Periodontitis In Diabetic Patients Research Articles

Albiflorin Inhibits Advanced Glycation End Products-Induced ROS and MMP-1 Expression in Gingival Fibroblasts.

Periodontitis is a common complication of diabetes, with advanced glycation end products (AGEs) playing a key role in its pathogenesis. Albiflorin, a monoterpene glycoside, has shown potential anti-inflammatory and antioxidant properties. This study aims to investigate the effects of albiflorin on AGEs-induced gingival fibroblasts and its underlying mechanisms. This study aimed to evaluate the role of albiflorin in mitigating ROS production, inflammation, and MMP-1 expression in AGEs-induced gingival fibroblasts. The viability of gingival fibroblasts treated with albiflorin and AGEs was assessed using CCK-8 assays. ROS levels were measured by DCF staining, and the expression of inflammatory markers and MMP-1 was evaluated by ELISA and qPCR. The involvement of the NF-κB and Nrf2 pathways was examined by immunoblotting. Albiflorin enhanced the viability of AGEs-induced gingival fibroblasts and reduced ROS production. It also decreased the expression of IL-6, IL-8, RAGE, and MMP-1, suggesting an anti- inflammatory effect. Mechanistically, albiflorin modulated the NF-κB and Nrf2 pathways in AGEs-induced gingival fibroblasts. Albiflorin exhibited protective effects against AGEs-induced oxidative stress and inflammation in gingival fibroblasts, highlighting its potential as a therapeutic agent for periodontitis in diabetic patients. The modulation of the NF-κB and Nrf2 pathways by albiflorin provides insight into its mechanism of action.

Association between carotenoid intake and periodontitis in diabetic patients.

This study aimed to evaluate the association between dietary carotenoid intake and periodontitis in diabetic patients. Data on diabetic patients were collected from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 for this cross-sectional study. Dietary intake of carotenoids was assessed through the first 24-hour dietary recall interview. Full-mouth periodontal examinations were conducted by trained dental examiners. Subgroup analysis was conducted in terms of age, gender, the number of missing teeth, cardiovascular disease, smoking, and anti-diabetic drugs. Totally 1914 diabetic patients were included, with 1281 (66.93%) in the periodontitis group. After adjusting for age, gender, race, education, smoking, dental implants, hepatitis, and the number of missing teeth, α-carotene intake ≥55.82 mcg was associated with lower odds of periodontitis than α-carotene intake <55.82 mcg [OR = 0.70, 95% CI: 0.53-0.91, P = 0.010]; lutein and zeaxanthin intake ≥795.95 mcg was associated with decreased odds of periodontitis than lutein and zeaxanthin intake <795.95 mcg (OR = 0.75, 95%CI: 0.57-0.98, P = 0.039). The association between carotenoid intake and periodontitis varied across different subpopulations. In diabetes, dietary intake of α-carotene and lutein and zeaxanthin was inversely associated with the odds of periodontitis, which may facilitate clinical periodontitis management.

Evaluation of fetuin-A and high-sensitivity C-reactive protein levels in gingival crevicular fluid in periodontitis diabetic and nondiabetic patients: an observational diagnostic accuracy study

Introduction Periodontitis is one of the most common chronic inflammatory diseases worldwide although its pathogenesis is still unclear. Diabetes complicates periodontitis changing its grade as a modifying factor. Gingival crevicular fluid (GCF) is regarded now as an important biological fluid especially in periodontal diseases. Hence, the aim of this study was to compare and correlate GCF fetuin-A and high-sensitivity C-reactive protein (hs-CRP) levels in nondiabetic periodontitis patients and diabetic periodontitis patients with healthy participants revealing their possible role in periodontal disease diagnosis. Patients and methods Thirty periodontitis stage III grade B/C patients categorized into two groups according to whether having diabetes mellitus or not were compared to 15 systemically and periodontally healthy participants. Clinical parameters were recorded. Assessment of GCF levels of fetuin-A and hs-CRP were done utilizing an enzyme-linked immunosorbent assay kit. Receiver operating characteristic curve was performed revealing sensitivity, specificity, predictive value, and diagnostic accuracy of both markers. Results GCF fetuin-A levels showed statistically significant difference between the three groups (P &lt; 0.001) with the highest level in healthy group followed by the nondiabetic periodontitis group then the diabetic periodontitis group. While for hs-CRP level, it showed significantly higher results in nondiabetic periodontitis group and the diabetic periodontitis group than in healthy group with no statistically significant difference between both periodontitis groups. Conclusions Both markers have diagnostic ability in discriminating periodontitis against healthy individuals. However, the diagnostic ability in discriminating diabetic patients with periodontitis against nondiabetic periodontitis patients, fetuin-A showed outstanding ability, while the ability of hs-CRP was acceptable.

