Oral health, diabetes, and body weight.

OBJECTIVES: The effects of apical periodontitis (AP) and periodontal disease (PD) on organ weights in rats with diabetes mellitus (DM) were evaluated. DESIGN: Eighty male rats (Rattus norvegicus albinus, Wistar) were divided into eight groups of ten: normoglycemic (N), AP, PD, AP+PD, DM, DM+AP, DM+PD, and DM+AP+PD. DM was induced by streptozotocin; AP, by dental exposure to the oral environment; and PD, by periodontal ligature. Blood glucose concentration was measured at 0, 6, 15, and 35days; body weight, measured daily; and animals were sacrificed after 30days after induction of oral infections. Liver, kidney, pancreas, brain, heart, lungs, and gonads were each weighed. Glycemia, feed intake, organ weight, and body weight were subjected to statistical analyses (p<0.05). RESULTS: Glycemic levels were higher in all diabetic groups after day 6, but were consistently similar in normoglycemic groups. Blood glucose was higher in DM+PD and DM+AP+PD groups than in the DM group at days 15 and 35. The feed intake was similar among all groups. Brain, heart, and gonad weights were significantly increased in DM+AP+PD. Kidney and lung weights were increased in DM, regardless of the presence of oral infections. Liver weight was reduced in AP and/or PD. Pancreas weight was reduced in DM, independent of AP or PD. Among the normoglycemic groups, there were no significant differences among organ weights. CONCLUSION: Apical periodontitis and periodontal disease may potentiate the adverse effects of diabetes.

Influence of Apical Periodontitis on Stress Oxidative Parameters in Diabetic Rats.

INTRODUCTION: In this study, we investigated if apical periodontitis (AP) associated with diabetes influenced the levels of endogenous antioxidants, the total antioxidant capacity (TAC), and the oxidant parameter in the serum of Wistar rats. METHODS: Forty male rats were divided into 4 equal groups: normal rats (N), rats with AP (AP), diabetic rats (D), and diabetic rats with AP (D + AP). Diabetes was induced by alloxan (150 mg/kg). AP was induced by exposing the pulpal tissue to the oral environment. After 36 days, blood and maxillae were collected. Albumin, bilirubin, uric acid, TAC, and malondialdehyde (MDA) levels were measured, and histologic analysis of the maxillae was performed. P < .05 was set as the threshold for statistical significance. RESULTS: Uric acid levels were higher in the D + AP group when compared with that of the N, D, and AP groups (P < .05). The MDA concentration was higher in the D and D + AP groups when compared with the N and AP groups (P < .05). The level of albumin was lower in the D + AP group when compared with the N, AP, and D groups. Inflammatory infiltration was more intense in the periapical region in the D + AP group compared with that in the AP group (P < .05). CONCLUSIONS: Our findings indicate that diabetes may change the antioxidant status, increase the concentration of MDA and uric acid, and decrease albumin levels in the serum. In addition, AP can potentiate the effects of diabetes by reducing the levels of albumin and increasing the levels of uric acid.

Diabetes increases interleukin-17 levels in periapical, hepatic, and renal tissues in rats.

OBJECTIVES: This study aimed to evaluate the association between endodontic infection and diabetes on interleukin-17 levels in periapical, hepatic, and renal tissues of rats. DESIGN: Forty male rats were divided into groups: normoglycemic rats (N), normoglycemic rats with apical periodontitis (N-AP), rats with experimental diabetes (ED), and rats with experimental diabetes and apical periodontitis (ED-AP). Diabetes was induced by intravenous streptozotocin injection, and blood sugar levels were monitored to confirm disease development. Apical periodontitis (AP) was induced by pulp exposure to the oral environment during 30days. After 30days, hepatic and renal tissues were obtained, and IL-17 levels were quantified by ELISA. The right hemi-jaw was used to quantify IL-17 levels by immunohistochemistry. The values obtained in parametric tests were tabulated and analyzed statistically by analysis of variance (ANOVA) and Tukey tests, and the values obtained for scores were statistically analyzed by using the Kruskal-Wallis and Dun tests. The level of significance was set at 5%. RESULTS: ED and ED-AP groups expressed significantly higher IL-17 levels in both hepatic and renal tissues (p<0.05), compared to N and N-AP groups. Apical periodontitis (AP) in ED-AP group was significantly more severe than that in N-AP group (p<0.05). Furthermore, there was a significantly larger increase in the IL-17 levels in ED-AP group compared to N group (p<0.05). CONCLUSION: Our results indicate that diabetes increases IL-17 levels in hepatic and renal tissues and also enhances IL-17 production in apical periodontitis area of rats.

