Understanding Inflammation: The Key to Targeted Preventive Measures for Diabetes and Periodontitis
Type 2 diabetes and periodontitis are both chronic inflammatory diseases. Common pathways of inflammation are responsible for these diseases and each appears to contribute to the severity and degree of control of the other. Periodontal treatment that redu
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Abstract Type 2 diabetes and periodontitis are both chronic inflammatory diseases. Common pathways of inflammation are responsible for these diseases and each appears to contribute to the severity and degree of control of the other. Periodontal treatment that reduces gingival inflammation aids in the control of hyperglycemia. Periodontitis is accompanied by gingival bleeding and the production of an inflammatory exudate termed gingival crevicular fluid (GCF) that arises from the inflamed gingival tissues surrounding the teeth. GCF contains byproducts of connective tissue degradation, enzymes from host and bacterial cells, cytokines and other inflammatory mediators, and has been studied for screening blood glucose and for biomarkers of both diabetes and periodontitis. This chapter focuses on the bidirectional nature of diabetes and periodontitis and the biomarkers common to both these diseases that may enable earlier detection, targeted preventive measures and individualized therapeutic intervention of these chronic conditions. Keywords Periodontitis • Diabetes • Inflammation • Biomarkers • Gingival crevicular fluid • Personalized treatment
R. Krishna (*) • C.W. Cutler Department of Periodontics, Georgia Regents University, College of Dental Medicine, 1120 15th Street, GC 1339, Augusta, GA 30912, USA e-mail: [email protected] P.J. Hanes Dental Academic Administration, Georgia Regents University, College of Dental Medicine, 1430 John Wesley Gilbert Drive, GC 1339, Augusta, GA 30912, USA M.S. Mozaffari (ed.), New Strategies to Advance Pre/Diabetes Care: Integrative Approach by PPPM, Advances in Predictive, Preventive and Personalised Medicine 3, DOI 10.1007/978-94-007-5971-8_12, © Springer Science+Business Media Dordrecht 2013
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Introduction
The identification and utilization of diagnostic biomarkers of various disease states has been advocated as a means of simplifying or improving the accuracy and efficiency of diagnostic procedures. In 2001, an NIH working group standardized the definition of a biomarker as “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention” [1]. Improved diagnostic efforts resulting from the utilization of novel biomarkers should enable optimal treatment planning and a more focused prevention of common human pathologies. Such biomarkers could also be used to screen healthy patients and identify those who may be predisposed to potential pathologies later in life and thereby enable the clinician to implement well-timed preventive measures. For the last two decades efforts have been made to identify biomarkers for diabetes mellitus and periodontitis. Diabetes and periodontitis are chronic inflammatory diseases which share a number of pathogenic mechanisms with common inflammatory mediators which have been investigated as possible biomarkers of disease status. This review describes the relationship between diabetes mellitus
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