High glucose condition aggravates inflammatory response induced by Porphyromonas gingivalis in THP-1 macrophages via autophagy inhibition.

BACKGROUND: Porphyromonase gingivalis (P. gingivalis) is a type of bacteria that causes periodontitis, which is strongly correlated with systemic diseases such as diabetes. However, the effect of hyperglycemia on periodontitis are unclear. The present study examined the effects of high glucose levels on the response to P. gingivalis infection. RESULTS: The expression of P. gingivalis-induced interleukin-1ß (IL-1ß) and inflammasomes increased as the glucose concentration increased. High glucose conditions suppressed P. gingivalis-induced autophagy in human acute monocytic leukemia cell line (THP-1) macrophages. Zingerone increased autophagy and alleviated P. gingivalis-induced inflammatory response in THP-1 macrophages under high glucose conditions. In addition, P. gingivalis- induced inflammation in bone marrow-derived macrophages of diabetic mice was higher than in wild-type mice, but a zingerone treatment decreased the levels. Alveolar bone loss due to a P. gingivalis infection was significantly higher in diabetic mice than in wild-type mice. CONCLUSIONS: High-glucose conditions aggravated the inflammatory response to P. gingivalis infection by suppressing of autophagy, suggesting that autophagy induction could potentially to treat periodontitis in diabetes. Zingerone has potential use as a treatment for periodontal inflammation induced by P. gingivalis in diabetes patients.

Periodontitis and the incidence of metabolic syndrome: An 8-year longitudinal study of an adult Japanese cohort.

AIM: To examine the effect of periodontitis on the development of metabolic syndrome (MetS) and MetS components. MATERIALS AND METHODS: This study included 4761 participants aged 30-74 years who underwent health examinations at both baseline and 8-year follow-up. The Japanese MetS criteria were used for diagnosis. The Community Periodontal Index was used to assess periodontal status. The association between periodontal status and MetS incidence was examined by Poisson regression analysis. RESULTS: Multivariate analysis revealed that individuals with a ≥6 mm periodontal pocket had a significantly higher relative risk (RR) for MetS onset, as compared to individuals without deep periodontal pockets (adjusted RR 1.30, 95% confidence interval [CI]: 1.01-1.67). Compared to individuals without a deep periodontal pocket, individuals with a ≥6 mm periodontal pocket had significantly higher RRs for developing two components of MetS; the RRs were 1.25 (95% CI: 1.01-1.56) for abdominal obesity and 1.39 (95% CI: 1.03-1.86) for hyperglycaemia. CONCLUSIONS: Individuals with periodontitis had a significantly higher risk of MetS onset, possibly due to the influence of periodontitis on abdominal obesity and hyperglycaemia.

Effects of apical periodontitis treatment on hyperglycaemia in diabetes: A prospective cohort study.

AIM: This prospective cohort study was undertaken to evaluate the success rate of root canal treatment (RCT) in type 2 diabetes mellitus (T2DM) patients with targeted level and unachieved targeted level of glycaemic control as well as the impact of RCT on the glucose blood level in T2DM patients. METHODOLOGY: Patients needing RCT were divided into three groups: these without T2DM, that is, the control group (CG), those with targeted level of glycated haemoglobin HbA1c < 7% (TL A1c) and the third ones with unachieved targeted level (UTL A1c), that is, with HbA1c ≥ 7%. Before RCT, HbA1c and the periapical index (PAI) score were assessed, as well as 1 year later. RESULTS: Our results showed less favourable treatment results of RCT such as a reduction of radiographic lesions in T2DM patients, particularly in subjects with UTL A1c. The intergroup analysis of PAI score at the 12-month follow-up revealed a significant difference in TL A1C (p = .022) and CG (p = .001) with respect to UTL A1c. Total number of healed teeth (PAI≤2) at the 12-month after RCT in UTL A1c was significantly lower in comparison to CG (p = .008). Contrariwise, RCT may improve the glycaemic control in diabetic patients with UTL A1c after 12 months of posttreatment. Regression analysis showed that UTL A1c patients were more likely to have AP persistence after endodontic treatment (OR = 4.788; CI: 1.157-19.816; p = .031). CONCLUSIONS: T2DM retards the AP healing and conversely AP contributes to increasing the inflammatory burden in T2DM. RCT reduces the cumulative inflammatory burden in T2DM and thus may contribute to improvement of glycaemic control particularly in patients with UTL A1c.

