Periodontitis Case Study

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MANAGEMENT OF DIABETES – PERIODONTITIS NEXUS a) THERAPEUTIC METHODS Periodontitis compromises the quality of life[108]. Both, periodontitis and DM exert a bidirectional influence on each other. Poor glycemic control deteriorates the periodontal health and periodontitis can perturb the glycemic status in a subject with DM. It is noteworthy that the total surface area of the diseased pocket epithelium, in a patient with generalized moderate periodontitis is approximately equal to the surface area of palm of adult hand. In severe periodontitis cases larger surface areas may be involved[109]. This is of concern for a health care professional involved in management of DM, whose primary objective is elimination of all potential infective foci. It…show more content…
Hence, it is prudent to incorporate PT as an important regimen in overall therapeutic management of a subject with DM[110]. Competent glycemic control improved periodontal conditions in periodontitis subjects, in absence of any periodontal intervention. This substantiated the ‘two-way relationship’ between DM and periodontitis[111]. Various studies have assessed the effect of PT in T2DM patients with periodontitis. These studies included HbA1c as a common parameter to assess the improvement in metabolic control[112-163]. These studies have employed SRP alone or combined with systemic/topical antimicrobials. However, there is a variation in the results of these prospective studies. The range in reduction of HbA1c is 0.4 to 1%, with results persisting for 3 to 9 months after periodontal therapy. PT ensues in the diminution of serum pro-inflammatory factors such as TNF- α and CRP in T2DM individuals. This accounts for the reduction in systemic…show more content…
When added to metformin and glimepiride, the HbA1c reduction is the same. In comparison to a placebo, gliptins mitigates HbA1c level by 0.6–0.7%. For DM subjects failing to maintain adequate metabolic control on two antidiabetic drugs, glucagon-like peptide-1 analogue (exenatide) can be added. Exenatide assists to reduce HbA1c level by about 1%. Pioglitazone, when added to an insulin regimen, favors the HbA1c reduction by about 0.54%[179]. The newer sodium–glucose co-transporter 2 inhibitors reduce HbA1c by 0.5–1.0%[180]. It is strategically important to note that that a decrement of HbA1c by 1% is associated with a decrease of microvascular complications by 37%, decrease in DM deaths by 21% and a decrease in the risk of myocardial infarction by 14%. Thus, any reduction in HbA1c although miniscule may translate into a decrease in the risk of DM related complications

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