Effectiveness of Probiotic Therapy in the Management of Periodontal Disease in Diabetic Patients: A Scoping Review.

Probiotics can compete with periodontal pathogens in the formation of dental biofilm, and they are able to modulate local and systemic immune responses. Thus, its use in diabetic patients with periodontal disease (PD) can overcome the limitations of conventional periodontal treatment. This scoping review aimed to understand the extent and type of evidence in relation to the effects of probiotic therapy on periodontal and glycaemic parameters of diabetic patients with PD. An electronic search was performed in the following databases: Cochrane Library, EMBASE, Virtual Health Library (including LILACS and BBO), PubMed (including Medline), Scopus, Web of Science, and Google Scholar. The review included clinical trials on patients with type 2 diabetes, diagnosed with gingivitis or periodontitis, who received probiotic therapy as a single therapy or adjuvant to scaling and root planning, and on whom the analyses of clinical periodontal, immunological, microbiological, or glycaemic parameters were performed. The electronic search yielded a total of 1165 articles. After removing duplicate titles and performing systematic screening, 6 studies were included in the qualitative summary. Probiotic administration improved clinical periodontal parameters (bleeding on probing and probing depth), oxidative stress markers, and inflammatory cytokines (IL-8, IL-10, and TNF-α) in relation to control groups. Experimental groups were also more advantageous in reducing the frequency of periodontopathogenic bacteria. However, the evidence of probiotics in decreasing glycated hemoglobin is still uncertain. Probiotics may provide safe additional benefits to periodontal parameters of patients with type 2 diabetes and periodontal disease.

Knowledge and practice attitudes regarding the relationship between diabetes and periodontitis: a survey among Swiss endocrinologists and general physicians

BackgroundThe objective of the present survey is to assess the knowledge about the relationship between oral health and diabetes and to identify the practice behaviors of Swiss endocrinologists and general practitioners regarding oral health in diabetic patients.MethodsA thirty- item questionnaire was mailed to 428 internists and 99 endocrinologists working in the French speaking part of Switzerland. Participants were asked about their awareness of the relationship between diabetes and periodontal disease, their practice behaviors as well as their willingness for an interdisciplinary education and collaboration with oral health professionals. The questions were answered according to a three-point or five-point Likert scale.ResultsThe response rate was 23%. All participants were aware of the inflammatory and infectious nature of periodontal disease. They all agreed that good periodontal health is important for overall health. However, most of the practitioners responded that only rarely received information during their education curricula on the link between systemic and oral health or concerning periodontal problems in diabetic patients (60.9% for endocrinologists and 54.1% for general physicians); thus, only a minority of health practitioners addresses oral health care to their patients (13% and 15.3%, respectively). Both endocrinologists and general health physicians agreed that an oral health screening could be included in their practice (79% for both groups).ConclusionsAn interdisciplinary education and collaboration among medical and dental health providers should be established to effectively prevent, manage, and control both diabetes and periodontal disease in diabetic patients.

Expression of advanced glycation end products and their receptors in diabetic periodontitis patients.

The systematic review aimed to compare the levels of advanced glycation end products (AGEs) and RAGE (AGE receptors) expression in diabetic periodontitis patients with non-diabetic periodontitis patients and to identify the relationship of AGE and RAGE levels with periodontal disease severity. The literature search was carried out according to PRISMA guidelines by two independent researchers using four online databases: PubMed, Scopus, Web of Science Core Collection, and Pro-Quest. Relevant studies published between 2000 and March 2023 were included in this review. The association of diabetes and AGE/RAGE levels on periodontal health, periodontal pocket depth (PPD), and clinical attachment loss (CAL) was studied. Sixteen cross-sectional studies, including 2794 patients (age range 15-75 years), were identified in the final stage. An elevated AGE level was observed among patients with diabetes and chronic periodontal disease compared to the non-diabetic group. Furthermore, the levels of AGE and RAGE are associated with CAL and PPD. Potential confounding factors like genetic and methodological differences were also responsible for AGE and RAGE variation. Levels of AGEs and RAGE expressions in diabetic periodontitis patients differ from non-diabetic periodontitis patients. The differences may impact the course and severity of periodontal disease.