Hyperglycaemia aggravates periodontal inflamm-aging by promoting SETDB1-mediated LINE-1 de-repression in macrophages.

AIM: To explore whether hyperglycaemia plays a role in periodontal inflamm-aging by inducing phenotypical transformation of macrophages, as well as the potential mechanism via SET domain-bifurcated histone lysine methyltransferase 1 (SETDB1). MATERIALS AND METHODS: A hyperglycaemic mouse model was established using streptozotocin injection. The alveolar bone was analysed using micro-computed tomography. Periodontal inflamm-aging was detected using western blotting, quantitative real-time PCR and immunohistochemical analysis. In vitro, RAW 264.7 macrophages were incubated with various doses of glucose. siRNA or overexpression plasmids were used to determine the regulatory mechanism of SETDB1 in macrophage senescence and inflamm-aging under hyperglycaemic conditions. Expression and distribution of SETDB1 and long interspersed element 1 (LINE-1) in gingival tissues of patients with or without diabetes were detected using immunofluorescent staining. RESULTS: SETDB1 expression in the periodontal tissues of patients and mice with diabetes was down-regulated compared with that in non-diabetic controls. SETDB1 deficiency induced senescence-like phenotypical changes in macrophages, which aggravated periodontal inflamm-aging in diabetic mice. Furthermore, metformin treatment rejuvenated SETDB1 activity and alleviated the hyperglycaemia-induced periodontal inflamm-aging. CONCLUSIONS: The findings of this study show that SETDB1 regulates senescence-like phenotypical switching of macrophages and is a potential candidate for the treatment of diabetes-induced periodontal inflamm-aging.

Elevated cerebrospinal fluid glucose levels and diabetes mellitus are associated with activation of the neurotoxic polyol pathway.

AIMS/HYPOTHESIS: During hyperglycaemia, some glucose bypasses glycolysis and is metabolised via the potentially neurotoxic polyol pathway, in which glucose is metabolised to sorbitol and fructose. Increased polyol concentrations have been demonstrated in the cerebrospinal fluid (CSF) of neurological patients with and without diabetes mellitus. However, polyol levels in patients without evident neurological abnormalities have not been investigated so far. The aim of this study was to determine CSF polyol concentrations in patients without major neurological disease with normal or elevated CSF glucose concentrations. METHODS: This observational cohort study used CSF and plasma analyses, as well as clinical data, from 30 participants of the Anaesthetic Biobank of Cerebrospinal Fluid study. Biomaterial was collected from adult patients scheduled for elective surgery under spinal anaesthesia. CSF polyol concentrations were measured by GC/flame ionisation detector in ten patients with normal CSF glucose levels (group 1), ten patients with elevated CSF glucose levels (group 2) and ten patients with elevated CSF glucose levels and type 2 diabetes (group 3). We compared the concentrations of plasma glucose, CSF glucose, sorbitol and fructose, and CSF polyol/glucose ratios between the three groups, and determined the correlation between plasma glucose levels and CSF glucose, sorbitol and fructose levels. RESULTS: Groups 2 and 3 had significantly higher CSF fructose levels compared with group 1 (p=0.036 and p<0.001, respectively). Group 3 showed significant differences compared with groups 1 and 2 for CSF sorbitol (p<0.001 and 0.036, respectively). Moreover, patients with diabetes had a significantly higher CSF sorbitol/glucose ratio compared with patients without diabetes. There was a strong positive correlation between plasma glucose and CSF glucose, sorbitol and fructose. Finally, age, sex, CSF/plasma albumin ratio and preoperative cognitive function scores were significantly correlated with plasma glucose and CSF glucose, sorbitol and fructose levels. CONCLUSIONS/INTERPRETATION: Hyperglycaemia causes a proportional increase in polyol concentrations in CSF of patients without major neurological disease. Furthermore, this study provides the first indication of upregulation of the cerebral polyol pathway in patients with diabetes without evident neurological abnormalities.

