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It has been suggested diabetes plays an important role in tooth loss. Studies examining the periodontal structures and the alveolar bone architecture in diabetics have revealed some alterations. However, mechanisms responsible for these alterations have not been elucidated completely. Established relationships between the cementum layer, which is resistant to resorption, and diabetes are few in number. The aim of this study was to compare the thickness of the cementum layer in Type 2 diabetic and non-diabetic subjects in order to improve the understanding of dental mobility in Type 2 diabetes and its effect on tooth loss. A total of 46 male patients with a mean age of 61.72 +/- 5.45 yr. were included in this study (Type 2 diabetics, n=23; non-diabetics, n=23); undecayed. Single rooted premolar teeth extracted from 46 male patients were used to assess the alterations in the cementum layer in Type 2 diabetics. Histological preparations from extracted teeth were examined under light microscopy. In each tooth, the thickness of the cementum layer was measured by an oculometer in 4 different sites on the specimen with the largest pulp space including the pulp chamber and root canals. Statistical analyses were performed with student's t test. The average thickness of the cementum layer in the decalcified teeth extracted from non-diabetic patients was compared to the average thickness of the cementum layer in Type 2 diabetic patients. A significant difference was observed in every site of measurement between Type 2 diabetic and non-diabetic patients with regard to the thickness of the cementum layer (p < 0.05). The cementum layer was thicker at the apical part of the root and at the midpoint of the apical half, and thinner at the central part of the root and at the midpoint of the coronal half in Type 2 diabetic patients.
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PMID:The comparison of the thickness of the cementum layer in Type 2 diabetic and non-diabetic patients. 1515 Jun 40

Diabetes mellitus, is a common chronic disease, and its prevalence in the United States, particularly type 2 diabetes, is increasing. Complications associated with diabetes impose a heavy burden on many people, especially among certain minority populations. Periodontal diseases, dental caries, and tooth loss also are common conditions in the United States, but their prevalence is generally decreasing. Nevertheless, among important subgroups of the population, particularly certain minority and economically disadvantaged groups, there is a disproportionately higher burden of periodontal diseases, dental caries, and tooth loss. This article reviews the post-1960 English-language literature on the relationship between diabetes and oral health, specifically focusing on periodontal disease, dental caries, and tooth loss. Substantial evidence exists to support the role of diabetes and poorer glycemic control as important risk factors for periodontal disease. Additionally, the evidence provides support for viewing the relationship between diabetes and periodontal diseases as bidirectional. However, additional research is necessary to firmly establish that treating periodontal infections can contribute to glycemic control management and possibly to the reduction of type 2 diabetes complications. The literature does not describe a consistent relationship between type 2 diabetes and dental caries. It reports increased, decreased, and similar caries experiences between those with and without diabetes. This review suggests that currently there is insufficient evidence to determine whether a relationship between diabetes and risk for coronal or root caries exists. Most of the reviewed studies reported greater tooth loss in people with diabetes. However, the differences were slight and not significant in several of the reports. Furthermore, this review of the association between diabetes and tooth loss reveals that valid population-based evidence generalizable to the US population is sparse. Further investigations of the association of diabetes with dental caries and tooth loss are warranted. If adverse effects of diabetes on dental caries and/or tooth loss are substantiated, the results of such studies would help design intervention studies to prevent or reduce the occurrence of dental caries and tooth loss in people with diabetes. These results also may affect existing clinical practice protocols and promote new public policy related to diabetes.
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PMID:Diabetes, periodontal diseases, dental caries, and tooth loss: a review of the literature. 1564 24

This paper outlines the burden of oral diseases worldwide and describes the influence of major sociobehavioural risk factors in oral health. Despite great improvements in the oral health of populations in several countries, global problems still persist. The burden of oral disease is particularly high for the disadvantaged and poor population groups in both developing and developed countries. Oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related oral disease and orodental trauma are major public health problems worldwide and poor oral health has a profound effect on general health and quality of life. The diversity in oral disease patterns and development trends across countries and regions reflects distinct risk profiles and the establishment of preventive oral health care programmes. The important role of sociobehavioural and environmental factors in oral health and disease has been shown in a large number of socioepidemiological surveys. In addition to poor living conditions, the major risk factors relate to unhealthy lifestyles (i.e. poor diet, nutrition and oral hygiene and use of tobacco and alcohol), and limited availability and accessibility of oral health services. Several oral diseases are linked to noncommunicable chronic diseases primarily because of common risk factors. Moreover, general diseases often have oral manifestations (e.g. diabetes or HIV/AIDS). Worldwide strengthening of public health programmes through the implementation of effective measures for the prevention of oral disease and promotion of oral health is urgently needed. The challenges of improving oral health are particularly great in developing countries.
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PMID:The global burden of oral diseases and risks to oral health. 1621 Nov 57

