Influence of Diabetes Mellitus on Periodontium.pptx

Influence of Diabetes on periodontium

1. Influence of Diabetes Mellitus on Periodontium Presented by- Dr.Hasibul Hasan Hasib Dr.Fauzia Nusrat Shahee Dr.Rima Akter Dr.Rajia Sultana

2. Diabetes Mellitus Diabetes mellitus is a systemic endocrine disorder driven primarily by a dysregulation of carbohydrate metabolism. The hallmark of this chronic disease is elevated blood glucose levels, which must be monitored regularly by the patient and practitioner.

3. Diabetes mellitus classification Type 1 diabetes Insulin-dependent diabetes Type 2 diabetes Non-insulin-dependent diabetes Gestational diabetes

4. Other types of diabetes Genetic defects in B-cell function or in insulin action Pancreatic diseases or injuries Infections Drug-induced or chemical- induced diabetes Endocrinopathies Other genetic syndromes associated with diabetes

5. Classic signs and symptoms Polydipsia , polyuria , nocturia , polyphagia Unexplained weight loss General fatigue Increased infections Leg cramps Numbness in the extremities Impotence Blurred vision Cuts/bruises that are slow to heal

6. Systemic effects of Diabetes Mellitus

7. Criteria for the diagnosis of diabetes HbA1C ≥6.5 %. OR FPG ≥126 mg/ dL (7.0 mmol /L). OR Two-hour PG ≥200 mg/ dL (11.1 mmol /L) during an OGTT . OR R andom plasma glucose ≥200 mg/ dL (11.1 mmol /L)

8. Classic complications of diabetes mellitus Macrovascular disease A ccelerated atherosclerosis Peripheral Cardiovascular (coronary artery disease) Cerebrovascular (stroke ) Nephropathy Renal failure

9. Classic complications of diabetes mellitus Neuropathy Sensory (peripheral) Autonomic ( dysrhythmias , alterations in BP, genitourinary, gastroparesis ) Retinopathy Blindness, blurred vision Altered wound healing Periodontitis

10. Factors affecting periodontal disease in patients with diabetes Duration of diabetes Degree of metabolic control Co-occurrences of complications Angiopathy (heart disease and stroke) Delayed wound healing Nephropathy (kidney disease) Neuropathy

11. Factors affecting periodontal disease in patients with diabetes Retinopathy (eye disease) Concurrent risk factors Hormonal variations (e.g., adolescence, pregnancy, menopause ) Medications Plaque Smoking Stress

12. The Impact of Diabetes on Periodontal Tissues

13. Factors Potentially Contributing to Development of Periodontal Disease Polymorphonuclear leukocyte function demenished . Bacterial infections and oral inflammation Advanced glycation end products Collagen Metabolism Altered Macrophage function and Wound healing Clinical Attachment loss and Bone resorption

14. Polymorphonuclear leukocyte function P olymorphonuclear leukocyte deficiencies resulting in impaired chemotaxis , defective phagocytosis , or impaired adherence resulting diminished primary defense against periodontal pathogens. increase collagenasae activity, decreased collagen synthesis, maturation, and maintenance of collagen and collagen is cross-linked by AGE formation, making it less soluble and less likely to be normally repaired or replaced

15. Bacterial Infection and Inflammation Glucose content of GCF & blood is higher in diabetics Resulting changed environment for the microflora . Presence of higher levels of specific microorganisms such as Capnocytophaga species , A . actinomycetumcomitans , E . corrodens , F . nucleatum , P . gingivalis , and P . intermedia . Resulting increased rate of infection and oral inflammation.

16. Advanced Glycation End products (AGEs) Advanced glycation end products (AGEs) are a family of compounds that are the products of nonenzymatic reactions between reducing sugars and proteins, lipids, or nucleic acids.

