Dark field microscopy of the subgingival microflora in insulin‐dependent diabetics

Abstract

The subgingival microflora was assessed by means of dark field microscopy in 106 pockets of 47 subjects with long-term insulin-dependent diabetes mellitus (IDD). The microbiota of 55 healthy sulci (probing depth < 4 mm) and 51 periodontally diseased (probing depth > or = 4 and 6 mm) pockets were analyzed. The mean duration of the IDD of the diabetic subjects was 23.7 years (range from 10 to 41 years). The diabetic patients, aged 30-65 years, were under medical treatment at the III Department of Medicine, University of Helsinki Central Hospital, and at 2 clinics of the Helsinki Health Centre. Based upon their long-term medical records, 26 subjects were assessed to have poorly controlled insulin-dependent diabetes mellitus (PIDD) and 21 had controlled insulin-dependent diabetes (CIDD). The PIDD subjects exhibited higher mean blood glucose levels (12.9 +/- 4.6 mmol/l, mean +/- S.D.) than the CIDD subjects (7.9 +/- 3.6 mmol/l) (p < 0.001, t-test). The mean glycosylated hemoglobin HBA1 (HBA1c) levels were 11.2 +/- 4.6% (10.3 +/- 1.2%) and 8.8 +/- 1.8% (7.7 +/- 1.4%) for PIDD and CIDD subjects, respectively. These differences were statistically significant (p < 0.01 and p < 0.001, t-test). For each individual, site-specific recordings were made for plaque index and bleeding index scores, probing depth, loss of attachment and radiographic loss of alveolar bone. Dark field microscopy analysis of the presence of spirochetes, motile rods, cocci, non-motile rods, filaments and fusiforms was performed in the total of 106 pockets. According to the results of the dark field microscopy, the % of spirochetes and motile rods in the periodontally diseased pockets was significantly higher in the PIDD than in the CIDD subjects (9.2 +/- 13.4% and 10.8 +/- 14.3% versus 4.0 +/- 5.2% and 3.1 +/- 3.2%, p < 0.01 and p < 0.001, chi 2-test, respectively). Moreover, the PIDD subjects had lower mean %s of coccoid cells in periodontally diseased sites than the CIDD subjects (52.1 +/- 20.8% versus 60.7 +/- 9.0%, p < 0.001, chi 2-test).

Microbiological Study of Oral Flora in Diabetic Patients With Gingivitis

“…In patients with poorly controlled diabetes and periodontal problems, the percentage of the most virulent microbial species was higher than in subjects with controlled diabetes and non-diabetic subjects, which is in agreement with data reported by Seppaa and Ainamo [32]. Epidemiological studies have also shown that type 2 diabetes can be predictive of periodontal disease when the systemic conditions are poorly controlled [33,34], in addition to responding poorer to surgical and non-surgical periodontal treatments [35,36].…”

Collagenases in Gingival Crevicular Fluid in Type 1 Diabetes Mellitus

“…Poorly controlled type 2 diabetes mellitus patients with advanced periodontitis, a complication of diabetes, have recently been shown to express high levels of active matrix metalloproteinase (MMP)‐8/collagenase‐2 in gingival crevicular fluid pathologically 9 . The pathogen microflora in hyperglycemic poorly controlled type 1 diabetes may also contribute to periodontal breakdown through exaggerated and/or prolonged host responses 4,10,11 . This study demonstrates that type 1 diabetes, particularly when poorly controlled, is characterized by high collagenase activity levels in gingival crevicular fluid.…”

Microbiological changes after periodontal therapy in diabetic patients with inadequate metabolic control

“…2,11 Differences among studies may be explained by the metabolic control used. 12,13 Scaling and root planing (SRP) therapy, in combination (or not) with antimicrobial agents, might be effective in reducing periodontal pathogens in persons with DM, 14,15 although others have reported that SRP alone may not be capable of eliminating or reducing Tannerella forsythia and Porphyromonas gingivalis in those individuals. 4,8,16,17,18 In general, a reduced level of those pathogens is crucial for a good response to therapy.…”