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

One of the major complications of diabetes is periodontal disease, a chronic infection of tissues supporting the teeth and a major cause of tooth loss. Adults with diabetes have both a higher prevalence of periodontal disease and more severe forms of the disease, contributing to impaired quality of life and substantial oral functional disability. In addition, periodontal disease has been associated with development of glucose intolerance and poor glycemic control among adults with diabetes. Regular dental visits provide opportunities for prevention, early detection, and treatment of periodontal disease among dentate adults (i.e., those having one or more teeth); moreover, regular dental cleaning improves glycemic control in patients with poorly controlled diabetic conditions. One of the national health objectives for 2010 is to increase the proportion of persons with diabetes who have an annual dental examination to 71% (revised objective 5-15). To estimate the percentage of dentate U.S. adults aged > or =18 years with diabetes who visited a dentist within the preceding 12 months, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys for 1999 and 2004. This report describes the results of that analysis, which indicated that, in 2004, age-adjusted estimates in only seven states exceeded 71% and estimated percentages for four states and District of Columbia (DC) increased significantly from their levels in 1999. The findings underscore the need to increase awareness and support for oral health care among adults with diabetes, including support for national and state diabetes care management programs.
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PMID:Dental visits among dentate adults with diabetes--United States, 1999 and 2004. 1630 54

This paper focused on the relationship between periodontitis and Type 2 diabetes mellitus (T2DM). There is an abundance of evidence that diabetes mellitus play important etiological roles in periodontal diseases. In addition, periodontal diseases have powerful and multiple influences on the occurrence and severity of systemic conditions and diseases, such as diabetes mellitus, cardiovascular disease, respiratory disease and pregnancy complications. The relationship of periodontitis and diabetes has been supported by sufficient evidences in the past twenty years: (1) diabetes is an independent risk factor of chronic periodontitis; (2) metabolic control will improve the prognosis of chronic periodontitis; (3) the treatment of chronic periodontitis will improve the metabolic level. Our recent investigation on periodontal status in the families of type 2 diabetes mellitus further confirmed the relationship. It was showed that the periodontal index such as probing depth (PD), attachment loss (AL) and numbers of tooth loss in diabetes family members were significantly higher than non-diabetes family members, while no difference of periodontal parameters was found between well control family members and non diabetes family members. In the development of type 2 diabetes (T2DM) and its complications, the advanced glycation end products (AGEs) and its receptors were to be recognized as important factors. The distributions of AGEs and the receptor for AGEs (RAGE) are highly consistent in various tissues. One study in our laboratory demonstrated that RAGE was strongly expressed in gingival tissues gathered from T2DM patients with periodontitis compared with systemically healthy chronic periodontitis patients, the expression of RAGE was positively correlated with the expression of TNF-alpha, indicating that AGE-RAGE pathway was involved in the development of periodontitis in T2DM patients. It is known that inflammation could induce the prediabetic status characterized by insulin resistance and dyslipidemia. However, it is still unclear whether periodontitis is a risk factor of type 2 diabetes mellitus or not. In a current study, the effect of periodontitis on serum levels of lipid and glucose of aggressive periodontitis (AgP) patients was implied, as the average serum levels of triglycerides and glucose of a large number of AgP patients were both significantly higher than healthy control group, and serum level of total cholesterol in AgP group was positively associated with the percentage of severe attachment loss sites. It seems that periodontitis may alter serum lipid and glucose levels. Furthermore, the effect of periodontitis on diabetes in an animal study has also demonstrated that experimental moderate periodontitis as well as castration could induce insulin resistance and beta cell impairment in rats, and that combination of the two factors would aggravate the degree of insulin resistance (IR). In conclusion, interrelationship between periodontitis and diabetes has been further approved recently.
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PMID:[Association between periodontitis and diabetes mellitus]. 1730 19

