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Inicio Revista Portuguesa de Estomatologia, Medicina Dentária e Cirurgia Maxilofacial Influência da Diabetes Mellitus no Desenvolvimento da Doença Periodontal
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Vol. 51. Issue 3.
Pages 167-176 (July - September 2010)
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Vol. 51. Issue 3.
Pages 167-176 (July - September 2010)
Revisão
Open Access
Influência da Diabetes Mellitus no Desenvolvimento da Doença Periodontal
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Diana Correia
,
Corresponding author
danaelc@hotmail.com

Correspondência para:.
, Gil Alcoforado**, Paulo Mascarenhas***
* Médica Dentista Militar no Serviço de Estomatologia e Medicina Dentária do HMP
** Professor Catedrático da FMDUL e regente da cadeira de Periodontologia. Director do Curso de Especialização em Periodontologia da FMDUL
*** Mestre em Periodontologia e Docente da disciplina de Periodontologia e do Mestrado na Universidade de Lisboa
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Abstract

Diabetes is a condition in which there is a chronically raised blood glucose levels caused by an absolute or relative lack of insulin due to insufficient production by the pancreas, or a deficit in the insulin action for the body needs. Periodontal disease is one of its complications, which is a chronic inflammatory disease that begins with an oral infection that leads to a destruction of periodontal tissues. The purpose of this review is to provide the reader with knowledge concerning the relationship between diabetes mellitus and periodontal diseases, focused on the effects of Diabetes in periodontal health, through the exacerbation of certain factors presents on this condition. It was made a research of scientifically articles via internet search engines like “Med-line” and “B-on”, as well scientifically magazines and books. Immunological, microbiological and wound healing factors were analyzed and compared between diabetics and non-diabetic patients. It was also analyzed clinical attachment loss, and other parameters, which were shown to be significantly higher in diabetes compared to that in non-diabetics, and the clinical attachment loss is higher in those with poor metabolic control. Periodontal therapy is an important factor on the control of diabetic patients and periodontal health. Diabetic patients with good metabolic control should be treated like healthy individuals. For some diabetic patients, the ideal HbA1c levels are not achieved even though they are considered controlled for the disease. There's not a consensus for the use of antibiotics in this patients, but we can see an improving of metabolic control in low doses or in doses without antibacterial effects.

Key-words:
Diabetes Mellitus
Periodontal Disease
Citokines
Inflamation
Periodontal Therapy
Resumo

A diabetes é uma condição sistémica em que se verifica uma elevação crónica dos níveis de glicose causada por uma absoluta ou relativa falta de insulina devido a uma insuficiente produção pelo pâncreas ou uma deficiência da sua acção no organismo. Uma das complicações da condição diabética é a doença periodontal. Esta revisão tem como objectivo mostrar a relação entre ambas as doenças, focando-se nas alterações de determinados factores presentes na Diabetes Mellitus que actuam sinergicamente com a condição de doença periodontal e são os principais responsáveis pelo aumento da destruição periodontal. Foi efectuada uma pesquisa de artigos científicos através dos motores de busca “Med-line” e “B-on”, bem como revistas e livros científicos. Dos artigos pesquisados foram analisados factores associados à resposta imunológica, microbiologia e cicatrização dos tecidos. Na análise dos parâmetros periodontais verificou-se que a perda de inserção é maior e mais prevalente em pacientes diabéticos e à medida que o controlo glicémico diminui os seus valores aumentam. A terapia periodontal é um importante factor no controlo da diabetes e saúde periodontal, verificando-se que pacientes diabéticos bem controlados devem ser tratados com os mesmos protocolos que os pacientes saudáveis. Porém grande parte destes pacientes não conseguem um controlo glicémico, segundo os padrões da ADA e os níveis de HbA1c que apresentam são uma condição controlada para esses pacientes. Alguns casos podem justificar o uso de antibióticos contribuindo para uma maior alteração de moléculas intervenientes na resposta pró-inflamatória e consequentemente um melhor controlo metabólico nestes pacientes.

Palavras-Chave:
Diabetes Mellitus
Doença Periodontal
Citoquinas
Inflamação
Terapia Periodontal
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Bibliografia
[2-]
Academy Reports. Position Paper.