Metabolic syndrome and periodontitis among adults: The 2018 Indonesia National Health Survey.

AIM: This study aimed to examine the association between metabolic syndrome (MetS), its components, and periodontitis among Indonesian adults. MATERIALS AND METHODS: Cross-sectional data from the 2018 Indonesia National Health Survey (Riskesdas) was analysed. The sample included dentate individuals aged 35 years or older for whom complete information was available on components of MetS and periodontitis, including bleeding on probing (BOP) (N = 13,356), pocket depth (PD) (N = 13,273), and clinical attachment loss (CAL) (N = 13,000). Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated with negative binomial regression models. RESULTS: The prevalence of MetS was 41.0%. The prevalence of individuals having at least one tooth with BOP, one tooth with PD ≥4 mm, or one sextant with CAL ≥4 mm was 74.9%, 40.7%, and 40.6%, respectively. No associations were observed between MetS and BOP, PD, or CAL, but hyperglycaemia was constantly positively associated with BOP (RR = 1.06; 95% CI 1.01-1.11), PD (RR = 1.13; 95% CI 1.03-1.23), and CAL (RR = 1.15; 95% CI 1.08-1.23). CONCLUSIONS: Our findings support the potential influence of hyperglycaemia on periodontitis. Incorporating oral disease prevention strategies into the management of systemic diseases could be beneficial for reducing the burden of these diseases in Indonesia.

Effects of diabetes mellitus on dental pulp: A systematic review of in vivo and in vitro studies.

OBJECTIVES: This systematic review (PROSPERO CRD42021227711) evaluated the influence of diabetes mellitus (DM) on the response of the pulp tissue and in the pulp cells behaviour. MATERIALS AND METHODS: Searches in PubMed/MEDLINE, Embase, Web of Science and OpenGrey were performed until March 2022. Studies evaluating the effects of DM in the pulp tissue inflammation and in the cell behaviour were included, followed by risk of bias assessment (Methodological Index for Non-Randomized Studies and SYRCLE's RoB tools). The meta-analysis was unfeasible, and a narrative synthesis for each outcome was provided. RESULTS: Of the 615 studies, 21 were eligible, mainly with in vivo analysis (16 studies). The pulp inflammation (10 studies) was analysed mainly by haematoxylin-eosin stain; DM increased pulp inflammation/degeneration in 9 studies, especially after dental procedures. The cell viability (5 studies) was analysed mostly using MTT assay; DM and glycating agents decreased cellular viability in 3 studies. DM reduced collagen in all of three studies. There were controversial results regarding mineralization; however, increased alkaline phosphatase was reported in three of four studies. CONCLUSIONS: DM seems to increase inflammation/degeneration and mineralization in the pulp tissue while reducing cell proliferation. Further analyses in human pulp are important to provide stronger evidence.

Hyperglycaemia-associated macrophage pyroptosis accelerates periodontal inflamm-aging.

AIM: Pyroptosis and inflamm-aging have been newly identified to be involved in diabetic periodontitis. This study aimed to elucidate whether macrophage pyroptosis plays a role in periodontal inflamm-aging by impacting the senescence of fibroblasts, as well as the potential mechanism via NLR family CARD domain-containing protein 4 (NLRC4) phosphorylation. MATERIALS AND METHODS: Diabetes was induced in mice using streptozotocin. Periodontal pyroptosis and senescence were detected using immunohistochemical analysis. Prior to evaluating senescence in human gingival fibroblasts cultured with conditioned medium derived from macrophages, RAW 264.7 macrophages were confirmed to undergo pyroptosis by scanning electron microscopy and gasdermin D (GSDMD) detection. The NLRC4-related pathway was examined under hyperglycaemic conditions. RESULTS: Our data showed that macrophage pyroptosis induced the expression of senescent markers in vivo and in vitro. Importantly, clearance of pyroptotic macrophages rescued senescence in fibroblasts. Furthermore, GSDMD activation and pyroptosis in hyperglycaemia were found to be mediated by NLRC4 phosphorylation. CONCLUSIONS: Hyperglycaemia could initially induce macrophage pyroptosis and lead to cellular senescence, thereby critically contributing to periodontal pathogenesis in diabetes. In particular, NLRC4 phosphorylation could be a potential therapeutic target for the inhibition of this process.

