Abstract
Diabetes mellitus has been linked with an increased risk for
oral diseases, especially periodontal diseases (Oliver & Tervonen
1994, Yalda et al. 1994). Further investigations
have, however, shown that this risk is not equal in all patients
with diabetes. These studies explored the relationship between the
diabetic status and periodontal diseases, dental caries and salivary
factors. In a group of the diabetic adolescents aged 12 to 18 years,
dental caries and gingivitis were shown to associate with poor metabolic
control of diabetes. An increase of caries prevalence and the severity
of gingivitis was evident in alarmingly poorly controlled patients
with glycosylated haemoglobin (HbA1) values
of 13% or higher. The hyperglycaemia-associated increase
of gingivitis was confirmed in a group of newly diagnosed diabetic
children and adolescents, whose gingival inflammation decreased
during a follow-up after the correction of hyperglycaemia by initiation
of insulin treatment. Decreased salivary flow rates and elevated
salivary glucose levels were observed during the hyperglycaemic
state of children and adolescents with newly diagnosed diabetes.
Higher salivary microbial counts, especially yeast counts, were
related to the lower salivary flow rates and higher salivary glucose
levels.
In adult patients with type 1 diabetes, the complex diabetic
status was assessed by means of the level of metabolic control and/or
the presence and severity of diabetic complications. Adult diabetic patients
with poor metabolic control and/or complications exhibited
more deepened pockets and clinical attachment loss, and after periodontal
treatment, the recurrence of deepened pockets was faster in these
patients compared to the other diabetic patients or the controls.
The high-risk subjects among adults with type 1 diabetes were categorised
as follows: subjects with long-term HbA1 values over
10%, independently of whether the patient has diabetic
complications or not; subjects with advanced diabetic complications,
such as preproliferative or proliferative retinopathy, nephropathy, limb
amputations or recurrent infections; and subjects with multiple
diabetic complications, irrespective of the level of metabolic control.
In conclusion, dental professionals should be aware of the
level of glycaemic control in their patients with type 1 diabetes,
and the prevention and intensified treatment should be focused on
those with a poor metabolic control (HbA1c values
around or over 10%). In the case of adult patients, more comprehensive
knowledge about the diabetic status of the patients is needed in
order to be able to identify the subjects at high risk for periodontitis
and in need of regular maintenance care at least twice a year. The
medical and nursing personnel should also be aware of periodontitis
as a complication of diabetes, and especially in the case of adult
diabetic patients, they should refer their patients to dental treatment
when necessary.
| Identifer | oai:union.ndltd.org:oulo.fi/oai:oulu.fi:isbn951-42-5639-5 |
| Date | 04 May 2000 |
| Creators | Karjalainen, K. (Kaisa) |
| Publisher | University of Oulu |
| Source Sets | University of Oulu |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/doctoralThesis, info:eu-repo/semantics/publishedVersion |
| Format | application/pdf |
| Rights | info:eu-repo/semantics/openAccess, © University of Oulu, 2000 |
| Relation | info:eu-repo/semantics/altIdentifier/pissn/0355-3221, info:eu-repo/semantics/altIdentifier/eissn/1796-2234 |
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