17. Role of AGEs in diabetic complications   Alter functions of extracelluar matrix Affects collagen stability and vascular integrity . Increased crosslinking between collagen molecules Reduced solubility Decreased turn over rate

18. Altered Macrophage function in Diabetes Mellitus Alteration of the function of macrophages causes Deregulation of macrophages cytokine production Tissue destruction and alveolar bone loss Pre- coagulatory changes Hyper-cellular state Increased Secreation of IL-1, IGF, TNF ἀ Focal thrombosis Vasoconstriction

19.   Altered wound healing in diabetes mellitus Altered cellular activity Decreased collagen synthesis Glycosylation of existing collagen Increase collagenase production Reduced Collagen solubility Delayed remodelling of wound site Readily degrade newly synthesized, less completely cross linked collagen Defective Healing

20. Link Between Periodontal Disease and Diabetes Impact of Periodontitis on Diabetes Healthy individuals with periodontitis face an increased likelihood of developing pre-diabetes and diabetes. Severe periodontitis elevates the risk of developing type 2 diabetes. Periodontitis is significantly linked to poorer glycemic control (HbA1C) and higher blood-glucose levels in both diabetic and non-diabetic individuals. People with periodontitis exhibit higher levels of insulin resistance. Individuals with periodontitis and diabetes (type 1 or 2) experience higher rates of ocular complications (retinopathy), renal complications (chronic kidney disease), cardiovascular complications (heart disease, cerebrovascular events), and an increased risk of mortality compared to those with diabetes alone.

21. Link Between Periodontal Disease and Diabetes Impact of Diabetes on Periodontitis Elevated blood sugar levels (hyperglycemia) increase the risk and severity of periodontitis . There is a clear relationship between the amount of sugar in the blood ( glycaemia ) and the extent of periodontal damage. Patients with diabetes are three times more likely to develop gum disease. Controlling diabetes becomes more complicated when periodontitis is also present in a patient (co-morbidity). Individuals with diabetes who maintain good control of their blood sugar levels experience no higher incidence of periodontitis than people without diabetes.

22. Periodontitis and Diabetes: A two way relationship

23. Oral manifestation and complications of diabetes mellitus E nlarged gingiva , sessile or pedunculated gingival polyp, polypoid gingival proliferations, abscess. C heilosis D iminished salivary flow, M ucosal drying, and cracking, B urning mouth and tongue, and with greater predominance of candida albicans,hemolytic streptococci, and staphylococci.

24. Oral manifestation and complications of diabetes mellitus   Increased rate of dental caries P eripheral diabetic neuropathy may be a risk factor for severe TMJ dysfunction. Geographic and fissured tongue L ichen planus , recurrent aphthous stomatitis , and oral fungal infections

25. CURRENT MEDICAL MANAGEMENT OF DIABETES MELLITUS DIET : The goals of this intervention include weight reduction, improved glycemic control, with blood glucose levels in the normal range, and lipid control . Exercise : Regular physical exercise to weight reduction, increased cardiovascular fitness, and physical working capacity . Pharmacological therapy :  Anti-AGE Therapies

26. DENTAL THERAPY CONSIDERATIONS Patients with well-controlled diabetes can often be treated in a similar way to non-diabetic patients . Communicate with patient’s physician to obtain control of blood glucose levels, Control acute infections as aggravated glycemic control increases the risk of micro & macrovascular diabetic complications like- Stroke, MI, Heart Failure.

27. Timing of treatment Patients with well controlled DM can be treated similarly to non-diabetic patients for most routine dental needs . Keep appointments short, atraumatic , and stress- freemorning appointments Use appropriate vasoconstrictor agents For stressful procedures the usual drug regime may be altered

28. Antibiotics Use Antibiotics are not necessory for routine procedures in patients with well-controlled diabetes . But considered in the presence of overt oral infection.The combination of mechanical debridement (Scaling and Root planing )+ systemic antibiotic provide greater positive effect on glycemic control in some DM patients . In diabetic patients with periodontitis , systemic antibiotics had significant improvement in PD and CAL in long-term. Topical antibiotics were also beneficial for PD improvement. 

29. Diabetic Emergencies Hypoglycemic crisis Hyperglycemic crisis Care is initiated by activating the emergency medical system, opening the airway, and administering oxygen. Circulation and vital signs should be maintained and monitored, and the patient should be transported to a hospital .

30. Conclusion Diabetes mellitus has significant impact on tissues throughout the body, including the oral cavity. As research indicates that poorly controlled diabetes increases the risk periodontitis.Alteration in host defence and tissue homeostasis appear to play a major role.Advances in medical management of DM require a heightened awareness by the periodontist in the various treatment regimens used by diabetic patients.