PERIO-DIABETES RELATIONSHIP

Question 1

1. DM how it affects periodontal health (Formative, 2005)

Answer 1

 Basement membrane thickening → microvascular and C.T. alternation

 Collagen metabolism → increase collagenase to increase break down of C.T.

 Impairment of PMN leukocytes (phagocytosis, chemotaxis)

 Delay healing → increase MMP production

 Advanced glycated end products (AGEs) → expression of endothelial vascular adhesion molecule-1, causing alteration in basement membrane → upregulation of pro-inflammatory cytokines IL-1B, TNF-a, IL-6  Bidirectional → cytokines contribute to insulin resistance

Question 2

MH: DM Type 2;
I/O Mobile 14 on chewing, generalized bleeding and swollen gums, 37 pain, bleeding on brushing; multiple bridges and missing teeth, bridge on 35 37

a. What are the mechanisms of DM to the periodontal condition? (5)

Answer 2

• Polyol pathway: fructose-6-phosphate converts to sorbital , decreases NADPH in blood, cant fight against ROS, retardation of immune system, destruction to connective tissue, neuropathy due to altered osmolarity of cell membrane, swell
• Protein kinase C pathway: alter metabolism, increase proinflammatory products, endothelial growth factor –> atheroschlerosis and thickening of basement membrane
• AGE = increased concentration of advanced glycation products in the blood due to persistant hyperglycemic condition results in an elevated immune response due to bacteria in the oral cavity, more rapid breakdown of periodontium, altered enzyme function
• Changes in components in GCF, GCF is an exudate of blood which is hyperglycemic, provide nutrients for bacterial in sulcus
• Prone to have high level of LDL! hyperlipidemia due to high level of fatty acids in bloodaltered immune response
• PMN dysfunction
• Upregulation of proinflammatory products in blood from PMN, monocytes, TNF, IL-1, IL-6
• Activates B, T lymphocytes
• Altered fibroblast: inhibit collagen synthesis
• An infection-mediated upregulation cycle of cytokine synthesis and secretion by chronic stimulus from
• lipopolysaccharide (LPS) and products of periodontopathic organisms may amplify the magnitude of the advanced glycation end product (AGE)-mediated cytokine response operative in diabetes mellitus.

Px with periodontitis are prone to have DM:

• Chronic Gram-negative infection of periodontal origin may induce insulin resistance, hence contributing to hyperglycemia and complicating the metabolic control of diabetes.