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GINGIVA CHANGES IN DIABETES MELLITUS PATIENTS:
LITERATURE REVIEW
(PERUBAHAN GINGIVA PADA PASIEN DIABETES MELITUS: LITERATURE
REVIEW)
Uswatul Husnaini1.
Badai Buana Nasution2.
M Ichwan3 Student Department of Biomedical Sciences.
Faculty of Medicine.
Universitas Sumatera Utara.
Department of Child Health.
Faculty of Medicine.
Universitas Sumatera Utara.
Department of Biomedical Sciences.
Faculty of Medicine.
Universitas Sumatera Utara Email: uswatulhusnaini281@gmail.
com, badai.
buana@usu.
id m.
ichwan@usu.
ABSTRAK
Latar belakang: Diabetes melitus merupakan penyakit metabolik kronis yang sering kali menyebabkan komplikasi oral, termasuk perubahan dan kerusakan gingiva akibat peningkatan inflamasi.
Insidensi penyakit periodontal meningkat dua hingga tiga kali lebih besar dibandingkan dengan individu tanpa diabetes, yang memperburuk kerusakan jaringan gingiva dan memperlambat penyembuhan.
Hiperglikemia memicu pembentukan advanced glycation end-products (AGE.
, yang meningkatkan produksi sitokin proinflamasi.
Penulisan artikel bertujuan untuk mengidentifikasi perubahan pada gingiva yang terkait dengan diabetes melitus.
Metode: Penelitian ini menggunakan metode literature rewiew terhadap artikel yang dipublikasikan secara daring melalui database seperti Google Scholar dan Pubmed.
Artikel yang dianalisis merupakan publikasi dari tahun 2019 hingga 2024, dengan total 21 artikel yang memenuhi kriteria inklusi serta relevan dengan tujuan penelitian.
Hasil: Hasil kajian menunjukkan perubahan pada gingiva pasien diabetes melitus disebabkan oleh interaksi antara hiperglikemia, peningkatan stres oksidatif, serta gangguan pada sistem imun, yang memperburuk peradangan dan kerusakan jaringan gingiva.
Faktor-faktor seperti peningkatan radikal bebas, gangguan penyembuhan jaringan akibat disfungsi vaskular, serta penurunan produksi kolagen turut memperparah kerusakan jaringan.
Kesimpulan: Perubahan fisiologis tubuh yang terjadi meningkatkan risiko terjadinya penyakit periodontal pada pasien diabetes melitus.
Gingivitis dan periodontitis merupakan dua bentuk umum dari penyakit periodontal yang disebabkan oleh biofilm patogen di sekitar gigi.
Kata kunci: Status gingiva.
Penyakit periodontal.
Diabetes melitus.
ABSTRACT
Background: Diabetes mellitus is a chronic metabolic disease that leads to oral complications generally, including changes and damage to the gingiva due to increased inflammation.
The incidence of periodontal disease is two to three times higher compared to individuals without diabetes, which exacerbates gingival tissue damage and slows down healing.
Hyperglycemia triggers the formation of advanced glycation end-products (AGE.
, which increase the production of pro-inflammatory This article aims to identify changes in the gingiva associated with diabetes mellitus.
Method: The method used is a literature review of articles published online through databases such as Google Scholar and PubMed.
The analyzed articles are publications from 2019 to 2024, with a total of 21 articles meeting the inclusion criteria and relevant to the research objectives.
Result: The study results indicate that the interaction between hyperglycemia causes changes in the gingiva of diabetic patients, increased oxidative stress, and dysfunction in the immune system, which worsens inflammation and gingival tissue damage.
Factors such as increased free radicals, impaired tissue healing due to vascular dysfunction, and decreased collagen production also contribute to the exacerbation of tissue Conclusion: Physiological changes in the body can increase the risk of periodontal disease in patients with diabetes mellitus.
Gingivitis and periodontitis are two common forms of periodontal disease caused by pathogenic biofilms around the teeth.
Keywords: Gingival status.
Periodontal disease.
Diabetes mellitus.
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INTRODUCTION
Diabetes mellitus (DM) chronic endocrine and metabolic disorders characterized by increased blood glucose levels, insulin resistance, and relative insulin deficiency which causes disturbances in carbohydrate, protein, and lipid metabolism.
These disorders affects more than 415 million people of all ages woldwide and is expected to affect 592 million people by 2035 (SriChinthu et al.
, 2021.
Sun et , 2023.
Xu et al.
, 2023.
Zhao et al.
This disease has long-term complications such as retinopathy, nephropathy, neuropathy, cardiovascular disorders, as well as various oral manifestations such as changes in saliva flow, xerostomia, burning mouth syndrome, candidiasis, cheilosis, caries, gingivitis, and periodontitis (Reddy & Gopalkrishna, 2.
