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Etiology and Pathogenesis of Factors Affecting Periodontal Disease Process in Diabetics
Basement Membrane and Microvascular Alteration Changes in the basement membrane and microvasculature are believed to be involved in the periodontal breakdown seen in diabetics. These changes include thickening of the basement membrane, narrowing of capillary lumen, and stasis in microcirculation. Similar to the changes seen in other body tissues, these events might lessen the amount of nutrients delivered and waste eliminated from the tissue resulting in a weakened host response to bacteria. (38-40,42)
Collagen Metabolism
Metabolism of collagen in diabetics is shown to be abnormal. The synthesis of collagen appears to be negatively affected by the presence of glucose. The impaired synthesis and increased breakdown of connective tissue seen in diabetics may account for rapid periodontal destruction. Decreased production by osteoblasts and fibroblasts has been demonstrated in experimentally induced diabetes. Crevicular fluid collagenase activity is also increased in diabetics but can be inhibited in vitro by tetracycline. (27,37)
Microflora
Findings as to the similarity of microflora in diabetics versus nondiabetics vary. (36,37) Glucose levels present in oral fluids may alter the presence of some organisms. Organisms present in individuals with Type 1 appear to be composed of anaerobic vibrios Capnocytophaga and Actinobacillus actinomycetemcomitans. In Type 2 diabetics, microflora is similar to that found in adults without diabetes. (37) It is suggested that the severe periodontitis seen in diabetics is the result of a reduced host response to microorganisms that cause periodontitis rather than the type of microorganism present.
Polymorphonuclear Leukocyte Function/Immune Response
Defective polymorphonuclear leukocyte (PMN) function prevents a normal response to infection. This defect may be reversed with insulin therapy. (27,35) Delayed and incomplete wound healing and susceptibility to infection increases the likelihood of developing periodontal disease. (27)
Age, Duration & Oral Hygiene
Prevalence of periodontal disease increases with age. More importantly, the increased duration of diabetes places the individual at a greater risk for onset and increased severity of periodontal disease. There is a relationship between good oral hygiene and a diminished severity of periodontal disease in individuals with diabetes. (37) Diabetic patients with gum disease should be brought in for recalls every 3-4 months in order to help curtail any problems that may be occurring.
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Pathogenesis of Factors