Quality of life related to periodontal disease in diabetic patients under the health subsidized regime in Manizales

Introduction: quality of life related to oral health is a relevant topic that involves the relationship of dentistry with chronic noncommunicable diseases such as diabetes, given its bidirectional relationship. This study emphasizes the importance of reviewing the impact of periodontal alterations on the quality of life of diabetic patients. The objective of this study was to establish the quality of life related to periodontal status in diabetic patients belonging to the subsidized regime of Manizales. Methods: 90 diabetic adults belonging to the diabetes program of the subsidized regime were observed by means of a structured interview, application of the OHIP-14 instrument (Oral Health Impact Profile on Quality of Life) and direct observation of periodontal status, to establish the index of periodontal extension and severity, description of the OHIP-14 index, establish its relationship with sociodemographic variables and with periodontal health status. Results: we found a prevalence of impaction according to OHIP-14 of 44.4%, extent of impaction with an average of 1.58 (CI: 1.0-2.1) and severity of impaction of 6.7 (CI: 6.2-7.8). When consolidating the OHIP-14 results by dimension, it was observed that the greatest impact corresponded to the physical pain dimension, with a percentage of 81.1%. The lowest percentage was presented in the dimensions of Social Incapacity and Disability or Handicap with 34.4%. Conclusions: although in the population studied, the presence of periodontal disease had a poor impact on quality of life, this was greater in the dimensions of physical pain and psychological discomfort.

Relationship between the levels of awareness and knowledge of periodontitis in diabetic patients at a Dental Hospital during the COVID-19 pandemic

Background: Diabetes mellitus (DM) and periodontitis are the most prevalent human diseases. Diabetes worsens the periodontal condition, but periodontitis also hampers glycemic control in diabetic patients. Based on staging and grading, the latest periodontitis classification puts DM as one of the grade modifiers. Periodic periodontal maintenance prevents reinfection and could help people with diabetes maintain effective glycemic control. Dental health education and periodontal disease awareness are crucially needed for diabetic patients, especially during the pandemic. Purpose: This study aimed to examine the relationship between levels of awareness and knowledge of periodontitis in diabetic patients during the COVID-19 pandemic. Methods: A closed-ended questionnaire was distributed to new patients referred to the Periodontology Clinic of the Dental Hospital of Universitas Indonesia. Patients’ data were collected during the COVID-19 pandemic from January to June 2021. Results: Eighty-four patients participated, of which 34.5 % were diabetic patients with periodontitis. Statistically, significant differences (P &lt; 0.05) were found between levels of awareness and knowledge of periodontitis among diabetic patients and nondiabetic patients (both groups are suffering periodontitis). Awareness and knowledge of periodontitis are inversely correlated with their current clinical periodontal status, therefore patients with less awareness and knowledge have more severe periodontitis. Conclusion: Lack of awareness and knowledge of periodontitis was found among both nondiabetic and diabetic periodontitis patients. Dental health education is required to improve understanding and awareness of the relationship between periodontitis and DM.

Comparative evaluation of the clinical and radiographic efficacy of 0.05% zoledronate gel as local drug delivery system in treating intrabony defects in stage III grade B periodontitis patients with and without type-2 diabetes mellitus-A randomized split-mouth clinical trial.

