management at the earliest recognition of diabetes. Preventive measures include frequent dental visits to assess plaque control, conducting risk assessment before surgical procedures are planned, postoperative antibiotic therapy if necessary, and elimination or modification of compounding risk factors such as smoking.
When these pro-inflammatory me-
diators eventually enter the blood
stream, this results in systemically
elevated levels of interleukins (IL- 1
and IL- 6), tumor necrosis factor-α
(TNF-α), and prostanoids, all known
The Systemic Impact of Oral Infec- to have a profound effect on diabetic
tion and Inflammation in Diabetes patients, leading to insulin resis-
The potential for an infectious chal- tance, and resulting in difficulties in
lenge to the oral and/or pocket epi- Case
1. Clinical presentation of severe peri- achieving glycemic control.
28
odontitis in an adolescent girl with type 1 dia-
thelium is well illustrated in Case 1 betes and poor glycemic control.
of a poorly controlled type 1 diabetic Case 2 (Figures 2 and 3), demon-
patient with extensive periodontal dis- strates the severity of oral disease
ease (Figure 1). that can occur in a poorly controlled
diabetic patient and its potential for
systemic injury. This case involves a
46-year-old obese female, registered
nurse, with type 2 diabetes. She also
has a history of hypertension and
hypothyroidism and reported smok-
ing one pack of cigarettes or less
per day. She was referred by her
physician to a radiologist for a man-
dibular and maxillary computerized
tomographic scan (CT scan) (2003)
to determine the extent of dental
disease. She has a history of multiple
If a patient had an equivalent bacterial challenge anywhere else on the body, such as a nonhealing ulcer on the foot of a diabetic patient, it certainly would be of concern as it is easily visible. A bacterial infection of the gingival tissues and the ensuing inflammation resulting in periodontitis can complicate the management of diabetes in the same fashion as other unresolved infections in the body.
Case 2. Clinical presentation of severe periodontal disease and generalized caries in a 46-year-old female with type 2 diabetes.
If periodontitis is left untreated, bacteria will eventually oral abscesses. Her physician noted a large draining ab-enter the bloodstream, interacting with platelets and put- scess in the left maxillary incisor region and was conting patients at greater risk for a number of systemic dis- cerned about paranasal sinus involvement. The CT scan eases, including CVD, the number one killer of people with indicated a mild maxillary and mandibular osteopenia diabetes. 12 The systemic exposure to microbial pathogens of the maxilla and mandible; however, the paranasal si-results from loss of epithelial integrity within the periodon- nuses were normal without involvement of dental disease. tal pocket, allowing bacterial and endotoxin penetration (Other intra-oral images and a panorex radiograph of this into the tissues and translocation into the blood stream, case may be accessed and viewed in the Collateral Case resulting in possible bacteremia and endotoxemia. Recur- Study Information section at www.thesystemiclink.com.) rent transient bacteremias can occur every time a person The physician referred the patient to the faculty practice with untreated periodontitis masticates or brushes their of the School of Dental Medicine at State University of teeth.27 New York at Stony Brook.
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