Correlation between glycaemic state and tooth mobility in patients with periodontal disease.

OBJECTIVE: To evaluate the association of tooth mobility with glycaemic levels in patients with periodontitis. METHODS: The cross-sectional study was conducted at the Department of Oral Medicine, Ziauddin Dental Hospital, Karachi, from December 2018 to May 2019, and comprised patients of either gender with chronic periodontitis. After recording demographic details and dental charting, tooth mobility scores were correlated with gingival crevicular blood glucose, finger capillary blood glucose and glycosylated haemoglobin levels using Pearson's correlation. Linear regression was applied to assess the inter-relation between the variables. Data was analysed using SPSS 20. RESULTS: Of the 348 patients, 202(58%) were females and 146(42%) were males. The overall mean age was 43±10.4 years. The mean number of teeth in patients with glucose levels <180mg/dl was 25.5±2.5 compared to 23.2±2.9 in individuals with glucose levels >200mg/dl. A moderate positive correlation (r=0.658) was seen between gingival crevicular blood glucose levels and tooth mobility. Finger capillary blood glucose levels also showed good correlation (r=0.653) with tooth mobility scores. Glycosylated haemoglobin scores showed a strong positive correlation(r=0.733). Linear regression confirmed increased glycaemic levels as a risk factor for tooth mobility (p<0.001). CONCLUSIONS: Tooth mobility and glycaemic levels were found to be strongly interrelated.

Gestational diabetes and the human salivary microbiota: a longitudinal study during pregnancy and postpartum.

BACKGROUND: An aberrant composition of the salivary microbiota has been found in individuals with type 2 diabetes, and in pregnant women salivary microbiota composition has been associated with preeclampsia and pre-term birth. Pregnant women, who develop gestational diabetes (GDM), have a high risk of developing type 2 diabetes after pregnancy. In the present study we assessed whether GDM is linked to variation in the oral microbial community by examining the diversity and composition of the salivary microbiota. METHOD: In this observational study the salivary microbiota of pregnant women with GDM (n = 50) and normal glucose regulation (n = 160) in third trimester and 9 months postpartum was assessed by 16S rRNA gene amplicon sequencing of the V1-V3 region. GDM was diagnosed in accordance with the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Cross-sectional difference in alpha diversity was assessed using Student's t-test and longitudinal changes were assessed by mixed linear regression. Cross-sectional and longitudinal difference in beta diversity was assessed by permutational multivariate analyses of variance. Differentially abundant genera and OTUs were identified by negative binomial regression. RESULTS: In the third trimester, two species-level operational taxonomic units (OTUs), while eight OTUs postpartum were differentially abundant in women with GDM compared with normoglycaemic women. OTU richness, Shannon diversity and Pielou evenness decreased from late pregnancy to 9 months after delivery regardless of glycaemic status. CONCLUSION: GDM is associated with a minor aberration of the salivary microbiota during late pregnancy and postpartum. For unknown reasons richness of the salivary microbiota decreased from late pregnancy to postpartum, which might be explained by the physiological changes of the immune system during human pregnancy.

Two-way relationship between diabetes and periodontal disease: a reality or a paradigm?

Diabetes mellitus (DM) and periodontal disease (PD) are both chronic diseases. From one side, DM have an adverse effect on PD, and on the other side PD may influence DM. Systemic therapy of DM with glycaemic control, affects the progress of PD. Reversely treatment of PD combined with the administration of systemic antibiotics seems to have a double effect on diabetic patients reducing the periodontal infection and improving the glycaemic control. Inflammation, altered host responses, altered tissue homeostasis are common characteristic of both DM and PD. The potential common pathophysiologic pathways of direct or reverse relationship of DM and PD are still unknown and further in vitro and in vivo studies are needed to explore this relationship.

Prevalence of undiagnosed diabetes and pre-diabetes in chronic periodontitis patients assessed by an HbA1c chairside screening protocol.

