The following are recommendations for dental practitioners who have patients diagnosed with diabetes or pre-diabetes: ● Let patients know that there is an increased risk of periodontal disease in people who have diabetes. ● Inform patients of the findings of the most current research examining diabetes and periodontal disease, especially in relation to glycemic control. ● Encourage patients to maintain excellent oral hygiene. ● Provide oral hygiene instruction. ● Encourage patients to keep recall appointments for professional cleanings and examinations; these patients may need more frequent recall appointments. ● Inform patients about potential oral problems related to diabetes, including mucosal ulcers, taste impairment, burning mouth, and candidiasis. ● Inform patients that there is an increased incidence of xerostomia among people with diabetes, which may be the result either of medication used to treat diabetes or of the disease itself. Recommend appropriate dry mouth products. neural route to the brain (Pisani, et al., 2022). Beyond the potential for periodontal disease to have an association with the development of Alzheimer’s disease, the role of a genetic predisposition in the development of this form of dementia must also be considered. This is important because the APOE-e4 gene seems to be a significant genetic risk factor for Alzheimer’s disease (Urfer-Buchwalder & Urfer, 2017). Susceptibility genes such as apolipoprotein (APOE-e4) allele increases the risk of the development of Alzheimer’s disease and decreases the age of onset (National Institute on Aging, 2019). A study by New York University found that of 34,074 participants those with more missing teeth had a 48% higher risk of cognitive impairment and a 28% higher risk of dementia (National Institute on Aging, 2021). What is the connection? How could poor oral health potentially contribute to the risk for dementia, specifically Alzheimer’s disease? Authors have proposed that the mechanism could be explained by the inflammatory nature of periodontal disease (Glick, 2019; Vasileios, et al., 2022). Research suggests that peripheral infections and chronic inflammation increase the risk for Alzheimer’s disease (American Academy of Periodontology, 2019; Pritchard, et al., 2017). The Alzheimer’s Disease Anti-inflammatory Prevention Trial (ADAPT) investigated the role of anti- inflammatory agents as a means of reducing the systemic inflammation that may contribute to the development of Alzheimer’s disease. The beneficial effect of these medications was evident in the early, asymptomatic stage of Alzheimer’s disease, but recent research has called these results into question and reveals the need for more research (Ali, et al., 2019). Blood levels of antibodies to periodontal bacteria have been found to be significantly elevated in subjects with Alzheimer’s disease and with it significantly higher levels Interleukin (IL)-6 and tumor necrosis factor alpha (TNF- α , both of which are systemic mediators of inflammation (Hamza, et al., 2021). This could simply reflect impaired oral hygiene and resulting periodontal disease caused by the cognitive decline in the subjects with Alzheimer’s disease. In order to discern the actual causation, the temporal nature of the association must be addressed: which came first, the cognitive impairment or the periodontal disease? Some studies have found that antibody levels to Fusobacterium nucleatum and Prevotella intermedia (two bacteria common in periodontal disease) were significantly elevated in baseline blood samples of those subjects who
The persistent hyperglycemic state of diabetes mellitus is ultimately a microvascular disease that exerts adverse effects upon all body tissues. Beyond periodontal disease, the most common systemic complications of diabetes mellitus include retinopathy, peripheral neuropathy, nephropathy, cardiovascular and cerebrovascular disease, and protracted healing of wounds (Goyal & Jialal, 2022). As a continuum between the medical and dental professions, patients must be educated that periodontal disease has been identified as the sixth most common serious complication of diabetes mellitus and how each of these pathologic entities influences the other (Agarwal & Baid, 2017). Dental professionals can help by educating patients, diabetes educators, physicians, and nurses about the role of good oral health in managing diabetes. In the future, there may also be opportunities for dental professionals to screen for undiagnosed diabetes and refer to the primary care provider when appropriate. Alzheimer’s disease Alzheimer’s disease is the most common form of dementia. Alzheimer’s disease is primarily a disease of older adults, with only a small percentage diagnosed as early onset, presenting before age 60 (CDC, 2018; Graff-Radford, 2017). Although the exact cause of Alzheimer’s disease is unknown, risk factors exist, including advanced age, cerebrovascular disease, head trauma, familial inheritance, and the presence of senile plaques due to the dysregulation of amyloid- beta precursor protein (Armstrong, 2019). Currently, one out of eight Americans age 65 and older is suffering from Alzheimer’s disease. Alzheimer’s disease deaths increased 70% between the years 2000 and 2020; it is the fifth leading cause of death among patients 65 years of age and older in the United States (Alzheimer’s Association, 2017; CDC, 2022b). It is understandable that a decline in cognitive abilities as seen in Alzheimer’s disease would lead to a decline in oral health status. Older adults with memory impairments face many barriers to good oral health. They may forget to remove dentures at night or forget how to brush and floss their teeth and how to clean prosthetic appliances. They may have difficulty communicating symptoms of oral pain. They may forget dental appointments or may be under the care of a caregiver who is unable to bring them to the dentist. In fact, many studies have confirmed the presence of poor oral health in those with Alzheimer’s disease (Marchini, et al., 2019). However, recently researchers have been investigating the association going in the opposite direction: oral disease as a potential risk factor for dementia. The bacterial species Porphyromonas gingivalis and Treponema denticola are known periodontal pathogens that have access to systemic dissemination via the inflamed periodontal pocket and both species have been implicated in aortic inflammation and the formation of atherosclerotic plaques (Pritchard, et al., 2017). Porphyromonas gingivalis can produce gingipains, an enzyme that is toxic to neural cells and that was found in 96% of the brain tissue samples of 53 Alzheimer’s patients in a study referenced by the American Academy of Periodontology (2019). Periodontal bacteria can access the dental pulp (which contains branches of the trigeminal nerve) of teeth affected by periodontal disease. Treponema denticola has been isolated from the trigeminal ganglionof the trigeminal nerve) where it can remain for years and has also been found in clusters of brain tissue sections of patients with Alzheimer’s Disease. which supports the hypothesis that pathogenic periodontal bacteria have a
Page 63
EliteLearning.com/Dental
Powered by FlippingBook