This 6-month randomized split-mouth and placebo-controlled clinical trial aimed to evaluate the clinical and radiographic efficacy of adjunctive use of 0.05% zoledronate (ZLN) gel as local drug delivery to scaling and root planing (SRP) in stage III, grade B periodontitis patients with and without controlled type-2 diabetes mellitus (DM). A total of 120 infrabony sites were divided into two groups: Group-1 (non-diabetic periodontitis) and Group-2 (periodontitis +DM). A total of 60 sites in each group were randomized to receive treatment with SRP+placebo gel (control) or SRP+0.05% ZLN gel (test). Plaque index (PI), modified sulcus bleeding index (mSBI), pocket probing depth (PPD), and relative attachment levels (RAL) were assessed at baseline, 3 and 6 months, and digital intraoral periapical and cone-beam computed tomography imaging were used to measure the linear and percentage reduction of intrabony defect depth (DD, DDR%) after 6 months. Group-1 showed significant reduction in PI (0.56±0.15 and 0.52±0.19 from 0.67±0.17), mSBI (0.7± 0.60 and 0.47± 0.57 from 0.9±0.48), PPD (4.6± 0.85 and 3.43 ± 0.63 from 6.5±1.04) and gain in RAL (7.03±0.85 and 5.93 ± 0.69 from 8.9±1.09) in the ZLN-treated sites than the placebo sites and also from Group-2 sites after 3 and 6 months, respectively. A significant reduction in DD of 28.79% in Group-1 and 22.20% in Group-2 at ZLN sites was seen compared to placebo sites of both groups. ZLN gel applied subgingivally in infrabony pockets resulted in significant clinical improvements evident by probing depth reduction and gain in attachment levels along with radiographic evidence of more bone fill seen in non-diabetic patients compared to diabetic periodontitis patients.

Efficacy of nonsurgical periodontal therapy affecting salivary biomarkers in non-diabetic and type 2 diabetic periodontitis patients. An observational study.

To assess the effects of non-surgical periodontal therapy on salivary biomarkers in non-diabetic and type 2 diabetic periodontitis patients and to investigate if saliva may be used to monitor glucose levels in type 2 diabetes. 250 participants with chronic generalized periodontitis aged 35-70 years were divided into two groups: test group with type 2 diabetes (125 subjects with 64 males & 61 females) and control group with non-diabetic (125 subjects with 83 males & 42 females). Participants received non-surgical periodontal treatment. Pre-NSPT and 6-week post-NSPT saliva glucose, amylase, total protein, and C-reactive protein (CRP) levels were measured. Intergroup correlations were assessed using Karl Pearson's correlation coefficient and paired t-test. Non-surgical periodontal therapy significantly decreased CRP (p<0.05) in diabetics and non-diabetics. CRP mean values changes from baseline 1.79 to post op 1.5 and baseline 1.5 to post-op 1.24 in males and females of test group, respectively. In control group males and females, mean values change from baseline 1.48 to post-op 1.42 and 1.499 to 1.40. Other parameters Glucose, amylase & total protein showed improvement in the level, but statistically non-significant (p>0.05). Salivary glucose levels corresponded favorably with HbA1C levels. In individuals with type 2 diabetes and non-diabetic generalized chronic periodontitis, non-surgical periodontal therapy may play a role in lowering the level of significant salivary biomarkers. Saliva can be utilized as a non-invasive approach for monitoring glucose levels in people with type 2 diabetes and chronic periodontitis.

Impact of Periodontitis on Glycemic Control and Metabolic Status in Diabetes Patients: Current Knowledge on Early Disease Markers and Therapeutic Perspectives.

Diabetes mellitus and periodontitis are two of the most common chronic diseases affecting the world's population, and they are intimately linked. For several years, in fact, it has been known that there is an interdependent relationship between the two diseases: Diabetes promotes the destruction of periodontal tissues, and periodontal disease negatively affects glycemic control. In relation to the control of dental plaque and oral dysbiosis responsible for periodontal disease, both nonsurgical and surgical therapy associated with proper home hygiene procedures have emerged as essential for good glycemic control. Moreover, several evidences suggest the essential role played by the control of periodontal disease in preventing the onset of the most common complications of diabetes: cardiovascular diseases, retinopathies, and other systemic diseases. The aim of this study is to update the current knowledge on the bi-univocal relationship between diabetes and periodontitis and the impact of therapy in the optimal management of these two disorders. From the information found in the literature, it has emerged that the correct treatment of periodontal disease in diabetic patients represents one of the main mechanisms and means currently established and valid to control periodontal disease and glucose metabolism and prevent the onset or development of diabetic complications.