OBJECTIVES: The objective of the present study was to implement a chairside diabetes screening strategy for the identification of undiagnosed hyperglycaemia in periodontal patients. MATERIALS AND METHODS: Measurement of HbA1c was performed in patients (n = 139) diagnosed with periodontal disease to determine possible unknown hyperglycaemia. Patients fulfilled the criteria for screening according to the questionnaire by the Centers for Disease Control and Prevention (CDC). The Cobas® b101 in vitro diagnostic system was used for the measurement of glycosylated haemoglobin (HbA1c) in capillary blood. Body mass index (BMI) and waist circumference were also measured to determine splanchnic obesity. Periodontal parameters were assessed with an automated probe and included probing depth, clinical attachment loss, bleeding on probing and presence/absence of plaque. RESULTS: Most patients had moderate periodontitis. Almost 25% of the subjects tested were found to have unknown hyperglycaemia while 80.5% of them had splanchnic obesity. A significant association was found between HbA1c and BMI (Mann-Whitney test; p = 0.0021) as well as between HbA1c and waist circumference (Spearman rho test; p = 0.0007). No differences were observed regarding periodontal parameters between subjects exhibiting HbA1c ≥ 5.7% and those with HbA1c < 5.7% (Mann-Whitney test; p > 0.05) although those with HbA1c ≥ 5.7% displayed higher proportions of sites with clinical attachment loss > 5 mm (z test with Bonferroni corrections; p < 0.05). CONCLUSIONS: Periodontal patients, especially those with a bigger than normal BMI and waist circumference, are a target group worth screening for diabetes. CLINICAL RELEVANCE: The dental practitioner can contribute significantly to the worldwide effort of health care professionals in diabetes screening and referring for early diagnosis of the disease.

Hyperglycaemia in critically ill patients: the immune system's sweet tooth.

There is an ongoing debate regarding the efficacy of glycaemic control in critically ill patients. Here we briefly highlight the key function of elevated glucose in critically ill patients, namely, to enable elevation of aerobic glycolysis in rapidly dividing cells. In particular, aerobic glycolysis provides metabolic intermediates necessary for expansion of biomass in immune cells and promotion of tissue repair. Furthermore, we emphasise that insulin may inhibit autophagy, a cell survival process used in the bulk degradation of cellular debris and damaged organelles. These observations provide a rational basis for tolerating elevated glucose levels in certain critically ill patients.

Pre-diabetes and well-controlled diabetes are not associated with periodontal disease: the SHIP Trend Study.

AIM: To examine associations of pre-diabetes and well-controlled diabetes with periodontitis. MATERIALS AND METHODS: The Study of Health in Pomerania (SHIP)-Trend is a cross-sectional survey in North-Eastern Germany including 3086 participants (49.4% men; age 20-82 years). Clinical attachment loss (CAL) and periodontal probing depth (PPD) were assessed applying a random half-mouth protocol. The number of teeth was determined. Pre-diabetes comprised impaired fasting glucose and impaired glucose tolerance. Previously known diabetes was defined as well controlled if glycated haemoglobin (HbA1c) was <7.0%. Participants were categorized as follows: normal glucose tolerance (NGT), pre-diabetes, newly detected type 2 diabetes (T2DM), known T2DM with HbA1c<7.0% and known T2DM with HbA1c≥7.0%. RESULTS: Pre-diabetes was neither associated with mean CAL and PPD in multivariable adjusted linear regression models nor with edentulism (OR = 1.09 (95%-CI: 0.69-1.71)) and number of teeth (OR = 0.96 (95%-CI: 0.75-1.22), lowest quartile versus higher quartiles) in logistic regression models. Associations with mean CAL and edentulism were stronger in poorly controlled previously known diabetes than in well-controlled previously known diabetes (for edentulism: OR = 2.19 (95%-CI: 1.18-4.05), and OR = 1.40 (95%-CI: 0.82-2.38), respectively, for comparison with NGT). CONCLUSIONS: Periodontitis and edentulism were associated with poorly controlled T2DM, but not with pre-diabetes and well-controlled diabetes.

