Biochemical Aspects of Diabetes and Oral Health
Keywords:Diabetes mellitus, type, type 2, complications, gum disease, tooth loss, periodontal disease, salivary glucose
Apart from the many other complications due to high blood sugar, people with uncontrolled diabetes are 3 times more likely to develop periodontal disease: gingivitis and periodontitis. Other complications include halitosis, dry mouth, taste disorders, aphthous stomatitis and oral precancerous infections. Periodontitis is the advanced stage of deep inflammation of tissue and the loss of the connective tissue. The breakdown of the collagen of the periodontal ligament fibers leads to a periodontal pocket between the gum and the tooth followed by loss of the tooth.
It has been shown that diabetics have 4 to 5 times more glucose in their saliva than non-diabetics. This hyperglycemia will play a vital role in the growth of the bacteria whether in planktonic form or in the form of biofilm. Based on the lipopolysaccharides released by bacteria, it has been demonstrated that this hyperglycemia increases the levels of several cytokines and other mediators in saliva and gingival crevicular fluid, increases oxidative stress in periodontal tissues and leads to the formation of end products to advanced glycation (AGE). So, if diabetes is not controlled it represents a significant risk factor in the etiology of periodontal disease, but more intriguing still is the notion that this link is reciprocal : serious periodontitis affects the control of blood glucose and could exacerbate diabetes
Today, the most widely used treatment by dentists is scaling and root planning every 90 days, in addition to the administration of antibiotics, despite the fact that antibiotic-resistant micro-organisms are becoming more and more prevalent.
Periodontal infection alters the biological activity of saliva. So why not focus on this activity which represents a first line non-immune defence mechanism for overall health. In many cases foaming toothpastes are recommended even though these preparations de-activate salivary protective molecules. It follows, therefore, that reinforcing saliva on a daily basis could lead to better control of bacterial growth, less oxidative stress, improve immune defences and healing, and above all avoid periodontal complications and, of course, bone loss.
Numerous research results have highlighted that several molecules existing naturally in saliva – such as lactoferrin, lysozyme, lactoperoxidase system, growth factors, superoxide dismutase - play an essential role in protecting human oral health. Incorporating these natural molecules in oral hygiene formulations could lead to better daily oral health in diabetics and even in non-diabetics.
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