diabetic periodontitis
Introduction
Introduction to diabetic periodontitis The relationship between diabetes and periodontal disease is a subject that people have been studying for a long time, but there is still no unified understanding. This is mainly due to factors such as the diabetes condition of the subject and whether the diabetes is controlled or not, and the periodontal diagnostic indicators used are not uniform. It is generally believed that diabetes itself does not cause periodontitis, but this disease reduces the body's resistance to periodontal stimulating factors, accelerates the alveolar bone absorption, slows tissue healing, and often presents periodontal abscesses. Some reports suggest that patients with uncontrolled diabetes have more severe periodontal disease than those without diabetes, while those with controlled diabetes have good periodontal tissue. There is a two-way relationship between diabetes and periodontitis, and there are common risk factors and high risk factors. Diabetes increases the risk and severity of periodontitis and is an important risk factor for the development and progression of periodontitis. At the same time, periodontitis is also a risk factor for the development of diabetes, and can increase the occurrence of diabetic complications such as diabetic nephropathy and heart. Risk of vascular disease, etc., effective periodontal treatment is conducive to blood sugar control. basic knowledge Sickness ratio: 0.1% Susceptible people: no specific population Mode of infection: non-infectious Complications: swelling
Cause
Causes of diabetic periodontitis
At present, many studies have confirmed the relationship between diabetes and periodontitis. It is recognized that diabetes is one of the risk factors of periodontal disease (OR2.1~3.0). It has been suggested that periodontitis is the sixth complication of diabetes. The pathological mechanism of diabetes associated with periodontal disease may be leukocyte chemotaxis and phagocytic function defects, changes in vascular basement membrane, decreased collagen synthesis, decreased bone matrix formation, and decreased immunity, resulting in decreased anti-infective capacity and wound healing. obstacle. In recent years, it has been found that the enhancement of the action of advanced glycosylation end products (AGEs) and its cellular receptor (RAGE) is a mechanism for strengthening periodontal disease in diabetic patients.
Diabetes patients with neutrophil adhesion, chemotaxis, phagocytosis, bactericidal function are significantly reduced; due to metabolic abnormalities, microvascular disease occurs, local anaerobic environment, subgingival microbial composition changes; some patients with diabetes due to specific genotypes, Highly reactive to periodontal pathogen infection. Under the stimulation of the same pathogenic bacteria, the amount of inflammatory mediators such as IL-1, PGE2, TNF expressed in type 1 diabetes patients was significantly higher than that in non-diabetic patients, resulting in excessive inflammatory reaction leading to excessive tissue damage. In addition, hyperglycemia can inhibit the activity of fibroblasts and osteoblasts in periodontal fibers, reduce the synthesis of collagen glycosaminoglycans and bone matrix, affect the renewal and reconstruction of periodontal tissues, and the tissue repair function is also weakened. Recent studies have found that type 1 diabetes and rapid progressive periodontitis are associated with histocompatibility antigens HUA-DQ and DR region genes, which affect host immune response through regulation of monocyte macrophage and T cell function. The unfavorable combination of this gene region may be the common genetic basis of severe periodontitis and type 1 diabetes, making both diseases often associated with the same patient. After the blood sugar level of diabetic patients is controlled, the function of neutrophils is improved, the periodontal bacteria are increased, collagen synthesis is increased, wound healing is accelerated, and periodontal lesions are alleviated. Because periodontitis associated with type 2 diabetes has little to do with genetic factors, and is more affected by glucose metabolism, the improvement of periodontal status after glucose metabolism control is more obvious than that of type 1 diabetes patients. On the other hand, severe teeth If patients with Zhouyan are not treated in time, they will aggravate existing diabetes, offset the effects of hypoglycemic agents, and further increase blood sugar.
Prevention
Diabetic periodontitis prevention
In clinical work, some gingival redness and swelling are severe and extensive. Patients with periodontitis with recurrent acute abscess and patients with poor response to conventional periodontal treatment should consider whether they have the possibility of diabetes and carry out the necessary internal medicine. Learn to check. In fact, in view of the important influence of periodontal disease and oral diseases on systemic diseases, the American Diabetes Association has included inquiries and understanding of the dental disease and treatment of diabetes patients in the diagnosis and treatment of diabetes, and the medical insurance industry also actively supports systemic patients. Regular periodontal examination and treatment, early detection, early diagnosis, early treatment.
Complication
Diabetic periodontitis complications Complications swelling Periodontal swelling, pain, submandibular lymph nodes, tenderness.
Symptom
Diabetic periodontitis symptoms Common symptoms Gingival swelling, gums, bleeding, periodontal pocket formation
The history of diabetes affects the onset and progression of periodontitis, especially in patients with poor glycemic control. The inflammation of the periodontal tissue is heavier, the edema of the gingival margin is granuloma-like, the bleeding is easy and the periodontal abscess occurs, and the alveolar bone is destroyed rapidly. Causes deep periodontal pockets and pronounced loose teeth. After blood sugar control, the condition of periodontitis will improve.
The severity of periodontal damage is related to the type of diabetes, the degree of metabolic control, the duration of diabetes, and the presence or absence of systemic complications. Periodontitis can occur in patients with type 1 after 12 years of age. In patients aged 13 to 18 years, the incidence of periodontitis is about 9.8%, compared with 39% for those over 19 years old. The periodontal tissue inflammation of the patient is heavier, and the lesion is heavier at the incisor and the first molar, but after the age increases, the lesion can be extended to other teeth. The subgingival plaque of this type of patients is mainly composed of carbonophilic phagocytic bacteria, anaerobic bacteria and actinomycetes, which are different from the subgingival flora of adult periodontitis and juvenile periodontitis.
Examine
Examination of diabetic periodontitis
Oral endoscopy, blood glucose check.
Diagnosis
Diagnosis and diagnosis of diabetic periodontitis
Diagnosis can be performed based on clinical performance and laboratory tests.
Differential diagnosis
1, early attention to simple periodontitis should be differentiated from marginal gingivitis.
2, when the periodontal abscess should be identified with the alveolar abscess.