Diabetes and periodontal Diseases.
Journal of Periodontology, 70 (1999), pp. 935-949
[3-]
R.L. Souhami, J. Moxham.
Textbook of Medicine.
4th, Churchill Livingstone, (2002),
[5-]
B. Liljenberg, J. Lindhe, T. Berglundh, G. Dahlen, R. Jonsson.
Some microbiological, histopathological and immunohistochemical characteristics of progressive periodontal disease.
J Clin Periodontal, 21 (1994), pp. 720-727
[6-]
B.G. Loos.
Systemic Markers of Inflammation in Periodontitis.
J Periodontol, 76 (2005), pp. 2106-2115
[11-]
B.L. Mealey, T.W. Oates.
Diabetes Mellitus and Periodontal Diseases –AAP-Commissioned Review.
J Periodontal, 77 (2006), pp. 1289-1303
[12-]
M.P. Preshaw.
Diabetes and periodontal disease.
International Dental Journal, 58 (2008), pp. 237-243
[13-]
S. Grossi, R.J. Genco.
Periodontal Disease and Diabetes Mellitus: A Two-Way Relationship.
Ann Periodontol, 3 (1998), pp. 51-61
[14-]
W.A. Soskolne, A. Klinger.
The Relationship Between Periodontal Diseases and Diabetes: an Overview.
Ann Periodontol, 6 (2001), pp. 91-98
[15-]
G.W. Taylor.
Bidirectional interrelationships between Diabetes and periodontal diseases: An epidemiologic perspective.
Ann Periodontol, 6 (2001), pp. 99-112
[16-]
D. Kasper, E. Braunwald, A. Fauci, S. Hauser, D. Longo, J.L. Jameson, et al.
Harrison's Medicina Interna.
McGraw-Hill, (2006),
[17-]
J. Lindhe, K. Thorkild, N. Lang.
Tratado de Periodontia Clínica e Implantologia Oral.
Guanabara Koogan, (2005),
[19-]
Y. Khader, A. Dauoda, S. EI-Qaderib, A. Alkafajei, W. Batayha.
Periodontal status of diabetics compared with nondiabetics: a meta-analysis.
Journal of Diabetes and its Complications, 20 (2006), pp. 59-68
[20-]
A.M. Iacopino.
Pathophysioloaical Relationships Between Periodontitis and Systemic Disease: Recent Concepts Involving Serum lipids.
J Periodontol, 71 (2001), pp. 1375-1384
[21-]
A. Garg.
Lipid-lowering therapy and macrovascular disease in diabetes mellitus.
Diabetes, 41 (1992),
[22-]
U.K. Prospective Diabetes Study (UKPDS) Group.
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
Lancet, 352 (1998), pp. 837-853
[23-]
V.I. Haraszthy, J.J. Zambon, M. Trevisan, M. Zeid, R.J. Genco.
Identification of Periodontal Pathogens in Atheromatous Paques.
J Periodontal, 71 (2000), pp. 1554-1560
[24-]
C.W. Cutler, E.A. Shinedling, M. Nunn, et al.
Association between periodontitis and hyperlipidemia: Cause or effect?.
J Periodontal, 70 (1999), pp. 1429-1434
[25-]
G.E. Salvi, M. Kandylaki, A. Troerulle, G.R. Persson, N.P. Lang.
Experimental gingivitis in type I diabetics a controlled clinical and microbiological study.
J Clin Periodontol, 32 (2005), pp. 31-316
[26-]
J.G. Caton, S.G. Ciancio, T.M. Blieden, M. Bradshaw, R.L. Crout, A.F. FIefti, et al.
Sub antimicrobial dose doxycycline as an adjunct to scaling and root planning: post–treatment effects.
J Clin Periodontol, 28 (2001), pp. 782-789
[27-]
D.L. Doxey, S. Nares, B. Park, C. Trieu, C.W. Cutler, A.M. lacopino.
Diabetes-induced impairment of macrophage cytokine release in a rat model: Potential role of Iserurn lipids.
Life Sci, 63 (1998), pp. 1127-1136
[29-]
C. Andersen, A. Flyvbjerg, K. Buschard, P. Holmstrup.
Relationship Between Periodontitis and Diabetes: Lessons From Rodent Studies.