Mechanism and effects of artesunate on the liver function of rats with type 1 diabetic periodontitis.

Periodontitis is an inflammatory disease of the gums. Periodontitis in diabetic patients can aggravate insulin resistance; however, its molecular and biological mechanism remains unclear. This study aimed to explore the effects of diabetic periodontitis on liver function and determine the mechanism by which artesunate improves liver function. Rats with streptozotocin-induced diabetes were divided into five groups: normal control (NC), diabetic periodontitis (DM+PD), artesunate intervention (ART), insulin intervention (INS), and combined medication intervention (ART+INS) groups. Drug interventions were then administered to the rats in each group as follows: 50mg/kg artesunate to the ART group, 6U/kg insulin to the INS group, and 50mg/kg artesunate + 6U/kg insulin to the ART+INS group. Blood samples, liver tissues, and the maxillary alveolar bone were collected postsacrifice. ART was found to significantly ameliorate hyperglycemia, blood lipid concentrations, and liver function. The levels of inflammatory factors reduced; the effect was more pronounced in the ART+INS group. Artesunate presumably inhibits the TLR4/NF-κB signaling pathway and expression of downstream inflammatory factors, thereby exerting a protective effect on diabetes-related liver function. This offers a fresh approach to treat diabetes mellitus.

Two Way Relationship between Diabetes and Periodontitis: A Cross-Sectional Survey of Knowledge, Awareness, and Attitude

Periodontitis is the inflammation of the periodontium which is the sixth complication of diabetes mellitus. Periodontitis influences the development and progression of diabetes and its complications. Improved knowledge and attitude about periodontitis in diabetic patients reduce the risk of periodontal disease and its effects on the diabetic status. The current study aimed to assess the knowledge, awareness, and attitude of diabetic patients towards periodontal disease. A total of 400 diabetic p

Differences in Oral Microbial Populations of Diabetic Periodontitis Patients with and Without Hypertension

Differences in Oral Microbial Populations of Diabetic Periodontitis Patients with and Without Hypertension

Association of Peroxisome Proliferator-Activated Receptor Gamma 2 Gene Polymorphism with Susceptibility to Diabetic Periodontitis: Experience of a Tertiary Hospital in Fujian Province, China

To investigate the association of the interaction between peroxisome proliferator-activated receptor gamma 2 (PPAR-γ2) gene polymorphism and glycosylated hemoglobin (HbAlc) level with susceptibility to diabetic periodontitis (DP). A total of 259 DP patients and 257 patients with type 2 diabetes mellitus (T2DM) treated from August 2017 to April 2020 were enrolled, and another 180 healthy subjects were selected as control group. The HbA1c level of T2DM patients was determined using automatic biochemical analyzer. PPAR-γ2 gene Pro12Ala polymorphism was detected by the dideoxy chain termination method. The risk factors for DP were analyzed by multivariate logistic regression model. The adjusted odds ratio (OR) and 95% confidence interval of PPAR-γ2 gene Pro12Ala polymorphism and HbA1c level for the risk of DP were estimated, and the interaction between Pro12Ala polymorphism and HbA1c level was analyzed. The risk of DP increased in T2DM patients with genotypes Pro12Ala (PA) and Pro12Ala (AA) (OR=2.529, OR=2.594, P<0.01). T2DM patients with 6%≤ HbA1c <8% or HbA1c ≥8.0% had significantly elevated risk of DP (OR=2.046, OR=3.105), and T2DM patients with HbA1c ≥8.0% had higher risk of DP than those with 6%≤ HbA1c <8% (P<0.01). There was a positive interaction between HbA1c level and Pro12Ala (PA) and Pro12Ala (AA) (γ>1). Individuals with genotypes Pro12Ala (PA) or Pro12Ala (AA) are high risk population of DP. The interaction between these genotypes and HbA1c level facilitates the occurrence and development of DP. Measures should be taken to control HbA1c level or to regulate gene expression, so as to prevent DP.

