolic control of some diabetic patient. Moreover, treatment of periodontal disease and reduction of oral signs of inflammation may have a beneficial result on the diabetic condition (1). Less clear are the mechanisms governing this interrelation (even the literature is abundant in this direction), and, very probably, periodontal diseases serve as initiators of insulin resistance (in a way similar to obesity), thereby aggravating glycemic control. Further research is so imposed in order to clarify this aspect of the relationship between diabetes and periodontal disease.
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PMID:[Relationship diabetes mellitus-periodontal disease: etiology and risk factors]. 1829 11

The aim of the present study was to evaluate the association between type I diabetes mellitus (DM) and periodontal disease in pregnant women. Fifty-two pregnant women aged 27.9 +/- 6.9 years with type I DM participated in the present study. Forty-two non-pregnant type I female diabetics (mean age: 27.9 +/- 6.1 years) and 121 healthy non-pregnant women (mean age: 29.1 +/- 5.7 years) without diabetes formed the control group. All subjects were given a clinical periodontal examination including probing pocket depth (PPD), probing attachment level (PAL), assessment of plaque and gingivitis scores (SBI). Blood parameters included levels of hemoglobin, glycosylated hemoglobin, total cholesterol, triglyceride and leukocytes. The pregnant diabetic subjects showed despite a good metabolic control significantly higher values for the SBI compared to the controls. Pregnant diabetic subjects displayed a significant correlation between the dose of insulin per day and PPD (p < or = 0.05) as well as the PAL (p < or = 0.05). In conclusion, the results of the study indicate that pregnant diabetics demonstrate a higher degree of periodontal inflammation and destruction compared to non-pregnant diabetics and healthy non-pregnant patients.
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PMID:Periodontal disease status of pregnant women with diabetes mellitus. 1849 96


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