2. AGEs and Complications
Blood Glucose
Glycosylated Proteins (AGEs)
Monocyte AGE Receptor (RAGE)
Secretion of Monokines
(cachectin/TNF, IL-1, IGF-1)
Mesenchymal Cells
Endothelial Cells
Proteinase Production
Growth Factor Release
Connective Tissue Breakdown
Proliferation of Cells and Matrix

3. Diabetes and Periodontitis
AGE - enriched gingival tissues
Activation of RAGE
Fibroblast RAGE
MMPs &
Collagen
Macrophage RAGE
MP migration &
immobilization at AGE
rich sites, cytokines
(IL-1&6, TNF-a), MMPs
Endothelial RAGE
permeability &
adhesion molecules
Exaggerated response to periodontal pathogens
Accelerated destruction of non-mineralized connective tissue
and bone in diabetes

4. Risk and Rate of Progression are Altered by Diabetes
Pockets
and
CAL
Tooth
Mobility
Loss
Prostanoids (PGE)
Cytokines
(IL-1,IL-6, TNF)
Enzymes
(MMPs)
Bone
Resorption
Connective
Tissue
Breakdown
Bacterial
Products
Host
Cells
Bacterial
Component
Clinical
Sequelae +
Host Response Component =
Simplified schematic depicting etiologic factors and cascade of events contributing to periodontitis which are altered by the systemic disorder, diabetes

6. Modifiers in Type 1 Diabetes
SALVI et al., 1998
High levels of GCF IL-1 & PGE2
Monocytic hypersecretory trait
PGE2 (4.2 fold)
IL-1 (4.4 fold)
TNF- (4.6 fold)
Moderate-Severe >Gingivitis-Mild >Non-Diabetics
Type 1 subjects are at significant risk for periodontitis due to excessive inflammation with equivalent bacterial burden

7. Diabetes & Periodontitis
GENERAL TRENDS
Poor control increases susceptibility
Oral Infections
Periodontitis, Candidiasis, Caries
Not correlated to plaque/calculus levels
Advanced systemic complications
Increases frequency and severity of periodontitis
Aging patient populations
Increases incidence of periodontitis

12. Other Oral Manifestations
Enlarged parotid glands
alterations in basement membranes
Xerostomia
related to glands and medications
Candidiasis
related to glucose and xerostomia
Burning mouth or tongue
Caries
increased glucose levels in GCF of poorly controlled diabetics