Without such progressive therapies, there is a risk that an unresolved periodontal infection and the related pro-inflammatory response may lead to insulin resistance. 40 This cascade of events makes it difficult for patients and their physicians to achieve and sustain optimal glycemic control which reinforces the importance of collaboration between dentists and physicians in monitoring diabetic patients, via HbA1c testing, for changes in glycemic control and oral health.
Case 3. Cinical presentation of severe periodontal disease in a 66-year-old male with poorly controlled type 2 diabetes.
resistance. This facilitates improved glycemic control, as evidenced by reductions in HbA1c levels. This case is an example of what happens to a poorly controlled diabetic patient with periodontal disease and illustrates the therapeutic potential of progressive disease management in bringing about greater periodontal health and metabolic control of diabetes. Radiographs and periodontal charts of this case may be accessed for viewing in the Collateral Case Study Information section available at www.thesystemiclink.com.
Education of diabetic patients regarding the significance
of active periodontal disease and preventive measures This patient was referred to our faculty practice in 1999
need to be incorporated into diabetic case management by a general dentist who had placed the patient on the
at the earliest recognition of diabetes. Patient self-care antibiotic Cleocin®ix (clindamycin) for a periodontal infec-
regimens may include toothpastes that contain antisep- tion (Figure 4). Five years previously this patient had been
tic agents such as triclosan/copolymerviii in addition to treated by a periodontist who performed 4 quadrants of
automated toothbrushes for optimal plaque removal, and periodontal surgery. The patient reported his diabetes
the use of oral irrigation. It is also essential that patients was well controlled; concomitant medications included
are thoroughly educated about the hyperinflammatory Vasotec®x (enalapril) and glyburide. Periodontal evalu-
response related to diabetes, and the importance of a ation revealed the presence of 5-10 mm probing depths
plaque-free mouth. with radiographic evidence of significant bone loss. (This
patient’s periodontal chart and radiographs may be ac-
Assessment of all risk factors for periodontitis and im- cessed for viewing in the Collateral Case Study Informa- plementation of risk reduction strategies (e.g., smoking tion section at www.thesystemiclink.com.) This case was cessation programs, nutritional counseling, and exer- diagnosed as generalized severe periodontitis. Blood sam-cise/weight loss programs) is important for the optimal management of the diabetic patient and should be incorporated into dental practice settings. Monitoring diabetic patient compliance to medication regimens is also part of proactive diabetes management in dental practices. All of these preventive measures are aimed at maintaining control of blood glucose levels, since this will help diabetic patients be more resistant to periodontal infection and allow for improved wound healing and therapeutic responses.
Table 1
Case 3. Blood chemistries of a 66-year-old type 2 diabetic male
More advanced cases of periodontal disease may require surgical intervention, which should be preceded by optimal metabolic control since the healing response is critical for optimal post-surgical responses. Case 3 (Figure 4) involving a 66-year-old, type 2 diabetic male demonstrates how periodontal therapy may reduce the systemic levels of the pro-inflammatory cytokines that contribute to insulin
viii Colgate® Total® Toothpaste, Colgate-Palmolive, Piscataway, NJ
ix Cleocin®, Pfizer, New York, NY
x Vasotec®, Merck Worldwide
Blood Levels Baseline 4 mo. post
therapy
237
Serum Glucose 288 (mg/dL) Glycated Hemoglobin 9. 1 9. 5 (%) Serum TNF-α 1793.3 400.0 (pg/ml) Serum IL- 6 6. 8 4. 7 (pg/ml) Culture IL-1β (pg/ml)
References:
Archives