J Periodontol, 78 (2007), pp. 1264-1275
[30-]
J.A. McMullen, E. Van Dyke, H.U. Horoszewicz, R.J. Genco.
Neutrophil Chemotaxis in Individuals with Advanced Periodontal Disease and a Genetic Predisposition to Diabetes Mellitus.
J Periodontology, 52 (1981), pp. 167-173
[31-]
D. Gonçalves, F.O.B. Correa, N.M. Khalil, O.M.M. Oliveira, S.R.P. Orrico.
The effect uf nun-surgical periodontal therapy on peroxidase activity in diabetic patients: a case-conlro pilot study.
J Clin Periodontol, 35 (2008), pp. 799-806
[32-]
T. Alpagot, S. Silverman, W. Lundergan, C. Bell, D. Chambers.
Crevicular fluid elastase levels in relation to periodontitis and metabolic control of diabetes.
J Periodont Res, 36 (2001), pp. 169-174
[34-]
F. D’Aiuto, L. Nibali, M. Parkar, J. Suvan, M.S. Tonetti.
Short-term effects of intensive periodontal therapy on serum inflammatory markers and cholesterol.
J Dent Res, 84 (2005), pp. 269-273
[35-]
F. Nishimura, K. Takahashi, M. Kurihara, S. Takashiba, Y. Murayama.
Periodontal disease as a complication of diabetes mellitus.
Ann Periodontol, 3 (1998), pp. 20-29
[36-]
P.M. Duarte, C.H. Tambeli, C.A. Parada, M.Z. Casati, F.H. Nociti.
Overexpression of interleukin- 1 beta and interleukin-6 may play an important role in periodontal breakdown in type 2 diabetic patients.
J Periodont Res, 42 (2007), pp. 377-381
[38-]
T. Raunio, M. Knuuttila, L. Hiltunen, R. Karttunen, O. Vainio, T. Tervonen.
IL-6-174 genotype associated with the extent of periodontal disease in type 1 diabetic subjects.
J Clin Periodontol, 36 (2009), pp. 11-17
[39-]
A. Mathur, B. Michalowicz, M. Castillo, D. Aeppli.
Interleukin I-alpha, interleucin 8 and interferon alpha levels in gingival crevicular fluid.
J Periodont Res, 31 (1996), pp. 489-495
[40-]
Paul Atish T., Gohil Vikrantsinh M., Bhutani Kamlesh K..
Modulating TNF-α signaling with natural products.
Drug Discovery Today, 11 (2006), pp. 15-16
[41-]
S. Engebretson, R. Chertog, A. Niclwls, J. Hey-Hadavi, R. Celenti, J. Grbic.
Plasma levels of tumor necrosis factor-alfa in patients with chronic periodontitis and type 2 diabetes.
J Clin Periodontal, 34 (2007), pp. 18-24
[43-]
M. Pushkareva, L. Obeid, Y. Hannun.
Ceramide: an endogenous regulator of apoptosis and growth suppression.
Imunology Today, 16 (1995), pp. 294-297
[44-]
G.E. Salvi, J.G. Collins, B. Yalda, R.R. Amold, N.P. Ang, S. Offenbacher.
Monocytic TNF alfa secretion patterns in IDDM patients with periodontal diseases.
J Clin Periodontol, 24 (1997), pp. 8-16
[45-]
S. Matsumoto, H. Ogawa, S. Soda, S. Hirayama, N. Amarasena, Y. Aizawa, et al.
Effect of antimicrobial periodontal treatment and maintenance on serum adiponectin in Type 2 Diabetes Mellitus.
J Clin Periodontol, 36 (2009), pp. 142-148
[46-]
M. Karima, A. Kantarci, T. Ohira, H. Hasturk, V.L. Jones, B.H. Nam, et al.
Enhanced superoxide release and elevated protein kinase C activity in neutrophils from diabetic patients: association with periodontitis.
J Leukoc Biol, 78 (2005), pp. 862-870
[47-]
G. King.
The Role of Inflammatory Cytokines in Diabetes and Its Complications.
