Periodontal disease in American Indians and Alaska Natives.

OBJECTIVE: The primary purpose of this paper is to provide information on the periodontal disease status of Native Americans using a variety of data sources. The impact of periodontal disease on the provision of dental care within the Indian Health Service (IHS) is also discussed. METHODS: Four data sources were used to evaluate the periodontal disease status of Native Americans: IHS periodontal disease monitoring system (1962-78), 1984 IHS Patient Oral Health Survey, 1990 WHO community-based survey (ICS-II), and the 1991 IHS Patient Oral Health Survey. RESULTS: There appears to be a trend toward a higher prevalence of incipient and overt periodontal disease among Native Americans over time. The prevalence of overt periodontal disease (periodontal pockets > 5.5 mm) is higher among Native American diabetic patients than nondiabetic patients (34% vs 19%). CONCLUSIONS: Due to the variety of indices used by the IHS during the last 20 years, it is difficult to make direct comparisons of the available periodontal disease data. However, it appears that the prevalence of periodontal disease among Native Americans is increasing. Type II diabetes accounts for significant increases in periodontal disease and tooth loss in Native American populations. Certain forms of early onset periodontal disease also may pose significant threats to the oral health of Native Americans.

Treatment of periodontal disease in diabetics reduces glycated hemoglobin.

Periodontal disease is a common infection-induced inflammatory disease among individuals suffering from diabetes mellitus. The purpose of this study was to assess the effects of treatment of periodontal disease on the level of metabolic control of diabetes. A total of 113 Native Americans (81 females and 32 males) suffering from periodontal disease and non-insulin dependent diabetes mellitus (NIDDM) were randomized into 5 treatment groups. Periodontal treatment included ultrasonic scaling and curettage combined with one of the following antimicrobial regimens: 1) topical water and systemic doxycycline, 100 mg for 2 weeks; 2) topical 0.12% chlorhexidine (CHX) and systemic doxycycline, 100 mg for 2 weeks; 3) topical povidone-iodine and systemic doxycycline, 100 mg for 2 weeks; 4) topical 0.12% CHX and placebo; and 5) topical water and placebo (control group). Assessments were performed prior to and at 3 and 6 months after treatment and included probing depth (PD), clinical attachment level (CAL), detection of Porphyromonas gingivalis in subgingival plaque and determination of serum glucose and glycated hemoglobin (HbA1c). After treatment all study groups showed clinical and microbial improvement. The doxycycline-treated groups showed the greatest reduction in probing depth and subgingival Porphyromonas gingivalis compared to the control group. In addition, all 3 groups receiving systemic doxycycline showed, at 3 months, significant reductions (P < or = 0.04) in mean HbA1c reaching nearly 10% from the pretreatment value. Effective treatment of periodontal infection and reduction of periodontal inflammation is associated with a reduction in level of glycated hemoglobin. Control of periodontal infections should thus be an important part of the overall management of diabetes mellitus patients.

Response to periodontal therapy in diabetics and smokers.

Diabetics and smokers are two patient groups at high risk for periodontal disease who also exhibit impaired wound healing and, therefore, constitute two different groups in whom the relationship between host-parasite interaction, outcome of periodontal therapy, and systemic factors is best represented. The results of two independent clinical trials involving treatment of periodontal disease in diabetics and smokers are presented. A new treatment regimen for the management of periodontal disease associated with diabetes mellitus is proposed. This treatment approach incorporates both antimicrobial agents and pharmacological modulation of the host response. Elimination of periodontal infection and reduction of periodontal inflammation in diabetic patients resulted in a significant short-term reduction in the concentration of glycosylated hemoglobin (HbA1c). Control of chronic infections and modulation of the host response offer a new therapeutic approach in the management of patients with both diabetes and periodontal disease. The effect of smoking on periodontal healing is also discussed. The clinical and microbiological response of smokers to non-surgical periodontal therapy is compared to non-smokers. In addition, possible mechanisms whereby diabetes mellitus and cigarette smoking increase the severity of periodontal disease are discussed.