IMPACT OF PERIODONTAL INFECTION ON SYSTEMIC HEALTH PERIODONTAL DISEASE AND DIABETES DEPARTMENT OF PERIODONTICS

By Dr Sachin Rathod Email:- drsachin.rathod@yahoo.com

CONTENT:

Pathobiology of periodontitis Focal infection theory revisited Periodontal disease & diabetes mellitus

•Periodontal disease is an infectious disease but environmental ,physical, social & host stresses may affect & modify disease expression

•Evidences has also shed light on converse sides of relationship between systemic health & oral health that is ,the potential effect of periodontal disease on a wide range of organ system

• Periodontitis is associated with small number of predominantly gram negative micro organism existing in subgingival biofilm

• Pathogenic bacteria are necessary to cause disease but they are not susceptible alone, a susceptible host is also imperative

• Difference in host susceptibility makes not all individual equally vulnerable to destructive effects of periodontal pathogens so response to treatment may vary

• Periodontal infection may enhance the risk for certain diseases

PATHOBIOLOGY OF PERIODONTITIS

•WILLIAM HUNTER , a british physician developed idea of oral micro organism being responsible for wide range of systemic conditions.

•He claimed the restorations of carious teeth instead of extraction resulted in trapping of infectious agents under restorations.

•He believed teeth are liable to infection primarily because of their relationship to alveolar bone & structuresTherefore he advocated extraction of teeth to eliminate source of sepsis.

•In 1940s & 1950s hunter and other advocates fell into disrepute when widespread extraction failed to reduce or eliminate systemic conditions

F O C A L I N F E C T I O N T H E O R Y R E V I S I T E D

PERIODONTAL DISEASE AND DIABETES MELLITUS

“ Diabetes mellitus is a complex metabolic disorder characterized by chronic hyperglycemia.”

Diminished insulin production Impaired insulin action Or a combination of both

Results in the inability of glucose to be transported from the bloodstream into the tissues, which results in high blood glucose level and excretion of sugar in the urine. Lipid and protein metabolism is altered in diabetes as well.

ORAL MANIFESTATION:-

Cheilosis Mucosal drying and cracking Burning mouth and tongue Diminished salivary flow Enlarged gingiva Sessile or pedunculated gingival polyps Polypoid gingival proliferation Abscess formation

CHEILOSIS

ENLARGED GINGIVA

periodontitis Loosened teeth Greater loss of attachment Increased bleeding on probing Reduction in defense mechanisms Increased susceptibility to infections which leads

to destructive periodontal disease

PERIODONTITIS

GINGIVAL POLYPS

BACTERIAL PATHOGENS:- The glucose content of gingival fluid and blood is higher. This leads to change in environment of microflora. This induces qualitative changes in bacteria. The sub gingival flora is composed mainly of –

Capnocytophaga Porphyromonas gingivalis Prevotella intermedia Actinobacillus actinomycetemcomitans

POLYMORPHONUCLEAR LEUKOCYTE FUNCTION

The increased susceptibility of diabetic patients to infection is due to polymorphonuclear leukocyte deficiencies resulting in

Impaired chemotaxis Defective phagocytosis Impaired adherence

This results in diminished primary defense against periodontal pathogens and bacterial proliferation is unchecked.

ALTERED COLLAGEN METABOLISM Increased collagenase activity and decreased collagen

synthesis is found in individuals with poorly controlled diabetes.

Decreased collagen synthesis, osteoporosis and reduction in height of alveolar bone occurs in diabetes.

Inhyperglycemic state, numerous proteins and matrix molecules undergo a nonenzymatic glycosylation resulting in accumulated glycation end products(AGE’s).

AGE’s play a significant role in the progression of priodontal disease. It renders the periodontal tissues more susceptible to destruction.

Collagen in tissues of diabetic patients is aged and more susceptible to breakdown.

The cumulative effects of altered cellular response to local factors, impaired tissue integrity and altered collagen metabolism patients to infection and destructive periodontal disease.

PERIODONTAL INFECTION ASSOCIATED WITH GLYCEMIC CONTROL IN DIABETES Acute bacterial and viral infections have shown to

increase insulin and aggravate glycemic control. Systemic infection increases tissue resistance to

insulin, preventing glucose level and requiring increased pancreatic insulin production to maintain normoglycemia.

In patient with periodontitis, persistent systemic challenge with periodontopathic bacteria and their products may act in a way similar to well recognized systemic infection.

COMPLICATIONS OF DIABETES MELLITUS

Retinopathy Nephropathy Neuropathy Macrovascular disease Altered wound healing Periodontal disease

RETINOPATHY

TREATMENT OF PERIODONTITIS IN DIABETICS

Type-I:- Scaling and root planing, surgery, selected tooth extraction and systemic antibiotics resulted in decreased insulin demand.

Also scaling and root planing combined with systemic doxycycline therapy for 2 weeks had shown significant improvement.

Type-II:- Scaling and root planing combined with systemic doxycycline therapy for 2 weeks had shown reduced probing depth and bleeding on probing.

a)Periodontal treatment in patient with uncontrolled diabetes is contraindicated.

b)If suspected to be a diabetic following procedure should be performed :

1)Consult the patient ‘s physician.

2)Analyze laboratory test , glucose tolerance test ,post prandial blood glucose . Glycated hemoglobin ,glucose tolerance test ,urinary glucose.

3)If there is a periodontal condition that requires immediate care prophylactic antibiotics should be given.

4)If patient is brittle diabetic optimal periodontal health is necessity. Glucose level should be continuosly monitored and periodontal treatment should be performed when a disease is in a well controlled state. Prophylactic antibiotics should be started two days preoperatively, penicillin is a drug of first choice.

GUIDELINES

• 1.Clinician should make certain that the prescribed insulin has been taken , followed by a meal. Morning appointments are ideal , after breakfast because of optimal insulin levels.

• 2.After any surgical procedures, post operative insulin dose should be altered.

• 3.Tissues should be handled as atraumatically and as minimally as possible for anxious patients ,if pre-operative sedation is required , epinephrine concentration should not be greater than 1:1,00,000

• 4.Diet recommendation should be made.

• 5.Antibiotic prophylaxis is recommended for extensive therapy.

• 6.Recall appointments and fastidious home oral care should be stressed.

SUMMARY AND CONCLUSION

• 1. Periodontal infections is one of many potential risk factors for the number of systemic conditions.

• 2. The emerging field of periodontal medicine offers new insights into the concept of oral cavity as one system interconnected with the whole human body.

• 3. For many years dental profession as recognized the effect of systemic condition.

REFERENCE

• Carranza’s 10th Edition

THANK YOUBy Dr Sachin Rathod Email:- drsachin.rathod@yahoo.com