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detection and prevention of periodontal disease in diabetes
The response to plaque leads to progressive destruction of the connective tissue fibers, resorption of the alveolar bone around the tooth, and deepening of the gingival sulcus or socket. The resulting condition is called periodontitis.
The periodontium--the tissues surrounding, supporting, and attaching to the teeth--is affected by the toxicity of bacterial plaque as well as the resistance of the tissue. The microvasculature of the periodontium in diabetes shows microangiopathic changes that may reduce the resistance of the tissue and allow more severe periodontal disease. If untreated, periodontitis may result in rapid destruction of the tooth support and eventual tooth loss.
This is a periodontal abscess between the lower front teeth in a person with diabetes. An increased susceptibility to acute periodontal abscesses has been reported in uncontrolled diabetes mellitus.
Periodontal abscesses also occur in individuals without diabetes, but their presence should alert the examiner to the possibility of undiagnosed diabetes or a change in diabetic control.
This is gingival granulation tissue on the side of the tooth. Such granulomatous growths from the wall of the gingival sulcus result from periodontal disease.
This is submerged gingival granulation tissue in the wall of a periodontal pocket. This gives the gingiva a magenta or violet color as compared to the normal adjacent periodontium. Abscesses and granulation tissue occur in all persons with periodontal disease but are exaggerated in patients with diabetes. When they occur, blood
glucose tests are indicated.
This is a periodontal abscess in a person with NIDDM of 8 years' duration.
Mouth of the same individual shows severe edema of the palatal tissue and granulation. Note the deep magenta color of the gingiva close to the tooth as compared to the pink of the palate.
Oral hygiene measures--prophy and scaling--carried out by professionals are extremely important in controlling periodontal disease. This slide shows an individual with newly diagnosed NIDDM prior to oral debridement.
One week after treatment, a decrease in inflammation is apparent at the margin of the gum. A dramatic response can occur in a short time with professional removal of calculus and plaque and diligent daily home care.
From the National Institute of Dental and Craniofacial Research
Detection and Prevention of Periodontal Disease in Diabetes
June 1994
http://www.nohic.nidcr.nih.gov/pubs/perdiab/perio/
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