Periodontal disease and diabetes.

Diabetes is considered to be a genetically and environmentally based chronic metabolic and vascular syndrome caused by a partial or total insulin deficiency with alteration in the metabolism of lipids, carbohydrates and proteins culminating with different manifestations in different organisms. In humans hyperglycemia is the main consequence of defects in the secretion and/or action of insulin, and its deregulation can produce secondary lesions in various organs, especially kidneys, eyes, nerves, blood vessels and immune systems. Periodontal disease is an entity of localized infection that involves tooth-supporting tissues. The first clinical manifestation of periodontal disease is the appearance of periodontal pockets, which offer a favorable niche for bacterial colonization. The etiology of periodontal disease is multifactorial, being caused by interactions between multiple micro-organisms (necessary but not sufficient primary etiologic factors), a host with some degree of susceptibility and environmental factors. According to current scientific evidence, there is a symbiotic relationship between diabetes and periodontitis, such that diabetes is associated with an increased incidence and progression of periodontitis, and periodontal infection is associated with poor glycaemic control in diabetes due to poor immune systems. Hence, for a good periodontal control it is necessary to treat both periodontal disease and glycaemic control.

Case report of necrotizing sialometaplasia.

INTRODUCTION: Necrotizing sialometaplasia is a rare inflammatory necrotizing reactive process that can involve minor and major salivary glands. Gland tissue ischaemia has been proposed as the aetiology. CASE REPORT: A 21-year-old woman was referred with a 1-week history of bilateral painful swelling of the palate, with the development of two deep ulcers after the first 3 days. Ulcer edges were elevated but not indurated, and the bases had a necrotic appearance. An incisional biopsy of the margin of one ulcer confirmed the diagnosis of necrotizing sialometaplasia. The ulcers spontaneously healed within 8 weeks without treatment. DISCUSSION: The clinical and histological similarity between this entity and a malignant lesion implies a risk of unnecessary or inadequate treatment. This case illustrates the need for an incisional biopsy to be analyzed by an experienced pathologist to establish a correct diagnosis.

Periodontal disease and diabetes-Review of the Literature.

AIMS: To provide updated knowledge on the relationship between periodontal disease and diabetes from an oral health perspective. METHODS: A review of the English-language literature was performed, gathering articles on the two diseases published over the past 10 years. RESULTS: Both diseases result from the confluence of various triggering and modifying factors, and there are inter-individual differences in the risk of their development. Recent research has shown that diabetes may increase the risk of periodontitis, and it has been proposed that chronic periodontal disease may influence the natural course of diabetes. There appears to be an association among oral infections, impaired sugar metabolism, and atherosclerosis, indicating a theoretical link between metabolic syndrome and periodontal disease. CLINICAL IMPLICATIONS: Control of periodontal disease may enhance glycemic control in patients with type 2 diabetes. In turn, improved glycemic control may contribute to a better control of periodontal disease.

[Diabetes and periodontitis: A bidirectional relationship]. / Diabetes y periodontitis: una relación bidireccional.

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, a defect in insulin action or a combination of both. Periodontitis is now considered a chronic localized infection of the oral cavity that can trigger inflammatory host immune responses at local and systemic levels, and can also be a source of bacteremia. It is now known that periodontitis has an influence on the pathogenesis of certain systemic diseases. The biological relationship between diabetes and periodontal disease is well documented. In the mid-90s sufficient scientific support for the association between diabetes and periodontitis was published, and periodontitis was designated as the sixth complication of diabetes. There have been studies that show an improvement in both clinical and immunological parameters of periodontitis and glycemic control in long-term diabetes after treatment of periodontal disease. In addition, scientific evidence confirms that poorer glycemic control contributes to a worse periodontal condition. The interplay between the 2 conditions highlights the importance of the need for a good communication between the internist and dentist about diabetic patients, considering always the possibility that the 2 diseases may be occurring simultaneously in order to ensure an early diagnosis of both.

[Relationship between odontogenic infections and infective endocarditis]. / Infecciones orales y endocarditis infecciosa.

Revised guidelines for the prevention of infective endocarditis published by national and international associations in the last years do not support the indiscriminate use of antibiotic prophylaxis for dental procedures. However, some of them still recommend its use in high-risk patients before dental treatments likely to cause bleeding. Given the high prevalence of bacteremia of dental origin due to tooth-brushing, mastication or other daily activities, it appears unlikely that infective endocarditis from oral microorganisms can be completely prevented. A good oral health status and satisfactory level of oral hygiene are sufficient to control the consequences of the systemic spread of oral microorganisms in healthy individuals. However, caution is still needed and prophylactic antibiotics must be administered to susceptible or medically compromised patients. This review briefly outlines the current concepts of odontogenic bacteremia and antibiotic prophylaxis for patients undergoing dental treatment.

