1.

Write on the effects of the following diseases on periodontal health

- Diabetes mellitus
- Hypertension
- Leukemia

Effects of Diabetes Mellitus on Periodontal Health: Type 2 diabetes mellitus

(DM2), the most common type of diabetes, is characterized by hyperglycaemia,

hyperlipidaemia and associated complications (Moeintaghavi, et al 2012).

Diabetes mellitus (DM) is a chronic, non-communicable disease and also one of

the major global public health issues. It is defined as a clinical syndrome

characterized by hyperglycemia due to absolute or relative deficiency of insulin.

An elevation of blood glucose level (hyperglycemia) is the primary feature of DM

and results from a defect in insulin secretion by pancreatic β cells, a decrease in

insulin sensitivity, or a combination of both. DM currently is the twelfth leading

cause of death in the world. One of the leading complications of diabetes,

periodontitis, is an infection of the periodontal support tissues (Loe, 1993).

There is an interacting, complex relationship between diabetes and periodontitis.

Many studies have shown a greater incidence and a greater severity of periodontitis

in diabetic patients (Taylor, 2008). Meanwhile, a number of studies have suggested

that periodontitis may actually be a risk factor for diabetic complications as well

(Grossi, 2001). The prevalence of DM has risen dramatically in recent years,

resulting in a rapid increase of diabetic patients. Asia in particular has the highest

prevalence of diabetes in the world. Countries exhibiting the fastest rate in diabetic

population growth include India and China, among many other developing

countries (Awuti, 2012).

Periodontal diseases are chronic inflammatory diseases of the tissues that support

and attach the teeth to the jaws (Offenbacher, 1996). They are caused by gram-

negative bacterial infections and are for the most part, asymptomatic; although

much of the actual destructive tissue changes observed clinically are results of the

inflammatory host response.

Periodontal disease (PD) is the second main cause of oral cavity disorders affecting

the population due to its high prevalence (Petersen, 2003). It is more frequent in

adults in contrast to cavities which are more common and much more frequent in

children. The risk of developing periodontitis may be greater in patients with

diabetes who have poor glycemic control than that in patients with well-controlled

diabetes. In a review article by Measley, (2006) cited a number of established

mechanisms by which diabetes can influence the periodontium which include the

following:

 alteration in the host immune-inflammatory response,

  altered wound healing,

 accumulation of advanced glycation end products (AGE’s), and

 elevated pro-inflammatory cytokines

Without mechanical debridement, the plaque biofilm matures and causes gingivitis

in a few days. Gingivitis represents chronic but reversible inflammation and can be

usually treated by proper plaque control and accumulation of plaque acts as a local

irritant in the oral cavity.

Effects of Hypertension on Periodontal Health: The periodontal diseases are a

group of chronic inflammatory diseases, involving the soft tissue and bone

surrounding the teeth in the jaws, or known as periodontium. Periodontal diseases

including gingivitis and periodontitis are among the most common dental diseases

after tooth decay in humans. Periodontal diseases are characterized by

inflammation of tooth-supporting tissues caused by bacterial infection (Jin et al,

2003). Gingivitis is a very common reversible condition, which manifests as

redness, gum swelling, and bleeding during tooth-brushing and flossing. Gingivitis

may progress into periodontitis with further destruction of periodontal tissues

ligament and alveolar bone if left without appropriate treatment. Teeth may

become mobile and eventually be exfoliated following the diminution of

periodontal supporting tissues (Tonetti, et al 2013). This process is attributed to the

release of toxic products from the pathogenic bacteria plaque in addition to the

inflammation of gingival tissues elicited by the host response (Noack, et al 2001).

Periodontitis is linked to an increased risk of cardiovascular diseases (CVD). The

chronic inflammatory process of periodontitis and the host response provide the

basis for the hypothetical association between periodontitis and CVD (Zamirian, et

al 2008). Hypertension increases the risk of various adverse cardiovascular events

such as atherosclerosis, stroke, and coronary heart disease. Oxidative stress and

endothelial dysfunction have been hypothesized to be involved in the pathogenesis

of hypertension. It is well known that hypertension and periodontitis share

common risk factors, namely, smoking, stress, increased age, and socioeconomic

factors. These risk factors may confound the association between hypertension and

periodontitis. Nevertheless, according to the scientific statement issued by the

American Heart Association (AHA) published in Circulation, observational studies

support an association between periodontal disease and cardiovascular disease,

independent of shared risk factors (Lockhart, 2012).

