Current scientific evidence for why periodontitis should be included in diabetes management.

This Perspective provides a brief summary of the scientific evidence for the two-way links between periodontal diseases and hyperglycemia (diabetes mellitus [DM] and pre-DM). It delivers in a nutshell current scientific evidence for manifestations of hyperglycemia on periodontal health status and effects of periodontal diseases on blood glucose levels and in turn incidence, progression, and complications of diabetes. Of outmost importance is presentation of scientific evidence for the potential of routine periodontal treatment to lower blood glucose levels, providing a novel, economical tool in DM management. Non-surgical periodontal treatment ("deep cleaning") can be provided by dental hygienists or dentists in general dental offices, although severe cases should be referred to specialists. Such therapy can decrease the costs of DM care and other health care costs for people with DM. The great importance of a healthy oral cavity free of infection and subsequent inflammation - especially periodontitis that if untreated will cause loosening and eventually loss of affected teeth - has largely gone unnoticed by the medical community as the health care curricula are largely void of content regarding the bi-directional links between oral health and systemic health, despite elevation of blood glucose levels being an integral part of the general systemic inflammation response. The importance of keeping disease-free, natural teeth for proper biting and chewing, smiling, self-esteem, and pain avoidance cannot be overestimated. Medical and dental professionals are strongly encouraged to collaborate in patient-centered care for their mutual patients with - or at risk for - hyperglycemia.

Periodontal complications of hyperglycemia/diabetes mellitus: Epidemiologic complexity and clinical challenge.

This report provides a comprehensive overview of the adverse effects of hyperglycemia on the periodontium. It combines data from literature reviews of original data from two large, population-based epidemiologic studies with comprehensive periodontal health assessment. Emphasis is placed on the exploration of hitherto sparsely reported effects of prediabetes and poorly controlled (uncontrolled) diabetes, in contrast to the umbrella term "diabetes." This stems from the realization that it is not simply having a diagnosis of diabetes that may adversely affect periodontal health. Rather, it is the level (severity) of hyperglycemia that is the determining factor, not the case definition of the diagnosis of diabetes or the type of diabetes in question. Importantly, based on existing evidence this paper also attempts to estimate the improvements in periodontal probing depth and clinical attachment level that can be expected upon successful nonsurgical periodontal treatment in people with chronic periodontitis, with and without diabetes, respectively. This exploration includes the implentation of new systematic reviews and meta-analyses that allow comparison of such intervention outcomes between hyperglycemic and normoglycemic subjects. Based on both existing literature and original analyses of population-based studies, we try to answer questions such as: Is there a glycated hemoglobin concentration threshold for periodontitis risk? Does short-term periodontal probing depth reduction and clinical attachment level gain after scaling and root planing depend on glycemic control in type 2 diabetes? Are short-term scaling and root planing outcomes in people with hyperglycemia/diabetes inferior to those in people without diabetes? Do periodontitis patients with diabetes benefit more from the use of adjuvant antibiotics with nonsurgical periodontal treatment than people without diabetes? Does hyperglycemia lead to greater tooth loss in patients in long-term post-periodontal treatment maintenance programs? Throughout this review, we compare our new findings with previous data and report whether the results of these new analyses corroborate, or are in discord with, similar scientific reports in the literature. We also explore the potential role of dental health-care professionals in helping patients control the risk factors that are identical for periodontitis and diabetes. Finally, we suggest various topics that still need exploration in future research.

Effects of a hydrogel patch on denture-related traumatic ulcers; an exploratory study.

PURPOSE: The aim of this exploratory study was to evaluate the effects of hydrogel patch wound dressing on healing time and pain level of denture-related lesions of the oral mucosa in edentulous individuals. MATERIALS AND METHODS: Twenty-three adults with newly fabricated complete sets of dentures who subsequently developed at least two ulcerative lesions related to their complete dentures were included in the study. For each participant, the smaller lesion (control lesion) was allocated to usual care, that is, adjustment of the denture's margins, whereas the larger lesion (test lesion) was assigned to receive usual care plus application of a hydrogel patch. In the latter, a patch was applied directly on the affected area three times within the first 24 hours, followed by application of three additional patches, namely one during each of the following 3 days. Participants were monitored until complete healing of all ulcers. The primary outcome measures were changes since baseline in each lesion's greatest dimension at days 1 and 7, as well as improvement in ulcer-related pain experienced. RESULTS: Participants were on average about 70 years old, about half were women, and just over 40% had type 2 diabetes. Lesions treated with the hydrogel patch extended between 4.3 and 10.2 mm (mean 7.1 mm) in their greatest dimension, and the smaller lesions receiving usual care were initially 4 mm on average, ranging from 2.0 to 7.0 mm. The hydrogel patch lesions attained 25% to 75% reductions in their greatest lesion extent from baseline to days 1 and 7, respectively, compared to 10% and just over 50% reduction in the lesions that received usual care. Healing rates were similar in patients with and without diabetes. The participants reported significant improvement in pain level 1 day following treatment initiation for 30% of the control lesions, compared to 65% of the lesions treated with the hydrogel patch. CONCLUSIONS: The results of this exploratory study suggest that application of hydrogel patches may represent a novel, effective treatment for accelerating the healing process and pain reduction in mucosal lesions associated with complete dentures also in people with type 2 diabetes; however, larger studies need to confirm these findings.