Differences in the expression of five senescence markers in oral cancer, oral leukoplakia and control samples in humans.

Oncogene-induced senescence (OIS) may be a response to oncogenic activation, acting as a natural barrier against carcinogenesis at a premalignant stage. Thus, numerous cells in premalignant lesions enter senescence, but none or few in malignant tumours. This event could be due to the loss of senescence pathway effectors, including p16 (INK4a)-pRb or ARF-p53. The aim of this study was to characterize and compare the expression of certain senescent markers between oral precancer and cancer tissue samples. The expression of cyclin D1, Rb, maspin, p53 and mouse double minute 2 (MDM2) was analyzed in 20 paraffin-embedded tissue samples of normal oral mucosa (NOM), 14 samples of oral leukoplakia without dysplasia (OLD-), 11 samples of leukoplakia with dysplasia (OLD+) and 15 samples of oral squamous cell carcinoma (OSCC) by immunohistochemistry in tissue arrays. The expression of p16-pRb pathway markers, cyclin D1, maspin and Rb, was more frequent in OLD+ samples than in OSCC samples, although a statistical significance was only observed for maspin (P=0.036). Cyclin D1 expression was also significantly more frequent in OLD- samples vs. NOM samples. For the ARF-p53 pathway, the expression of p53 and MDM2 was significantly more frequent in the OLD- samples compared to in the NOM ones. These findings may indicate a role for cellular senescence in oral carcinogenesis, considering maspin as a reliable senescence marker and prognostic factor in oral premalignant lesions.

Epidemiological study of oral cancer patients in Alava province, Spain.

The authors conducted a retrospective study of oral squamous cell carcinoma (OSSC) patients in the province of Alava, Spain, to investigate the various epidemiological factors involved. The study included data on 30 patients referred to the Otolaryngology Department of our hospital. The authors identified epidemiological data, including age, symptoms, localization, tumor size, risk factors, tumor stage, treatment and outcome. An elevated percentage of risk factors was found, underlining the importance of early diagnosis. The highest prevalence was in the sixth decade of life. The most frequent symptom was pain, and the localization was in the tongue in 70% of cases. Tumor size ranged from 2 to 3 cm, and 85% of patients underwent surgical resection. Risk factors of smoking and drinking affected 50% of the patients.

Diabetes y periodontitis: una relación bidireccional / Diabetes and periodontitis: A bidirectional relationship

La diabetes mellitus es un grupo de enfermedades metabólicas caracterizadas por una hiperglucemia resultante de un defecto en la secreción de insulina, un defecto en la acción de esta, o bien una combinación de ambos. La periodontitis se considera actualmente una infección crónica localizada en la cavidad oral, que puede activar la respuesta inmunitaria inflamatoria del hospedador a nivel local y sistémico, y que además puede ser una fuente de bacteriemia. Hoy en día se sabe que la periodontitis tiene una influencia sobre la patogénesis de ciertas enfermedades sistémicas. La relación biológica entre la diabetes y la enfermedad periodontal está bien documentada. A mediados de la década de 1990 se encontró soporte científico suficiente para la asociación entre la diabetes y la periodontitis, que se comenzó a designar como la sexta complicación de la diabetes. Se han realizado estudios que muestran una mejora tanto en los parámetros clínicos e inmunológicos de la periodontitis como en el control glucémico a largo plazo de la diabetes tras el tratamiento de la enfermedad periodontal. Además, la evidencia científica confirma que un peor control glucémico contribuye a un peor estado periodontal. La interrelación entre ambas afecciones deja constancia de la importancia de la necesidad de una buena comunicación entre el médico internista y el odontólogo de los pacientes diabéticos, teniendo siempre en cuenta la posibilidad de que ambas enfermedades puedan estar ocurriendo simultáneamente, para garantizar el diagnóstico precoz de ambas (AU

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, a defect in insulin action or a combination of both. Periodontitis is now considered a chronic localized infection of the oral cavity that can trigger inflammatory host immune responses at local and systemic levels, and can also be a source of bacteremia. It is now known that periodontitis has an influence on the pathogenesis of certain systemic diseases. The biological relationship between diabetes and periodontal disease is well documented. In the mid-90s sufficient scientific support for the association between diabetes and periodontitis was published, and periodontitis was designated as the sixth complication of diabetes. There have been studies that show an improvement in both clinical and immunological parameters of periodontitis and glycemic control in long-term diabetes after treatment of periodontal disease. In addition, scientific evidence confirms that poorer glycemic control contributes to a worse periodontal condition. The interplay between the 2 conditions highlights the importance of the need for a good communication between the internist and dentist about diabetic patients, considering always the possibility that the 2 diseases may be occurring simultaneously in order to ensure an early diagnosis of both (AU)

Infecciones orales y endocarditis infecciosa / Relationship between odontogenic infections and infective endocarditis