Prevalence of Non-diabetic Hyperglycemia in Young Adults and Its Impact on Periodontal Health.

Background Non-diabetic hyperglycemia is a transitional phase of hyperglycemia that poses a hidden risk for the development of diabetes mellitus and related complications, including periodontal destruction. The current study sought to determine the prevalence of non-diabetic hyperglycemia in young adults and any possible links to periodontal health. Methods A total of 400 participants in this cross-sectional study were evaluated for non-diabetic hyperglycemia between the ages of 18 and 35 years. Group I consisted of non-diabetic hyperglycemic participants. Group II comprised an equal number of matched, healthy subjects. The groups' hyperglycemic and clinical periodontal characteristics were contrasted. Using a one-sample t-test and logistic regression analysis, the acquired data were subjected to statistical analysis. Results The prevalence of non-diabetic hyperglycemia was 19%, with men (13%) having a higher prevalence than women (6%). The mean fasting plasma glucose and hemoglobin A1c (HbA1c) levels were 114.47 ± 6.40 mg/dL and 6.10 ± 0.21%, respectively, for group I, and 85.72 ± 7.24 mg/dL and 4.38 ± 0.70% for group II. When compared to healthy controls, all periodontal parameters, including plaque index, gingival index, bleeding on probing, probing depth, and clinical attachment loss, were significantly higher in group I non-diabetic hyperglycemic patients. The regression analysis revealed statistically significant links between hyperglycemic and periodontal parameters. Conclusion The prevalence of non-diabetic hyperglycemia among young adults is a serious concern similar to that of older adults with the risk for periodontal diseases. Non-diabetic hyperglycemic considerations in young adults should be emphasized in dental and medical clinics to reduce the risk of developing diabetes mellitus and to avoid irreversible periodontal tissue damage.

Diabetes mellitus and inflammatory pulpal and periapical disease: a review.

Diabetes mellitus (DM) is one of the most common metabolic disorders. DM is characterized by hyperglycaemia, resulting in wound healing difficulties and systemic and oral manifestations, which have a direct effect on dental pulp integrity. Experimental and clinical studies have demonstrated a higher prevalence of periapical lesions in patients with uncontrolled diabetes. The influence of DM on periapical bone resorption and its impact on dental intervention of such patients are reviewed, and its aetiology and pathogenesis are analysed at molecular level. Pulps from patients with diabetes have the tendency to present limited dental collateral circulation, impaired immune response, increased risk of acquiring pulp infection (especially anaerobic ones) or necrosis, besides toothache and occasional tendency towards pulp necrosis caused by ischaemia. In regard to molecular pathology, hyperglycaemia is a stimulus for bone resorption, inhibiting osteoblastic differentiation and reducing bone recovery. The relationship between poorly controlled diabetes and bone metabolism is not clearly understood. Molecular knowledge about pulp alterations in patients with diabetes could offer new therapeutic directions. Knowledge about how diabetes affects systemic and oral health has an enduring importance, because it may imply not only systemic complications but also a higher risk of oral diseases with a significant effect on pulp and periapical tissue.

Diabetes linked oral complications in south Indian cohorts.

Diabetes is characterized by elevated blood sugar and insulin resistance. In poorly controlled or uncontrolled diabetes, persistent hyperglycemia causes oral and systemic problems. Therefore, it is of interest to evaluate biochemical indicators for oral health and diabetes using a fully automatic biochemistry analyzer which separates patient serum from blood samples. Data shows that diabetic oral complex patients showed high RBS, HbA1c, FBS, and PBSS. Thus, dental condition is linked to diabetes.

Diabetic Striatopathy: A Case Report of a Patient With Poor Glycaemic Control and Abnormal Movements.