J Periodontol, 79 (2008), pp. 1527-1534
[48-]
F.K. Gorus, C.L. Vandeealle, F. Winnock, F. Lebleu, B. Keymeulen, Auwera Van der, et al.
Increased prevalence of abnormal immunoglobulin M, G, and A concentrations at clinical onset of insulin-dependent diabetes mellitus: a registry-based study.
The Belgian Diabetes Registry, 16 (1998), pp. 50-59
[49-]
V. Moreno, M. Candia, M. Robles-Burguefioa.
Hypersialylated macromolecular serum immunoglobulin Al in type 2 diabetes mellitus.
Clinical Biochemistry, 34 (2001), pp. 35-41
[50-]
A. Gugliucci.
Glycation as the glucose link to diabetic complications.
JAOA, 100 (2000), pp. 621-632
[51-]
M.A.B. Gomes, F.H. Rodrigues, S.R. Afonso-Cardoso, A.M. Buso, A.G. Silva, S. Favoreto Jr., M.A. Souza.
Levels of immunoglobulin Al and Messenger RNA for interferon y and tumor necrosis factor a in total saliva from patients with diabetes mellitus type 2 with chronic periodontal disease.
J Periodont Res, 41 (2006), pp. 177-183
[52-]
D. Sternlicht, Z. Werband.
How matrixmetalloproteinases regulate cell behavior.
Annu Rev Cell Dev Biol, 17 (2001), pp. 463-516
[53-]
J.A.F. Silva, M. Lorencini, L.A. Peroni, C.L.R. De La Hoz, H.F. Carvalho, D.R. Stach-Machado.
The influence of type I diabetes mellitus on the expression and activity of Gelatinases (matrix metalloproteinases-2 and I -9) in induced periodontal disease.
J Periodont Res, 43 (2008), pp. 48-54
[54-]
American Diabetes Association.
Diagnosis and classification of diabetes mellitus. Position statement.
Diabetes Care, 29 (2005), pp. S37-S42
[55-]
T. Trevonen, T. Raunio, M. Knuutilla, R. Karttunen.
Polymorphisms in the CD14 and IL-6 genes associated with periodontal disease.
J Clin Periodontal, 34 (2007), pp. 377-383
[56-]
C.S. Alley, R.A. Reinhardt, C.A. Maze, et al.
HLA-D and T Lymphocyte reactivity to specific periodontal pathogens in type 1 diabetic periodontitis.
J Periodontal, 64 (1993), pp. 974-979
[57-]
B.L. Mealey, A.J. Moritz.
Hormonal-influences: effects of diabetes mellitus. And. endogenous female sex steroid c hormones on the· periodontium.
Periodontology, 32 (2003), pp. 59-81
[58-]
A.M. Schmidt, S.D. Van, J.L. Wautier, D. Stem.
Activation of receptor for advanced glycation end products. A mechanism for chronic vascular dysfunction in diabetic vasculopathy and atherosclerosis.
Circ Res, 84 (1999), pp. 489-497
[59-]
P. Wei, K. Ho, Y. Wu, Y. Yang, C. Tsai.
The investiation of glutathione peroxidase, lactoferrin, myeloperoxidase and interleukin-1 beta in gingival crevicular fluid: implications for oxidative stress in human periodontal diseases.
Journal Of Periodontal Research, 39 (2004), pp. 287-293
[60-]
E. Lalla, B. Cheng, S. Lal, S. Kaplan, B. Softness, E. Greenberg, et al.
Diabetes-related parameters and periodontal conditions in children.
J Periodont Res, 42 (2007), pp. 345-349
[61-]
M.J. Hussain, M. Peakman, H. Gallati, S.S. Lo, M. Hawa, G.C. Viberti, P.J. Watkins, R.D. Leslie, D. Vergani.
Elevated serum levels of macrophage-derived cytokines precede and accompany the onset of IDDM.
Diabetologia, 391 (1996), pp. 60-69
[62-]
F. Lanza.
Clinical manifestations of myeloperoxidase deficiency.
Journal of Molecular Medicine, 76 (1998), pp. 676-681
[63-]
S. Offenbacher, P.A. Heasman, J.G. Collins.
Modulation of host PGE2 secretion as a determinant of periodontal disease expression.
