Biochemical Aspects of Diabetes and Oral Health

Jean Paul Perraudin

Abstract


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.

 


Keywords


Diabetes mellitus, type , type 2, complications, gum disease, tooth loss, periodontal disease, salivary glucose

Full Text:

PDF HTML

References


Bowyer, V., Sutcliffe, P., Ireland, R., Lindenmeyer, A., Gadsby, R., Graveney, M. 2011 Oral health awareness in adult patients with diabetes: a questionnaire study. British Dental Journal. 211 (6), 262-311

Chapple. ILC., Genco. R., 2013 Diabetes and periodontal diseases consensus report of the joint EFP/AAP workshop on periodontitis and systemic diseases J. Clin. Periodontol., 40 Suppl.14S, 106-112

Chen, L., Luo, G., Xuan, D., Wei, B., Liu, F., Li, J. 2012 Effects of non-surgical periodontal treatment on clinical response, serum inflammatory parameters, and metabolic control in patients with type 2 diabetes: a randomized study Journal of periodontology, 83 (4), 435-443

Correa, F.O., Goncalves, D., Figueredo, C.M., Bastos, A.S., Gustafsson, A., and Orrico, S.R. 2010 Effect of periodontal treatment on metabolic control, systemic inflammation and cytokines in patients with type 2 diabetes. J. Clin. Periodontol, 37, 53-58

Da Cruz, GA., De Toledo, S., Sallum, EA., Ambrosano, GMB., De Cassia Orlandi Sardi, J. 2013 Clinical and laboratory evaluations of non-surgical periodontal treatent in subjects with diabetes mellitus Journal of Periodontology, 79 (7), 1150-1157

Doucet, Ph., Lowenstein, M. 2006 Activation de l’ostéoclasie par les endotoxins bactériennes au cours des maladies parodontales Medecine/Sciences, 22, 614-619

Ellison, R.T.D., Giehl, T.J., La Force, F.M. 1988

Damage of the outer membrane of enteric gram-negative bacteria by lactoferrin and transferrin Infect. Immun., 56 (11), 2774-2781

Emrich, L., Schlossman, M., Genco, R. 1991 Periodontal disease in non-insulin-dependant diabetes mellitus J. Periodontol. 62, 123-131

Engebretson, S., Kocher, T. 2013 Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta-analysis. J. Clin. Periodontol., 40 Suppl 14S, 153-163

-Gregory, R.L., Kindle, J.C., Hobbs, L.C., Filler, S.J., Malmstrom, H.S. 1990 Function of anti-Streptococcus mutans antibodies: inhibition of virulence factors and enzyme neutralization. Oral Microbiol Immunol. 1990, 5(4):181-188.

Jenkins WM., Said SH., Radvar, M., Kinane, DF. 2000 Effect of subgingival scaling during supportive therapy Journal of Clinical Periodontology, 27 (8), 590-596

Jenssen, H., and Hancock, R.E. 2009 Antimicrobial properties of lactoferrin Biochimie, 91 (1), 19-29

Jurysta C., Bulur, N., Oguzhan, B., Satman, I., Yilmaz, T., Malaisse, W., Sener, A., 2009 Salivary glucose concentration and excretion in normal and diabetics subjects J. of Biomedecine and Biotechnology, 2009, 1-6

Konishi, M., Iwasa, M., Yamauchi, K., Sugimoto, R., Fujita, N., Kobayashi, Y., Watanabe, S., Teraguchi, S., Adachi, Y., Kaito, M. 2006 Lactoferrin inhibits lipid peroxidation in patients with chronic hepatitis C. Hepatol. Res., 36 (1), 27-32

Laible, N.J. Germaine, G.R. 1985 Bactericidal activity of human lysozyme, muramidase-inactive lysozyme, and cationic polypeptides against Steptococcus faecalis, inhibition by chitin oligosaccharides Infect. Immun., 48 (3), 720-728

Lamster, I.B., Lalla, E., Borgnake, W.S., Taylor, G.W. 2008 The relationship between oral health and diabetes mellitus J. AM. Dent. Assoc., 139 (Suppl): 19S-24S

Legrand, D. 2012 Lactoferrin, a key molecule in immune and inflammatory processes Biochem. Cell. Biology, 90, 252-268

Nelson, R., Shlossman, M., Budding, L., 1990 Periodontal disease and NIDDM in Pima Indians Diabetes Care, 13, 836-840

Preshaw, P.M., Alba, A.L., Herrera, D., Jepsen, S., Konstantinidis, A., Makrilakis, K., Taylor, R., 2012 Periodontitis and diabetes: a two-way relationship Diabetologia, 55, 21-31

Petersen, P.E., Kwan, S. 2011 Equity, Social determinants and public health programmes – the case of oral health. Community Dent Oral Epidemiol., 39, 481-487

Pihlstrom, B.L., Michalowicz, B.S., Johson, N.W. 2005 Periodontal diseases Lancet., 366, 1809-1820

Poudel, P., Griffiths, R., Wong, V.W., Arora, A., George, A., 2017 Knowledge and practices of diabetes care providers in oral health care and their potential role in oral health promotion: a scoping review. Diabetes Res. Clin. Pract., 130, 266-267

Reiter, B. 1978 Review: of non-specific antibacterial factors in colostrum. Ann. Rech. Vet., 9 (2), 205-224

Simpson, T., Needleman, I., Wild, S., Moles, D., Mills, E. 2010 Treatment of periodontal disease for glycaemic control in people with diabetes Australian Dental Journal, 55 (4), 472-474

Simpson, T.C., Weldon, J.C., Worthington, H.V., Needleman, I., Wild, SH., Moles, D.R. 2015 Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Cochrane Syst. Rev., 11, CD004714

Singh, P.K., Parsek, M.R., Greenberg, E.P., Welsh, M.J. 2002 A component of innate immunity prevents bacterial biofilm development Nature, 417, 552-555

Taylor, G.W., Burt, B., Becker, M., 1998 Non-insulin dependant diabetes mellitus and alveolar bone loss progression over 2 years J. Periodontol., 69, 76-83

-Taylor, G.W., Burt, B., Becker, M., 1998 Glycemic control and alveolar bone loss progression in Type 2 diabetes Ann. Periodontol., 3, 30-39

Taylor, GW. 2001 Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective Annals of periodontology – American of Periodotolongy, 6 (1), 99-112

Taylor, G.W., Borgnakke, W.S. 2008 Periodontal diseases: association with diabetes, glycemic control and complications Oral Diseases, 14 (3), 191-203

Taylor, J.J., Preshaw, P.M., Lalla, E.A., 2013 Review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes J. Clin. Periodonl, 40 Suppl 14S, 113-134

Valerio, MA., Kanjirath, PP., Klausner, CP., Peters, MC. 2011 A qualitative examination of patient awareness and understanding of type 2 diabetes and oral health needs. Diabetes Research and Clinical Practice. Elesevier Ireland, 93 (2), 159-165

Yamauchi, K., Wakabayashi, H., Shin, K., and Takase, M. 2006 Bovine lactoferrin: benefits and mechanism of action against infections Biochem. Cell. Biol., 84 (3), 291-296

Yuen, H.K., Wolf, B.J., Bandyopadhyay, D., Magruder, K.M., Salinas, C.F., London, S.D. 2009 Oral health knowledge and behavior among adults with diabetes Diabetes Res. Clin. Pract., 86(3), 239-246


Refbacks

  • There are currently no refbacks.


The Journal of the Association of British Clinical Diabetologists