Although current epidemiological data are yet to provide sufficient evidence to

prove a causal relationship between these two diseases, researchers have identified

chronic inflammation as an independent link of periodontal disease in the

development and progression of CVD in some patients. Both AHA and the

American Academy of Periodontology (AAP) were in agreement that more

thorough and long-term interventional studies should be carried out in order to gain

an in-depth knowledge of the diseases’ mechanism.

Effects of Leukemia on Periodontal Health: according Deliverska et al (2013)

the oral signs and symptoms may be reflect a undetected serious systemic diseases.

Depending on the oral manifestation the dentists and physicians make attention and

focusing on specific diagnoses. In some cases oral involvement may be frequently

herald the onset of the disease which requires the dentists to better knowledge of

changes in the oral cavity. In the oral cavity local symptoms and findings of

leukemia include paleness of the oral mucosa with gingival bleeding that develops

into painless gingival hyperplasia, petechiae, hemorrhages, and ulcerative necrotic

lesions Because of their clinical importance, all such lesions deserve the full

attention of the dental doctors.

Some effects of leukemia on oral health include:

- Gingival bleeding,

- Gingival Enlargement,

- Gingival ulceration and oral infection.

 REFERENCES

Awuti, G., Younusi, K., Li, L., Upur, H, & Ren, J. (2012). Epidemiological Survey
on the Prevalence of Periodontitis and Diabetes Mellitus in Uyghur Adults
from Rural Hotan Area in Xinjiang. Exp Diabetes Res 20()12, 758 – 765.
Deliverska, E. G., & Krasteva, A. (2013). Oral signs of leukemia and dental
management – literature data and case report. Journal of IMAB - Annual
Proceeding, 19(4), 388 – 391.
Grossi, S. G. (2001). Treatment of periodontal disease and control of diabetes: an
assessment of the evidence and need for future research. Ann Periodontol
6(1), 138–145.
Jin, L. J., Chiu, G. K. C., & Corbet, E. F. (2003). Are periodontal diseases risk
factors for certain systemic disorders—what matters to medical
practitioners? Hong Kong Medical Journal, 9(1), 31–37.
Lockhart, P. B., Bolger, A. F.. & Papapanou, P. (2012). Periodontal disease and
atherosclerotic vascular disease: does the evidence support an independent
association? A Scientific Statement from the American Heart Association,”
Circulation, 125(20), 2520–2544.
Loe, H. (1993). Periodontal disease: the sixth complication of diabetes mellitus.
Diabetes Care, 16(1), 329– 334.
Measley, B. L. (2006). Periodontal Disease and Diabetes: A Two-way Street. J Am
Dent Assoc, 137 (1), 26S-31S.
Moeintaghavi, A., Arab, H. R., Bozorgnia, Y., Kianoush, K., & Alizadeh, M.
(2012). Non-surgical periodontal therapy affects metabolic control in
diabetics: a randomized controlled clinical trial. Australian Dental Journal,
57(1), 31– 37.
Noack, B., Genco, R. J., Trevisan, M., Grossi, S., Zambon, J. J., & De Nardin, E.
(2001). Periodontal infections contribute to elevated systemic C-reactive
protien level. Journal of Periodontology, 72(9), 1221–1227.
Petersen, P. E. (2003). The World Oral Health Report 2003: Continuos
improvement of oral health in the 21st century – The approach of the WHO
Global Oral Health Programme. Community Dent Oral Epidemiol, 31(1),
3−24.
Offenbacher, S. (1996). Periodontal disease patogénesis. Ann Periodontol 1(1),
821−878.
Taylor, G. W., & Borgnakke, W. S. (2008). Periodontal disease: associations with
diabetes, glycemic control and complications. Oral Dis,14(3), 191–203.
Tonetti M. S. & Van Dyke, T. E. (2013). Periodontitis and atherosclerotic
cardiovascular disease: consensus report of the Joint EFP/AAP Workshop
on Periodontitis and Systemic Diseases. Journal of Periodontology, 84(4),
S24– S29.
Zamirian, M., Raoofi, S., Khosropanah, H., & Javanmardi, R. (2008). Relationship
between periodontal disease and acute myocardial infection. Iranian
Cardiovasular Research Journal, 1(4), 216–221.