Evaluation of Serum, Saliva and GCF Visfatin Levels in Chronic Periodontitis Patients with Uncontrolled /Controlled Type2 Diabetes Mellitus

Background: Visfatin is a multifaceted protein that plays an important role in diabetes (DM) and periodontitis (CP). It has been known that during inflammation, the production of IL-1b, TNF-a can be induced by visfatin. Therefore, visfatin is an important mediator for both diseases. The aim of this study is to investigation of visfatin levels in serum, saliva and GCF samples of non-diabetic periodontitis patients and controlled and uncontrolled diabetic periodontitis patients, and evaluation of the relationship with clinical and biochemical parameters of periodontitis &#x0D; Methods: Study protocol, 5 groups which each one were consisted of 15 subjects were planned: periodontally healthy patients with systemically healthy (DM-P-); patients with systemically healthy and CP (DM-P+), periodontally healthy patients with diabetes (DM+P-), patients with diabetes and CP (DM+P+), patients with uncontrolled diabetes and CP (uDM+P). Serum, saliva and GCF samples were obtained and, levels of visfatin, TNF-α and IL-1β were determined by ELISA. &#x0D; Results: The highest visfatin, TNF-α and IL-1β levels were seen in (uDM+P+) group (p&gt;0.001). Significant positive correlations between GCF visfatin levels and GCF TNF-α and IL-1β levels were detected in (uDM+P+) group (p

Measurement of Salivary Lipid Peroxidation in Periodontitis Patients with or Without Diabetes Mellitus

Aim: The aim of the present study is to assess the association of lipid peroxidation in the saliva of healthy and periodontitis patients with or without diabetes mellitus.&#x0D; Study Design: Cross-sectional study.&#x0D; Materials and Methods: The study was conducted in the subjects who visited the University dental hospital as outpatients from October 2020 to January 2021.The subjects were categorized into 3 groups: periodontally healthy (Group a), Periodontitis with diabetes mellitus (Group b) and Periodontitis only (Group c)&#x0D; Results: Lipid peroxidation levels were found to be significantly higher (p&lt;0.021 which is statistically significant) in patients with periodontitis and diabetes mellitus (108 + 7.1) when compared to patients with periodontitis only (77 + 3.5) and healthy group (66+5.6).&#x0D; Conclusion: The study concluded that lipid peroxidation levels are elevated in patients with periodontitis and diabetes mellitus compared to periodontitis only and also when compared to periodontal health which indicate that lipid peroxidation levels could serve as a biomarker for periodontitis in diabetic patients.

New perspective for probe development assessing salivary biomarkers in periodontal affected diabetic patients

The study was performed to have chairside identification of specific biomarkers for diagnosing periodontal disease in diabetic patients at a very early stage using spectroscopic probe design and parameters. Patients were divided into groups: Group (A) - healthy patients, Group (B) - patients with type 2 Diabetes Mellitus (DM) without chronic periodontitis, Group (C) - mild chronic periodontitis patients without type 2 DM, Group (D) - moderate chronic periodontitis patients without type 2 DM, Group (E) - mild chronic periodontitis patients with type 2 DM, and Group (F) - moderate chronic periodontitis patients with type 2 DM. Conceptual and practical design for achieving chairside Raman probe has specific tips and optics applied based on temperature of the mouth. Activation of Matrix metalloproteinase-8 (MMP-8) within salivary specimens were analysed. For molecular docking studies, binding pocket was selected with larger SiteScore. MMP-8 and C-terminal cross-linked telopeptide (CTX) of type I collagen levels in saliva were analysed using MMP-8 Immunoassay. Raman measurements were carried out of salivary specimens. Continuous variables were compared by one‑way analysis of variance. Rate of MMP-8/CTX release was significantly higher in diabetes chronic moderate periodontitis group (p < 0.05). Heat map colour scheme of green indicates increase while the yellow track lines indicate a decrease. Striking difference is seen in Amide regions amongst different groups with lowest intensities seen in diabetic chronic moderate groups and the highest amongst healthy patients (p < 0.05). Major peak at 1447 cm−1 differed in intensities between all groups. Chairside identification of specific biomarkers to diagnosing periodontal disease at a very early stage using spectroscopic probe design and parameters has shown potential.

