About 2 years after the patient was diagnosed with an important risk factor that needs to be controlled in periodontal disease, she was diagnosed with rheuma- order to improve overall health. It is known that the more toid arthritis. Since that time, she has also suffered from complications a diabetic individual may have the more hypertension. Her medications included: Lente human likely he/she is to develop other complications of diabetes. insulin (morning and bedtime) and Humalog®xi (insu- Periodontitis has been linked to other well-known compli-lin sliding scale), captopril, Lasix®xii (furosemide), folic cations such as retinopathy, angiopathy, and nephropa-acid, Zoloft®xiii (sertraline), methotrexate, and predni- thy. 3,54,55 A recent study in Type 2 diabetic patients has sone. Full mouth charting revealed generalized 5-7 mm linked periodontitis to mortality in diabetic patients from probing depths and radiographs revealed mild to mod- nephropathy and CVD. 4 Just as physicians closely moni-erate bone loss. (This patient’s radiographs, periodontal tor diabetic patients for metabolic control, compliance, charts, and other intra-oral images may be accessed for and overall systemic health, it is necessary for the den-viewing in the Collateral Case Study Information sec- tal providers to do the same. Periodontal disease may be tion at www.thesystemiclink.com.) A diagnosis of gen- monitored and controlled with careful attention to patient eralized moderate periodontitis with localized severe compliance to self-care, and regular care from dental periodontitis on tooth #10 was made. The patient was practitioners who are diligent in monitoring periodontal given oral hygiene instructions and prescribed Periostat. status and glycemic control. With newly developed treat-This was followed by 4 visits of deep scaling and root ment modalities that target both the microbial and host planing with anesthesia, reevaluation, and maintenance response components of periodontal disease, it is rea-therapy at 3 and 6 months, at which time all probing sonable to expect that metabolic control may improve in depths were < 5 mm. Blood, urine and gingival crevicular diabetic patients simultaneous to improvements in peri-fluid samples were obtained at baseline and 6 months odontal health. This type of progressive care may provide and were evaluated for HbA1c, hsCRP, microalbumin- great promise in decreasing the risk for complications of uria, albumin/creatinine ratio, proteinuria, the presence diabetes. of the cytokines IL-1β, IL- 8, and vascular endothelial growth factor (VEGF). The data collected at baseline and Acknowledgements
6 months is listed in Table 2. The author would like to acknowledge Mrs. Laura Bertolotti for her assistance in the organization of this manuscript and Dr.
It is evident that periodontal therapy resulted in improve- John Rose for his assistance with clinical photographs. ments in the patient’s metabolic control and may have reduced her risk for CVD, as supported by the significant Financial Disclosure reduction in hsCRP levels from a high risk level to a low Dr. Ryan is a consultant, serves on a number of advisory boards risk level. It is interesting to note that this same dental and is named on patents as an inventor of therapeutic applica- host modulatory therapy was used in a pilot medical trial tions of tetracyclines discussed in this article. These patents have to assess it’s usefulness as an agent to prevent acute cor- been fully assigned to the research foundation of Stony Brook onary syndromes.53 In this study it significantly reduced University, State University of New York, Stony Brook, NY, and systemic levels of the cytokine IL- 6, consequently reduc- have been exclusively licensed to CollaGenex Pharmaceuticals, ing hsCRP levels, and it also significantly inhibited the Newtown, PA. enzymes responsible for the disruption of atheromatous plaques. References
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