Journal of Periodontology, 64 (1993), pp. 432-444
[64-]
T. Dyke.
The Management of Inflammation in Periodontal Disease.
J Periodontol, 79 (2008), pp. 1601-1608
[65-]
L. Sbordone, L. Ramaglia, A. Borone, R.N. Ciaglia, V.J. Iacono.
Periodontal status and selected cultivable anaerobic microflora of insulin-dependent juvenile diabetics.
J Periodontol, 66 (1995), pp. 452-461
[66-]
R. Mandell, J. DiRienzo, R. Kent, K. Joshipura, J. Haber.
Microbiology of healthy and diseased periodontal sites in poorly controlled insulin dependent diabetics.
Journal of Periodontology, 63 (1992), pp. 274-279
[67-]
S. SastroWijoto, U. ven der Veiden, T. van Steenbergen, A. Hart, J. deGraff, L. Abraham-Inpijn.
Improved metabolic control, clinical periodontal status and subgingivaI microbiologyin insulin·dependent diabetes mellitus. Prospective study.
J CIin Penodontol, 17 (1990), pp. 233-242
[70-]
X. Wang, X. Shen, X. Li, C.M. Agrawal.
Age-related changes in the collagen network and toughness of bone.
Bone, 31 (2002), pp. 1-7
[72-]
L. Bourguignon, M. Ramez, E. Gilad, P. Singleton, A. Man, D. Crumrine.
Hyaluronan-CD44 interaction stimulates keratinocyte differentiation, lamellar body formalion/secretion, and penneability barrier homeostasis.
Journal of Investigative Dermatology, 126 (2006), pp. 1356-1365
[73-]
B. Seppala, T. Sorsa, J. Ainamo.
Morphometric analysis of cellular and vascular changes in gingival connective tissue in long-term insulin-dependent diabetes.
J Periodontol, 68 (1997), pp. 1237-1245
[74-]
E. Unlu, Guneri, J.M. Hekimgi, B. Yesilbek, H. Boyacioglu.
Expression of vascular endothelial growth factor in human periodontal tissues: comparison of healthy and diabetic patients.
Journal of Periodontology, 74 (2003), pp. 181-187
[75-]
A.M. Schmidt, E. Weidman, E. lalla, et al.
Advanced glycation end products (AGEs) induce oxidant stress in the gingival: A potential mechanism underlying accelerated periodontal disease associated with diabetes.
J Periodontal Res, 31 (1996), pp. 508-515
[76-]
K. Esposito, F. Nappo, R. Marfella, et al.
Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: Role of oxidative stress.
Circulation, 106 (2002), pp. 2067-2072
[78-]
A. Yin, S. Miraglia, E. Zanjani, G. Porada, M. Ogawa, A. Leary, et al.
AC 133, a novel marker for human hematopoietic stem and progenitor cells.
Blood, 90 (1997), pp. 5002-5012
[79-]
G. Lucarini, A. Ziw, S.D. Aspriello, L. Ferrante, E. Tosco.
Lo Muzio et al. Involvement of vascular endothelial growth factor, CD44 and CD133 in periodontal disease and diabetes: an Immunohistochemical study.
J Clin Periodontol, 36 (2009), pp. 3-10
[80-]
T. Rees.
Periodontal management of the patient with diabetes mellitus.
Periodontology, 23 (2000), pp. 63-72
[81-]
L. Darre, J. Vergnes, P. Gourdy, M. Sixou.
Efficacy of periodontal treatment on glycaemic control in diabetic patients: A meta- -analysis of interventional studies.
Diabetes & Metabolism, 34 (2008), pp. 491-506
[82-]
L.M. Golub, H. Lee, G. Lehrer, A. Nemiroff, F. Mcnamara, R. Kaplan, et al.
Minocycline reduces gingival collagenolytic activity during Diabetes.
Journal of Periodontal Research, 18 (1983),

(Correia D, Alcoforado G, Mascarenhas P. Influência da Diabetes Mellitus no Desenvolvimento da Doença Periodontal. Rev Port Estomatol Med Dent Cir Maxilofac 2010;51:167–176)

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