Study of effect of normal occlusion and malocclusion on periodontal condition of diabetes mellitus patients in dental OPD (Orthodontics) at tertiary care centre, Patna, Bihar, India: A case-control study

: Diabetes mellitus is a metabolic disorder in which there is an abnormal elevation of blood glucose level. The periodontitis is recognized as the sixth complication of diabetes. The role of malocclusion in accelerating plague deposition is well known however in normal occlusion with well aligned teeth is less documented. So, the objectives of the study are to study the prevalence of periodontitis in diabetic patients with malocclusion and in normal occlusion and to study the effect of various determinants of diabetes mellitus if at all exists.: It is case-control observational study. Two hundred (200) patients were included in the study from the dental OPD (Orthodontics) of Dept. of Dentistry, and from the Dept. of Endocrinology, Indira Gandhi institute of medical sciences, Patna, Bihar, India. The statistical analysis was done Microsoft office excel. The results were analysed in frequencies and percentages to estimate the prevalence of malocclusion and occlusion in patients with diabetes mellitus and their effects on periodontium of the teeth.The prevalence rate of severe destructive periodontal diseases (SDPD) in malocclusion group was 81.72% than in normal occlusion group with less prevalence rate of 55.21%.The prevalence of severe destructive periodontal diseases in the uncontrolled diabetes mellitus in malocclusion group was more than in normal occlusion group, with maximum periodontium destruction observed during first between 1-5 years of detection of diabetes.

Hyperglycemia modulates M1/M2 macrophage polarization via reactive oxygen species overproduction in ligature-induced periodontitis.

Periodontitis in diabetic patients is characterized by enhanced inflammation and aggravated tissue damage in comparison with that in non-diabetic counterparts. The progression of periodontal damage under diabetic condition can be partly ascribed to hyperglycemia-induced disturbance between immune activation and inflammation resolution, where macrophages are capable of participating given their plasticity in response to different stimuli. Herein, we aimed to investigate the changes of macrophage polarization in periodontitis under diabetic condition and the underlying mechanism. Type-1 diabetes was induced by the injection of streptozotocin (STZ, 60mg/kg) in Sprague-Dawley rats. Rats in N-acetyl cysteine (NAC)-treated groups received NAC dissolved in drinking water (200mg/kg/day). Experimental periodontitis was induced by ligating 3-0 silk around left maxillary second molars for 4weeks. Alveolar bone destruction was tested by micro-computed tomography and tartrate-resistant acid phosphatase (TRAP) staining. M1/M2 macrophage polarization in periodontal tissue was detected by immunohistochemistry staining. RAW264.7 were cultured in normal glucose (5.5mM) or high glucose environment (25mM) with or without NAC (8mmol/L). LPS (100ng/ml) and IL-4 (20ng/ml) were used to induce M1macrophages and M2 macrophages, respectively. M1/M2 macrophage polarization was detected by qRT-PCR, immunofluorescent staining, and flow cytometry. Reactive oxygen species (ROS) accumulation was detected by fluorogenic probes. RANKL (100ng/ml) were applied to induce osteoclastogenic differentiation of RAW264.7, and osteoclast formation was examined by TRAP staining. Rats with diabetes displayed enhanced macrophages infiltration and M1 macrophage polarization in periodontal lesions compared with vehicle-treated rats. Under LPS or IL-4 stimulation, high glucose culture of RAW264.7 elevated ROS level and increased the expression of M1 macrophage markers (iNOS, TNF-α, and IL-6) whereas decreased the expression of M2 macrophage markers (Arg-1 and CD206). Supernatants of high glucose-treated M1/M2 macrophages enhanced osteoclast formation compared to normal glucose-cultured cells. Decreasing ROS level via NAC partially reversed the effect of high glucose on M1/M2 macrophage polarization. Meanwhile, daily intake of NAC in rodent models inhibited M1 macrophage polarization, which subsequently ameliorated alveolar bone loss and decreased osteoclast numbers in periodontitis in diabetic rats. These findings demonstrated that hyperglycemia could polarize macrophage toward M1 macrophages via overproducing ROS under inflammatory condition, which might take responsibility for aggravated periodontal damage in periodontitis under diabetic condition. Inhibiting M1 macrophages and restoring M2 macrophages by ROS scavenger is hopefully a potential adjunct treatment strategy for diabetic periodontitis.