Las nuevas directrices de las sociedades nacionales e internacionales publicadas en estos últimos años para la prevención de la endocarditis infecciosa no defienden el uso indiscriminado de la profilaxis antibiótica ante procedimientos dentales. Sin embargo, en algunas de ellas aún se recomienda el uso de profilaxis previa en pacientes con alto riesgo que vayan a someterse a tratamientos dentales que conlleven un sangrado. Teniendo en cuenta la alta prevalencia de la bacteriemia de origen dental debida a actividades como el cepillado dental o la masticación, parece improbable que se puedan controlar completamente las endocarditis infecciosas producidas por microorganismos de origen oral. En individuos sanos, se debe mantener una buena salud oral y una correcta higiene, y esto será suficiente para poder controlar las consecuencias de los microorganismos orales. En pacientes susceptibles o médicamente comprometidos serán necesarias otras medidas para el control de estas bacterias. Esta revisión repasa los conceptos de la bacteriemia de origen oral y la profilaxis antibiótica para pacientes que van a ser sometidos a tratamiento dental (AU)

Revised guidelines for the prevention of infective endocarditis published by national and international associations in the last years do not support the indiscriminate use of antibiotic prophylaxis for dental procedures. However, some of them still recommend its use in high-risk patients before dental treatments likely to cause bleeding.Given the high prevalence of bacteremia of dental origin due to tooth-brushing, mastication or other daily activities, it appears unlikely that infective endocarditis from oral microorganisms can be completely prevented. A good oral health status and satisfactory level of oral hygiene are sufficient to control the consequences of the systemic spread of oral microorganisms in healthy individuals. However, caution is still needed and prophylactic antibiotics must be administered to susceptible or medically compromised patients. This review briefly outlines the current concepts of odontogenic bacteremia and antibiotic prophylaxis for patients undergoing dental treatment (AU)

Periodontal disease and diabetes-Review of the literature

Aims: To provide updated knowledge on the relationship between periodontal disease and diabetes from an oralhealth perspective.Methods: A review of the English-language literature was performed, gathering articles on the two diseases publishedover the past 10 years.Results: Both diseases result from the confluence of various triggering and modifying factors, and there are interindividualdifferences in the risk of their development. Recent research has shown that diabetes may increase therisk of periodontitis, and it has been proposed that chronic periodontal disease may influence the natural course ofdiabetes. There appears to be an association among oral infections, impaired sugar metabolism, and atherosclerosis,indicating a theoretical link between metabolic syndrome and periodontal disease.Clinical implications Control of periodontal disease may enhance glycemic control in patients with type 2 diabetes.In turn, improved glycemic control may contribute to a better control of periodontal disease (AU)

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Estudio comparativo de la capacidad de fluir entre distintos materiales de obturación en conductos laterales artificiales mediante la técnica System B / Comparative analysis of the flow capacity among different obturation materials in artificial lateral canals by means of the System B technique

Introducción y objetivo: El objetivo del presente trabajo es comparar la penetración de distintas marcas comerciales de gutapercha así como de Resilón® en los conductos laterales mediante el uso de la técnica de ola continua (System B).Material y métodos: Se han seleccionado bloques de resina con conductos principales simulados, teniendo cada uno un conducto lateral coronal y otro apical. Un tercer conducto lateral ha sido realizado entre los anteriores, con el fin de sustituir al apical. Un cono de gutapercha( Roeko®, Sybron Endo® y Maillefer®) o de Resilón® es termo plastificado en cada conducto lateral. Después de obtener la imagen radiográfica se realizaron las mediciones en un analizador de imagen y los datos se analizaron estadísticamente. Resultados y conclusiones: Más allá de 2 mm de la punta del System B no se ha observado penetración de ninguna de las presentaciones comerciales de gutapercha ni de Resilón®. Se han encontrado diferencias estadísticamente significativas en relación a la obturación del conducto lateral superior (p≤0,05), siendo el Resilón® el material que más ha penetrado (AU)

Introduction and objective: The objective of the study was to compare the penetration of different commercial brands of gutta-percha and Resilon® in the lateral canals using the continuous wave technique (System B).Material and methods: We selected blocks of resin with simulated main canals, each with a lateral coronal canal and apical canal. A third lateral canal was made between these two, with the purpose of substituting the apical canal. Agutta-percha cone (Roeko®, Sybron Endo® or Maillefer®) or Resilon® was thermoplastified in each lateral canal. After obtaining the radiograph, we took measurements in an image analyser and statistically analysed the data. Results and conclusions: Beyond the 2 mm of the System B point, none of the commercial presentations of gutta-percha or Resilon® demonstrated penetration. Statistically significant differences were found as regards the obturation of the upper lateral canal (p≤0.05), with Resilon® recording the highest penetration (AU)