Dental and Medical Problems

Dent Med Probl
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Dental and Medical Problems

2011, vol. 48, nr 3, July-September, p. 311–318

Publication type: editorial

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

A Clinical and Histological Study on the Micro-Vascular Diseased Gingiva of Diabetic Patients

Badanie kliniczne i histologiczne zmian mikronaczyniowych w zmienionym zapalnie dziąśle u pacjentów chorych na cukrzycę

Christine Tesseromatis1,, Antonia Kotsiou2,, Eleni Parara1,, Nicolaos Seferos1,, Constantin Mourouzis3,, Jane Messari1,, George Rallis4,, Magdalene Tsamouri5,

1 Department of Pharmacology Medical School, University of Athens, Greece

2 Aretaieion University Hospital Athens, Greece

3 Oral and Maxillofacial Surgery, Queen Alexandra Hospital, University of Portsmouth, United Kingdom

4 Department of Oral and Maxillofacial Surgery General Hospital of Athens «KAT», Greece

5 Department of Pathology Red Cross Hospital of Athens, Greece

Abstract

Background. Diabetes mellitus is involved in many degenerative processes leading to the manifestation of great morbidity. Furthermore, diabetes mellitus is strongly associated with periodontal disease. The severity of the defects due to diabetes depends on the blood glucose level. Similarly, the progression and the extent of tissues changes are influenced by the control of glucose levels.
Objectives. The aim of the study was to investigate the periodontal status in patients suffering from diabetes and to estimate the severity of the morphological changes of blood bed vessels or to assess the degree of diabetes morbidity from the histological findings of gingival biopsy specimen.
Material and Methods. Thirty patients with mean age 58 years (± 12,11), 18 men and 12 women with mean blood glucose of 250 mg/dl and 10 healthy subjects were included in the study. All of them underwent periodontal examination using the Ramfjord index (dental plaque, gingival inflammation degree and periodontal pocket depth) in order to obtain the most constant criterion possible of the clinical features of diabetes in the oral cavity. In parallel, biopsies from buccal gingivae were obtained, so as to investigate possible changes attributed to diabetes mellitus. Results and
Conclusion. The histological findings from the buccal gingival papilla demonstrated hyperplasia of the multilayer squamous epithelium and intense chronic inflammation with fibrosis of the lamina propria. In addition microangiopathy was detected from the PAS positive material on the vessel wall. Perivascular inflammation with intense thickness and narrowing of the arteriole lumen was also observed.

Streszczenie

Wprowadzenie. U osób chorych na cukrzycę dochodzi do wielu procesów degeneracyjnych prowadzących do złożonej symptomatologii klinicznej. Cukrzyca pozostaje także w ścisłym związku z chorobami przyzębia. Ciężkość zmian zależy od stężenia glukozy w surowicy krwi. Podobnie zaawansowanie i rozległość zmian tkankowych są modulowane za pomocą kontroli stężenia glukozy.
Cel pracy. Ocena stanu klinicznego przyzębia pacjentów chorych na cukrzycę, ocena zaawansowania zmian morfologicznych naczyń w dziąśle tych osób oraz próba określenia zaawansowania cukrzycy na podstawie badania histopatologicznego dziąsła.
Materiał i metody. Do badania zakwalifikowano 30 osób (18 mężczyzn i 12 kobiet) o średniej wieku 58 lat (± 12,11) ze średnim stężeniem glukozy w surowicy krwi 250 mg/dl. Grupę kontrolną stanowiło 10 ogólnie zdrowych osób. W ocenie stanu klinicznego przyzębia zastosowano wskaźnik Ramfjorda (płytka nazębna, stan zapalny dziąsła i głębokość kieszonek przyzębnych) w celu wykazania najbardziej stałych zmian w jamie ustnej w przebiegu cukrzycy. Aby ocenić zmiany histopatologiczne zależne od cukrzycy, równolegle pobierano wycinki dziąsłowe. Wyniki i wnioski. W badaniu histopatologicznym językowych brodawek dziąsłowych wykazano rozrost wielowarstwowego nabłonka rogowaciejącego oraz rozległy stan zapalny z włóknieniem w blaszce właściwej. Dodatkowo stwierdzano mikroangiopatie w PAS pozytywnym materiale ściany naczyń. Obserwowano również rozległy proces zapalny w obszarze okołonaczyniowym oraz zwężenia światła naczyń.

Key words

diabetes mellitus, periodontal status, gingival microangiopathy

Słowa kluczowe

cukrzyca, stan kliniczny przyzębia, mikroangiopatie dziąsłowe

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