Prevalence of Periodontitis in Diabetic Patients of Egyptian Population

Periodontitis is a common chronic inflammatory disease which is characterized by destruction of the supporting structures of the teeth especially the periodontal ligament and alveolar bone. Their classification is complex and takes into consideration many factors such as the clinical presentation, age at diagnosis, rate of disease progression, and systemic and local factors which may increase risk (Pihlstrom BL etal., 2005).

Tissue destruction in periodontitis results in the breakdown of the collagen fibers of the periodontal ligament, that results in the formation of a periodontal pocket between the gingiva and the tooth. "Pocketing" is not evident on simple visual inspection, and assessment using a periodontal probe is needed. Periodontitis is a slowly progressing disease, however the tissue destruction that happens is largely irreversible. The condition is asymptomatic in the early stages, it is not usually painful, and many patients are unaware till progression in the condition occurs and is enough to result in tooth mobility. As a result of the further destruction of fibers of the periodontal ligament (referred to as attachment loss), the pockets deepen, and the resorption of the alveolar bone occurs in parallel with the progressing attachment loss (Grossi SG etal., 1995).

Diabetes mellitus is a metabolic disorder which is characterized by hyperglycemia as a result of defective secretion or activity of insulin (Tan M etal., 1997). It may be further complicated by poor regulation of protein and lipid metabolism. In the current classification of this condition, the terms "insulin-dependent diabetes mellitus" and "non-insulin dependent diabetes mellitus" are not used, in part because they relate to treatment rather than to the diagnosis. A conclusive diagnosis of diabetes mellitus is done through assessment of glycated hemoglobin levels. In those people with diabetes, sequential fasting plasma glucose levels will be 7 mmol/L or more.

Type 1 diabetes mellitus normally occurs as a result of destruction of the beta cells in the islets of Langerhans of the pancreas by the autoimmune system. This condition often leads to absolute deficiency of insulin. Type 1 diabetes tends to occur in young, lean individuals, usually before 30 years of age; however, older patients may also present with this form of diabetes occasionaly.

With Type 2 diabetes, patients can still produce insulin but do so relatively inadequately. In many cases, the pancreas produces larger than normal quantities of insulin. A major feature of Type 2 diabetes is a lack of sensitivity to insulin by the cells of the body, especially fat and muscle cells. These larger quantities of insulin are produced as an attempt to get these cells to recognize that insulin is present.

There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycemic control (Fox CH., 1992) \& (Mealey BL \& Ocampo GL, 2007).