Diabetic striatopathy (DS) is a condition occurring in individuals with type II diabetes mellitus (T2DM) where there are abnormal (usually single-sided) bodily movements (hemiballismus-hemichorea (HBHC)). DS involves the interaction between diabetes leading to damage to areas such as the striatum with the development of a noticeable hyperkinetic movement disorder. Here, we present a case of a 72-year-old man with T2DM, ischaemic heart disease, and dyslipidaemia, who presented with involuntary movements of the bilateral upper limbs (the left side more affected than the right) for three weeks along with progressively worsening subtle involuntary movements of the mouth and tongue, with intact speech, swallowing, and gait. The neurological examination revealed high-amplitude intermittent, sudden onset involuntary movements of the bilateral upper limbs, primarily affecting the left side. Based on clinical findings, which were supported by imaging studies, a diagnosis of diabetic striatopathy was made. His presentation was beyond the classical presentation of unilateral involvement seen in HBHC, but with early identification and strict glycemic control, satisfactory improvement of his clinical status was achieved.

A Case-Finding Protocol for High Cardiovascular Risk in a Primary Care Dental School-Model with Integrated Care.

BACKGROUND: National Health Service (NHS) strategies in the United Kingdom (UK) have highlighted the need to maximise case-finding opportunities by improving coverage in non-traditional settings with the aim of reducing delayed diagnosis of non-communicable diseases. Primary care dental settings may also help to identify patients. METHODS: Case-finding appointments took place in a primary care dental school. Measurements of blood pressure, body mass index (BMI), cholesterol, glucose and QRisk were taken along with a social/medical history. Participants with high cardiometabolic risk were referred to their primary care medical general practitioner (GP) and/or to local community health self-referral services, and followed up afterwards to record diagnosis outcome. RESULTS: A total of 182 patients agreed to participate in the study over a 14-month period. Of these, 123 (67.5%) attended their appointment and two participants were excluded for age. High blood pressure (hypertension) was detected in 33 participants, 22 of whom had not been previous diagnosed, and 11 of whom had uncontrolled hypertension. Of the hypertensive individuals with no previous history, four were confirmed by their GP. Regarding cholesterol, 16 participants were referred to their GP for hypercholesterolaemia: 15 for untreated hypercholesterolaemia and one for uncontrolled hypercholesterolaemia. CONCLUSIONS: Case-finding for hypertension and identifying cardiovascular risk factors has high acceptability in a primary dental care setting and supported by confirmational diagnoses by the GP.

Stress hyperglycaemia or diabetes mellitus in cervicofacial infections? A Maxillofacial Surgery Trainee Research Collaborative (MTReC) study.

Diabetes mellitus (DM) is thought to be associated with poor outcomes in cervicofacial infections (CFI), yet little is known about the prevalence of DM in these cases. Stress hyperglycaemia (SHG), a normal physiological response to inflammation, is distinct from DM, though they overlap and may be conflated. We aimed to establish the prevalence of DM and SHG in CFI, and to determine the effect of each on severity of disease and outcome measures. The Maxillofacial Surgery Trainee Research Collaborative (MTReC) carried out an audit of all patients with CFI admitted to 25 hospitals between May and October 2017. To the best of our knowledge this created the largest prospective database on CFI, with information collected on presentation, source of infection, biological data, and outcomes. We recorded 1002 admissions, of which 78 (7.8%) had DM. Random blood glucose was measured on admission in 401 patients (40%), of which 45 (11%) displayed SHG. Patients diagnosed with DM were more likely to have infections arising from a salivary source (13% vs 4%, p<0.00), more returns to theatre (9% vs 2%, p<0.00), and a longer hospital stay (median (range) 2 (0-34) vs 1 (0-139) day, p=0.01) than non-DM patients. In contrast, patients with SHG had more severe disease (multiple fascial spaces involved in 59% vs 19%, p=0.01, and systemic inflammatory response syndrome present in 66% vs 45% p=0.03), but did not have significantly more returns to theatre (2% vs 3%, p=0.91) or longer stays in hospital (median (range) 1 (0-63) vs 1 (0-6), p=0.55) than normoglycaemic patients. The prevalence of DM in our cohort was only marginally higher than in the general population, despite previous retrospective case reviews suggesting a significantly higher prevalence. SHG was not associated with poor outcomes in our cohort, but is likely to be associated with a small increased risk of subsequent diagnosis of DM, which can be quantified using a calculator tool. On discharge, it is important to give appropriate advice about diet, lifestyle, exercise, and weight loss to all patients with CFI.