Blood profile and histology in oral infections associated with diabetes.

INTRODUCTION: We aimed to investigate the relationship between blood profile and histologic findings in both apical periodontitis (AP) and periodontal disease (PD) associated with diabetes. METHODS: Wistar rats (N = 80) were assigned to the following 8 groups: control, AP, PD, AP associated with PD, diabetes, diabetes with AP, diabetes with PD, and diabetes with AP and PD. Diabetes mellitus (DM) was induced with streptozotocin, AP was induced by exposure to the oral environment, and PD was induced using periodontal ligature. After 30 days, blood samples were collected, and the rats were euthanized. Subsequently, the maxillae were processed for light microscopy. Hematologic examinations were conducted to determine the total number of erythrocytes and leukocytes, erythrocyte constant, and blood glucose level. One-way analysis of variance and Kruskal-Wallis tests were used for statistical analysis, and the significance was set at P < .05. RESULTS: A significant correlation was found between the histologic findings and blood parameters. CONCLUSIONS: In conclusion, diabetes accelerated the development and progression of AP and PD in the rats and caused an increase in the average erythrocyte volume as well as the leukocyte and neutrophil counts. Oral infections increase the total number of leukocytes, the number of neutrophils and lymphocytes, and blood glucose concentrations in DM rats.

Periapical lesions decrease insulin signal and cause insulin resistance.

INTRODUCTION: Inflammatory cytokines are associated with decreased insulin signal transduction. Moreover, local oral inflammation, such as that accompanying periodontal disease, is associated with insulin resistance and type 2 diabetes mellitus. The aim of this study was to evaluate the effect of periapical lesions (PLs) on insulin signaling and insulin sensitivity in rats. We hypothesized that PLs alter systemic insulin signaling and insulin sensitivity via elevated plasmatic tumor necrosis factor α (TNF-α). METHODS: Wistar rats were divided into control (CN) and PL groups. PLs were induced by exposing pulpal tissue to the oral environment. After 30 days, insulin sensitivity was measured using the insulin tolerance test. After euthanization, maxillae were processed for histopathology. Plasmatic concentrations of tumor necrosis factor α (TNF-α) were determined via the enzyme-linked immunosorbent assay. Insulin signal transduction was evaluated using insulin receptor substrate tyrosine phosphorylation status and serine phosphorylation status in periepididymal white adipose tissue via Western blotting. For insulin signaling and insulin tolerance tests, the analyses performed were analysis of variance followed by the Tukey post hoc test. For TNF-α analysis, the Student's t test was used. In all tests, P < .05 was considered significant. RESULTS: The rats with PLs showed higher plasmatic TNF-α, lower constant rate for glucose disappearance values, and reduced pp185 tyrosine phosphorylation status but no change in serine phosphorylation status in white adipose tissue after insulin stimulation. CONCLUSIONS: PLs can cause alterations to both insulin signaling and insulin sensitivity, probably because of elevation of plasmatic TNF-α. The results from this study emphasize the importance of the prevention of local inflammatory diseases, such as PLs, with regard to the prevention of insulin resistance.

Combined therapy with mineral trioxideaggregate, and guided tissue regeneration for a large radicular cyst: a 13-year follow-up

Biomaterials such as membrane barriers and/or bone grafts are often used to enhance periapical new bone formation. A combination of apical surgery and these biomaterials is one of the latest treatment options for avoiding tooth extraction. In case of periapical lesions, guided tissue regeneration (GTR) is attempted to improve the self-regenerative healing process by excluding undesired proliferation of the gingival connective tissue or migration of the oral epithelial cells into osseous defects. In many cases, GTR is necessary for achieving periodontal tissue healing. This report describes the healing process after surgery in a challenging case with a long-term followup. In this case report, endodontic surgery was followed by retrograde sealing with mineral trioxide aggregate (MTA) in the maxillary right central incisor and left lateral incisor. Apicectomy was performed in the maxillary left central incisor and a 1-mm filling was removed. The bone defect was filled with an anorganic bone graft and covered with a decalcified cortical osseous membrane. No intraoperative or postoperative complications were observed. After 13 years of follow-up, the patient showed no clinical signs or symptoms associated with the lesion and radiographic examination showed progressive resolution of radiolucency. In conclusion, the combination of apical surgery and regenerative techniques can successfully help the treatment of periapical lesions of endodontic origin and is suitable for the management of challenging cases.

