DİABETİK HASTALARDA PERİODONTAL TEDAVİ ile HbA1c ARASINDAKİ İLİŞKİ

Son yarım yüzyılda periodontal infeksiyonların sadece periodonsiyumda lokalize olduğu ileri sürülmüşse de günümüzde bu görüş tamamen değişmiştir. Yapılan araştırmalar sonucunda periodontitisin subklinik kronik bir hastalık gibi sistemik inflamatuar cevaba katıldığı ve yüksek serum C-reaktif protein (CRP), interlökin-6 (IL-6) , interlökin-1 (IL-1) ve tümör nekroze edici faktör (TNF-α) konsantrasyonlarına eşlik ettiği ileri sürülmektedir. Periodontitisin, diabetes mellitusun (DM) komplikasyonlarından biri olduğu çalışmalarda gösterilmiştir. Periodontal lezyonlardaki porphyromonas gingivalis gibi potent bakteriyel ürünlerin, diabetik hastalarda diabetik olmayanlara göre daha fazla TNF-α üretimini uyardıkları ileri sürülmektedir. TNF-α’nın diabetik hastalarda insülin direncini attırdığı bilinmektedir. Dolayısıyla, periodontitis ve hiperglisemi birlikteliğinde serum TNF-α seviyesi daha da yükseleceğinden diabetik kontrolün güçleşmesi söz konusu olacaktır. Başarılı bir periodontal tedavinin periodontal hastalığı olan kişilerde serum TNF-α seviyesini azattığı rapor edilmiştir. Serum TNF-α seviyesindeki azalma ile glisemik kontrol üzerindeki iyileşme arasında pozitif korelasyon tespit edilmiştir. Bu ilişki, muhtemelen azalan serum TNF-α’nın insulin direncinde de azalmaya neden olmasına bağlanmaktadır. Amacımız ‘diabetik hastalarda periodontal tedavinin glisemik kontrol üzerine etkisi’nin araştırıldığı çalışmaların sonuçlarını mevcut literatür ışığında tartışmaktır

DİABETİK HASTALARDA PERİODONTAL TEDAVİ ile HbA1c ARASINDAKİ İLİŞKİ

-
Keywords:

-,

___

  • Altuntas Y, Diabetes Mellitus’un Tanımı, Tanısı ve Sınıflanması, Her Yönüyle Diabates Mellitus, Ed: Yenigün M, Altuntas Y, Nobel Tıp Kitabevleri; 2001: 51-62
  • İmamoğlu S. Diabetes Mellitus. Ed. Dolar E, Iç Hastalıkları, Nobel&Günes Tıp Kitabevi İstanbul; 2005: 692-719
  • Reaven G, Strom T. Tip 2 Diyabet Sorular ve Cevaplar, Çev. ed: Satman İ, Merit Publishing International; 2003: 17-35
  • Satman I, Yılmaz MT, and TURDEP group. Population-Based Study of Diabetes and Risk Characteristics in Turkey: Results of the Turkish Diabetes Epidemiology Study (TURDEP). Diabetes Care 2002; 25(9):1551-56
  • Iacopino AM. Periodontitis and diabetes interrelati- onships: role of inflammation. Ann Periodontol. 2001;6(1):125-37
  • D'Aiuto F, Parkar M, Andreou G, Suvan J, Brett PM, Ready D, Tonetti MS.Periodontitis and Systemic Inflammation: Control of the Local Infection is Associated with a Reduction in Serum Inflamma- tory Markers. J Dent Res 2004;83(2):156-60
  • Ide M, McPartlin D, Coward PY, et al. Effect of treatment of chronic periodontis on levels of serum markers of acute-phase inflammatory and vascular responses: J Clin Periodontol 2003;30(4): 334 -340
  • Altuntaş Y. Diyabetes Mellitusta tanı izleme testleri ve metodları. Her yönüyle diabetes mellitus 2. Baskı. Editör Yenigün M İstanbul: Tayf ofset 2001;63-68, 645
  • Mealey BL. Periodontal disease and diabetes: A two-way street .J Am Dent Assoc 2006;137(2):26- 31
  • Moritz AJ, Mealey BL. Periodontal Disease, Insulin Resistance, and Diabetes Mellitus: A Review and Clinical Implications. Grand Rounds in Oral- Systemic Medicine 2006;2(1):13-20.
  • Kanety H, Feinstein R, Papa MZ, et al. Tumor necrosis factor alpha-induced phosphorylation of insulin receptor substrate (IRS-1). Possible mechanism of suppression of insulin-stimulated tyrosine phosphorylation of IRS-1. J Biol Chem 1995;270(40):23780-84
  • Nishimura F, Iwamoto Y, Mineshiba J, Shimizu A, Soga Y, Murayama Y. Periodontal Disease and Diabetes Mellitus: The Role of Tumor Necrosis Factor-α in a 2-Way Relationship. J Periodontol 2003 ;74(1):97-102.
  • Mishima Y, Kuyama A, Tada A, Takahashi K, Ishioka T, Kibata M. Relationship between serum tumor necrosis factoralpha and insulin resistance in obese men with Type 2 diabetes mellitus. Diabetes Research and Clinical Practice 2001; 52(2): 119–23
  • Saito T, Shimazaki Y, Kiyohara Y, Kato I, Kubo M, Iida M, et al. The severity of periodontal disease is associated with the development of glucose intolerance in non-diabetics: the Hisayama study. J Dent Res. 2004;83(6):485–90
  • Kiran M, Arpak N, Unsal E, Erdogan MF. The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus. J Clin Periodontol 2005; 32(3):266 –72
  • Lim LP, Tay FB, Sum CF, Thai AC. Relationship between markers of metabolic control and inflammation on severity of periodontal disease in patients with diabetes mellitus. J Clin Periodontal 2007; 34(2): 118–23.
  • Al-Mubarak S, Ciancio S, Aljada A, Mohanty P, Ross C, Dandona P. Comparative evaluation of adjunctive oral irrigation in diabetics. J Clin Periodontol 2002; 29(4):295 –300
  • Christgau M, Palitzsch KD, Schmalz G, Kreiner U, Frenzel S. Healing response to non-surgical periodontal therapy in patients with diabetes mellitus: clinical, microbiological, and immunologic results. J Clin Periodontol. 1998; 25(2):112-24
  • Herring ME, Shah SK. Periodontal Disease and Control of Diabetes Mellitus JAOA 2006; 106(7): 416-421
  • Stewart JE. Wager KA, Friedlander AH, Zadeh HH. The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus: The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus. J Clin Periodontol 2001; 28(4):306-10
  • Janket SJ, Wightman A, Baird AE, Van Dyke TE, Jones JA. Does periodontal treatment improve glycemic control in diabetic patients? A meta- analysis of intervention studies. J Dent Res 2005;84(12):1154–9
  • Garcia R. Periodontal treatment associated with improved glycaemic control in type 2 diabetic patients. Evid Based Dent. 2007;8(1):13
  • Faria-Almeida R, Navarro A, Bascones A. Clinical and treatment of type 2 diabetic patients with chronic periodontitis. J Periodontol. 2006;77(4):591-8
  • Navarro-Sanchez AB, Faria-Almeida R, Bascones- Martinez A. Effect of non-surgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitis. J Clin Periodontol 2007; 34(10): 835–843
  • Shen CJ, Yin YZ, Shu R . The effect of initial periodontal therapy on metabolic control in type 2 diabetes mellitus. Shanghai Kou Qiang Yi Xue. 2008 ;17(1):6-9
  • Darré L, Vergnes JN, Gourdy P, Sixou M.Efficacy of periodontal treatment on glycaemic control in diabetic patients: A meta-analysis of interventional studies. Diabetes Metab. 2008;34(5):497-506
  • Yang PS, Wang Y, Oi XM, Ren JM, Ge SH. The Effect of initial periodontal therapy on circulating TNF- α and HbA1c in type 2 diabetes patients with periodontitis. Zhongua Kou Qiang Yi Xue Za Zhi.2003; 38(5): 364-6
  • Westfelt E, Rylander H, Blohme G, Jonasson P, Lindhe J. The effect of periodontal therapy in diabetics. Results after 5 years. J Clin Periodontol 1996;23(2): 92-100
  • Yang YZ, Sun Z, Jin LJ, Liang HQ, Hu CZ, Yang YG, Corbet EF. Observation of the non-surgical treatment response on diabetic patients with chronic periodontitis. Shanghai Kou Qiang Yi Xue. 2004;13(1):6-9
  • Promsudthi A, Pimapansri S, Deerochanawong C,Kanchanavasita W. The effect of periodontal therapy on uncontrolled type 2 diabetes mellitus in older subjects. Oral Diseases 2005; 11(5):293-8
  • Iwamoto Y, Nishimura F, Nakagawa M, et al. The effect of antimicrobial periodontal treatment on circulating tumor necrosis factor-alpha and glycated hemoglobin level in patients with type 2 diabetes. J Periodontol 2001;72(6):774–8
  • Miller LS, Manwell MA, Newbold D, Reding ME, Rasheed A, Blodgett J, et al. The relationship between reduction in periodontal inflammation and diabetes control: a report of 9 cases. J Periodontol.1992; 63(10): 843 -8.
  • Grossi SG, Skrepcinski FB, DeCaro T, Robetrson DC, Ho AW, Dunford RG, Genco RJ. Treatment of periodontal disease in diabetics reduces glycated hemoglobin. J periodontol. 1997;68(8):713-9.
  • O'Connell PA, Taba M, Nomizo A, Foss Freitas MC, Suaid FA, Uyemura SA, Trevisan GL, Novaes AB, Souza SL, Palioto DB, Grisi MF.Effects of periodontal therapy on glycemic control and inflammatory markers. J Periodontol. 2008;79(5): 774-83.
  • Katagiri S, Nitta H, Nagasawa T, Uchimura I, Izumiyama H, Inagaki K, Kikuchi T, Noguchi T, Kanazawa M, Matsuo A, Chiba H, Nakamura N, Kanamura N, Inoue S, Ishikawa I, Izumi Thus. Multi-center intervention study on glycohemoglobin (HbA1c) and serum, high-sensitivity CRP (hs-CRP) after local anti-infectious periodontal treatment in type 2 diabetic patients with periodontal disease. Diabetes Res Clin Pract. 2009;83(3):308-15.
  • Rodrigues DC, Taba MJ, Novaes AB, Souza SL, Grisi MF. Effect of non-surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus [published correction appears in J Periodontol. 2004;75:780]. J Periodontol.2003; 74(9):1361 –7.
  • Li X, Kolltveıt KM, Tronstad L, Olsen I. Systemic Diseases Caused by Oral Infection. Clin Microbiol Rev 2000 ;13(4): 547–58.
  • Slots J. Selection of antimicrobial agents in periodontal therapy [review]. J Periodontal Res 2002; 37(5): 389 -398.
  • Preshaw PM, Hefti AF, Jepsen S, Etienne D, Walker C, Bradshaw MH. Subantimicrobial dose doxycycline periodontitis. A review. J Clin Periodontol 2004; 31(9): 697 -707. treatment for
  • Loesche WJ, Grossman NS. Periodontal disease as a specific, albeit chronic, infection: diagnosis and treatment [review]. Clin Microbiol Rev. 2001;14(4): 727-52.