Chronic periodontitis is an inflammatory disease that affects the supporting tissues of the teeth. It is initiated by specific bacteria within the plaque biofilm and progresses due to an abnormal inflammatory-immune response to those bacteria. Periodontitis is the major cause of tooth loss and is also significantly associated with an increased risk of stroke, type-2 diabetes and atheromatous heart disease. Oxidative stress is reported in periodontitis both locally and peripherally (serum), providing potential mechanistic links between periodontitis and systemic inflammatory diseases. It is therefore important to examine serum antioxidant concentrations in periodontal health/disease, both at an individual species and total antioxidant (TAOC) level. To determine whether serum antioxidant concentrations were associated with altered relative risk for periodontitis, we used multiple logistic regression for dual case definitions (both mild and severe disease) of periodontitis in an analysis of 11,480 NHANES III adult participants (>20 y of age). Serum concentrations of vitamin C, bilirubin, and TAOC were inversely associated with periodontitis, the association being stronger in severe disease. Vitamin C and TAOC remained protective in never-smokers. Higher serum antioxidant concentrations were associated with lower odds ratios for severe periodontitis of 0.53 (CI, 0.42,0.68) for vitamin C, 0.65 (0.49,0.93) for bilirubin, and 0.63 (0.47,0.85) for TAOC. In the subpopulation of never-smokers, the protective effect was more pronounced: 0.38 (0.26,0.63, vitamin C) and 0.55 (0.33,0.93, TAOC). Increased serum antioxidant concentrations are associated with a reduced relative risk of periodontitis even in never-smokers.
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PMID:The prevalence of inflammatory periodontitis is negatively associated with serum antioxidant concentrations. 1731 56

During the last decades, many published studies have focused on the associations between periodontal disease and different systemic disorders. The purpose of the present investigation was to study the relationship between occurrence of systemic disorders and the two variables mean number of teeth and periodontal probing pocket depth after stratification according to smoking habits. The study was conducted as a retrospective study based on consecutive selection of patients at a specialist clinic of Periodontology. The study population consisted of 1854 individuals. Of these, 797 were males, and 1057 were females. Multiple regression analyses were adopted in order to calculate the partial correlations between the number of remaining teeth/the relative frequency of periodontal probing depths > or = 5 mm and presence of systemic disease for different strata according to sex and smoking habits with age included as an independent variable. Non-smoking men with cardiovascular disease, diabetes and rheumatoid disease had significantly fewer teeth compared to non-smoking men without systemic disorder. In conclusion, cardio-vascular disease, diabetes and rheumatoid disease may be regarded as risk indicators of tooth loss in men. However, in order to investigate hypotheses concerning potential risk factors, emerging from cross-sectional studies, being true risk factors of tooth loss, longitudinal prospective studies including established risk factors along with new exposures of interest as covariates are required.
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PMID:Relationship between tooth loss/probing depth and systemic disorders in periodontal patients. 1750 5

Aging per se has a small effect on oral tissues and functions, and most changes are secondary to extrinsic factors. The most common oral diseases in the elderly are increased tooth loss due to periodontal disease and dental caries, and oral precancer/cancer. There are many general, medical and socioeconomic factors related to dental disease (ie, disease, medications, cost, educational background, social class). Retaining less than 20 teeth is related to chewing difficulties. Tooth loss and the associated reduced masticatory performance lead to a diet poor in fibers, rich in saturated fat and cholesterols, related to cardiovascular disease, stroke, and gastrointestinal cancer. The presence of occlusal tooth contacts is also important for swallowing. Xerostomia is common in the elderly, causing pain and discomfort, and is usually related to disease and medication. Oral health parameters (ie, periodontal disease, tooth loss, poor oral hygiene) have also been related to cardiovascular disease, diabetes, bacterial pneumonia, and increased mortality, but the results are not yet conclusive, because of the many confounding factors. Oral health affects quality of life of the elderly, because of its impact on eating, comfort, appearance and socializing. On the other hand, impaired general condition deteriorates oral condition. It is therefore important for the medical practitioner to exchange information and cooperate with a dentist in order to improve patient care.
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PMID:The stomatognathic system in the elderly. Useful information for the medical practitioner. 1822 59


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