Treatment of periodontitis in the diabetic patient. A critical review.

Both type 1 and type 2 diabetes mellitus are associated with increased periodontal disease susceptibility. Conventional periodontal therapy appears to be effective in diabetic patients. It has not been demonstrated that chemotherapeutics are necessary for successful periodontal therapy in most diabetic patients. The effect of periodontal therapy on metabolic control of diabetes may not be clinically significant.

Irrigation with antimicrobial agents for the treatment of periodontitis--is it effective?

Subgingival irrigation has been proposed as a beneficial adjunct to scaling and root planing or ultrasonic scaling. The most commonly investigated agents are iodine and chlorhexidine. Clinical studies from the past 15 years are reviewed to determine the real benefits of antimicrobial irrigants in conjunction with root planning. With knowledge of the treatment protocols and results of these clinical studies, the clinician is equipped with a biologic rationale for his treatment decisions in nonsurgical periodontics.

HLA-DR alleles are associated with IDDM, but not with impaired neutrophil chemotaxis in IDDM.

Insulin-dependent diabetes mellitus (IDDM) is a risk factor for periodontitis. Depressed neutrophil chemotaxis has been demonstrated in IDDM and in early-onset periodontitis (EOP). HLA-DR antigens are associated with both IDDM and periodontitis. This investigation sought to determine an association of HLA-DR3, -DR4, and -DR53 with impaired neutrophil chemotaxis in an IDDM sample. The neutrophil chemotaxis index of 41 diabetics and 27 controls was determined by a modified Boyden chamber method, and certain class II HLA genotypes were determined by polymerase chain-reaction amplification of genomic DNA by means of sequence-specific primers (PCR-SSP). The mean chemotaxis index of the diabetics was significantly less than that of the controls (p < or = 0.02). HLA-DR3 (p < or = 0.002), -DR4 (p < 0.003), and -DR53 (p < or = 0.001) were associated with IDDM. Neutrophil chemotaxis and glucose metabolism were not significantly correlated. None of the HLA-DR alleles was associated with impaired neutrophil chemotaxis. Therefore, the neutrophil chemotaxis defect of IDDM appears to be independent of these HLA-DR-associated genes.

A review of localized juvenile periodontitis (LJP): Part I. Clinical features, epidemiology, etiology, and pathogenesis.

Localized juvenile periodontitis (LJP) is not commonly encountered in dental practice. Yet, when it is encountered, prompt and effective therapy is required to combat the severity of disease and its rapid progression. Failure to understand its diagnosis and etiology leads to failures in management of LJP. The clinical features, etiology, and pathogenesis of LJP are reviewed to provide the clinician with a sufficient understanding to appropriately manage or refer LJP patients.

A review of localized juvenile periodontitis (LJP): II. Clinical trials and treatment guidelines.

Localized juvenile periodontitis (LJP) causes severe alveolar bone loss and early tooth loss in adolescents and young adults. If it is not appropriately treated as an infection in association with Actinobacillus actinomycetemcomitans, treatment failure is likely. This review of clinical trials of treatment of LJP uses those trials to construct guidelines for LJP treatment.

Interleukin-10 promotes anti-collagen antibody production in type I diabetic peripheral B lymphocytes.

Previous studies have shown that type I diabetes (IDDM) increases the risk of developing periodontitis by 2-3-fold. IDDM patients exhibit destruction of the pancreatic beta cells, most probably caused by an autoimmune reaction. Evidence is accumulating to support the role of the autoimmune response in periodontal pathogenesis. A cytokine, interleukin (IL)-10, has been reported to selectively promote the expansion of a B lymphocyte lineage (CD5/LY1/B1) which has the propensity for secreting high levels of autoantibody. Therefore, the purpose of this project was to evaluate IL-10 production, percentage of CD5 B cells and the frequency of anti-collagen secreting cells in peripheral blood mononuclear cells of age, gender and race matched IDDM patients and controls. IL-10 production was evaluated by an ELISA using the supernatant of adherent peripheral blood cells cultured for 24 h in the presence of Porphyromonas gingivalis lipopolysaccharide (LPS). In 8 of 31 patients, IL-10 levels were significantly increased in IDDM compared to controls and a higher percentage of CD5 B cells was also observed by flow cytometry. In addition, these patients exhibited a higher frequency of anti-collagen secreting cells as elucidated by an ELISPOT. Moreover, treatment with a neutralizing anti-IL-10 antibody diminished the anti-collagen antibody response by 70%. These findings support the concept that a subset of IDDM patients possess an extremely robust IL-10 response following exposure to Gram-negative LPS, which could predispose them to the development of periodontitis through a heightened autoimmune mechanism.