Metabolismo oxidativo sérico em ratos diabéticos com lesão periapical / Oxidative metabolism in blood serum of diabetic rats with or without periapical lesion

Este trabalho teve como objetivo avaliar a influência da infecção endodôntica associada ou não à diabetes, nas concentrações séricas dos antioxidantes endógenos albumina, bilirrubina e ácido úrico, da capacidade antioxidante total (TAC) e do parâmetro oxidante malonaldeído (MDA) em soro sanguíneo de ratos Wistar. Foram utilizados 40 ratos divididos em 4 grupos: euglicêmicos (C); euglicêmicos com lesão periapical (LP); diabético (D) e diabético com lesão periapical (D+LP). A diabetes foi induzida quimicamente pela utilização da droga Aloxano, via intramuscular, na dose de 150 mg/kg, e a lesão periapical, por meio da exposição pulpar do primeiro molar superior direito ao meio bucal durante 30 dias. Após este período, foi coletado o sangue, através de punção cardíaca para obtenção do soro, e também, as hemimaxilas, para o processamento histológico. No soro foi realizada a mensuração da albumina pela técnica verde de bromocresol, bilirrubina por Van der Bergh, ácido úrico pela uricase, TAC pela captura do radical livre ABTS, e MDA pelo ensaio das substâncias reativas ao ácido tiobarbitúrico (TBARS). Na análise histológica foram avaliadas a intensidade e extensão da inflamação, reabsorção radicular e tamanho da lesão. Os valores foram analisados pelos testes de análise de variância (ANOVA) e de Tukey (p<0,05). Os valores obtidos em escores foram analisados estatisticamente, por meio dos testes de Kruskal-Wallis e Dunn (p<0,05). Nos ratos diabéticos (D e D+LP) houve um aumento da concentração de MDA e ácido úrico e uma diminuição de albumina em relação aos ratos euglicêmicos (C e LP). O grupo D+LP comparado ao D apresentou um aumento de ácido úrico e diminuição de albumina. A análise histológica mostrou que a lesão periapical de ratos diabéticos (D+LP) possui maior severidade quando comparada com a dos ratos euglicêmicos (LP). A lesão periapical associada com a diabetes altera o status antioxidante, diminuindo a concentração sérica de albumina e aumentando...

This study aimed to evaluate the influence of endodontic infection associated with or without diabetes, in the serum concentrations of endogenous antioxidants albumin, bilirubin and uric acid, total antioxidant capacity (TAC) and oxidant parameter, malondialdehyde (MDA) in blood serum of the Wistar. It were used 40 rats in 4 groups: euglycemic (E); euglycemic with periapical lesion (PL); diabetic (D) and diabetic with periapical lesion (D + PL). Diabetes was chemically induced by alloxan intramuscularly at a dose of 150 mg/kg and periapical lesion by exposure right first molar to the oral environment for 30 days. After this period, blood was collected via cardiac puncture to obtain serum, and also the hemi-jaws for histological processing. Albumin measurement by bromocresol green technique, bilirubin by Van der Bergh, uric acid by uricase, TAC by capturing the free radical ABTS, and MDA by assay of thiobarbituric acid reactive substances (TBARS) were performed in serum. In the histological analysis, the intensity and extent of inflammation, root resorption and bone loss were evaluated. The values were analyzed by analysis of variance tests (ANOVA) and Tukey‟s test (p < 0.05). The values obtained for scores were statistically analyzed by the Kruskal- Wallis test and Dunn‟s tests (p < 0.05). In diabetic rats (D and D + PL) there was an increase in the concentration of MDA and uric acid while decrease in albumin compared to euglycemic rats (E and PL). D + PL group compared to D showed an increase of uric acid and decreased albumin. Histological analysis showed periapical lesion of diabetic rats (D + PL) has a greater severity when compared with the euglycemic rats (PL). Periapical lesion associated with diabetes changes the antioxidant status, reducing serum levels of albumin and increasing serum levels of uric acid...