Gingival changes in DM sufferers are caused by interactions between hyperglycemia, increased oxidative stress, and immune system dysfunction that worsen inflammation (Tabatabaei et , 2.
Excessive inflammation response and vascular disruption in periodontal tissue also contribute to Hyperglicemia triggers the formation of advanced glycation end-products (AGE.
, which proinflammation cytokines such as IL1.
IL-6, and tumor necrosis factoralpha (TNF-), causes inflammation and demage to gingival tissue.
Diabetes also disrupts neutrophil function, making it easier for periodontopathogenic bacterial infections and slowing tissue healing due to vascular dysfuction and decreased collagen production.
Accumulation of AGEs and increased production of free radicals exacerbate tissue demage which increases the risk of gingivitis and periodontitis in diabetes sufferers (Rapone et al.
, 2021.
Sun et al.
, 2.
Universitas Batam Batam Batam DM sufferers often has various disorders or abnormalities in the epithelial tissue in the oral cavity (Graves et al.
, 2.
These complications include periodontal disease such as gingivitis and Uncontrolled diabetes also increases the risk of oral health problems such as fungal infections, increased risk of caries, gingivitis, and bone loss associated with periodontal diseases (Rapone et al.
, 2.
Gingivitis and periodontitis are two common features of periodontal disease caused by pathogenic biofilms around the teeth (Alqedra & Aljeesh.
Pathogenis bacterial infections in periodontal pockets can spread through the bloodstream and infect other parts of the body.
Moreover, there are other oral xerostomia, taste disorders, burning mouth syndrome, aphthous stomatitis, and risk of pre-cancer infections in the oral cavity (Agustina et al.
, 2022.
Rohani, 2.
The complications is generally proportional to the degree and duration of Uncontrolled blood sugar levels can also affect white blood cells, including neutrophils, monocytes and macrophages which play an important role in the bodyAos defense against infection, making DM sufferers more susceptible to infection because the ability of body to fight bacteria An increase in the number of bacteria in the oral cavity in diabetes patients can cause changes and abnormalities of gingiva.
Reviewing various disorders and complications of DM in the oral cavity, especially changes in the gingiva which can ultimately reduce the patientAos quality of life.
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limitations in previous studies.
Based on the results of field observations and literature review, this article aims to identify changes in the gingiva that are associated with DM.
METHOD
The research method used literature review by taking references as a basis for forming a clear theoretical framework related to the problem or question being studied.
This method involves reviewing and outlining theories, as well as reviewing other relevant research sources.
Through the literature review method, researchers examine several articles whose content and discussion are in accordance with the topic and research objectives, so that they can provide a strong foundation for understanding the problem being The analysis method was carried out by selecting articles that met the inclusion criteria.
Search for articles via the internet and research journal databases including Google Scholar and Pubmed with the Indonesian and English keywords Austatus gingivaAy OR Augingival statusAy Aupenyakit periodontalAy OR Auperiodontal diseaseAy, dan Audiabetes melitusAy OR Audiabetes mellitusAy accompanied by boolean operators (AND.
NOT, and OR).
The information obtained from references then selected to obtain data that matces the predetermined criteria.
the inclusion criteria, studies were considered eligible for systematic review with the target group of patients Universitas Batam Batam Batam suffering from DM.
Selected articles come from publications within a 5 year period .
and must be open access articles.
Exclusion criteria included filtering out data that was irrelevant or did not provide the requires information, as well as articles that only presented abstracts or used literature review methods.
The authors specified the population, sampling, methods, and documents that did not discuss gingival changes in DM patients were excluded.
Research is reviewed in English and Indonesian, with a maximum publication year limit of 5 years.
Researchers obtained 274.
articles based on keywords in Google Scholar and 72.
880 Pubmed, then sorted them into 37.
591 articles.
Articles were sorted again according to the criteria, namely 123 articles.
There are 21 articles that are relevant to the research The strategy for searching data uses the Preferred Repoting Items for Systematic Review and MetaAnalysis (PRISMA) flowchart diagram (Figure .
RESULT AND DISCUSSION
The result of a literature review of artcles published in the 2019-2024 period using Indonesian and English, in total found 21 articles that met the inclusion criteria, namely focusing on discussing gingival changes in DM Page 184 ZONA KEDOKTERAN VOL.
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Figure 1.
Article search flow based on PRISMA flowchart.
Research articles that meet the inclusion criteria will be collected and summarized, including information such as article title, author, year of methodology, samples used, results or findings, as well as similar and different A summary of the articles reviewed by researchers is presented briefly in Table 1 below.
Table 1.
Matrix of reviewed articles.
Article Title.
Author.
Publication Exfoliative Cytology Buccal Gingival Mucosa in Diabetes Mellitus Type 2, (Andini et al.
, 2.
Universitas Batam Batam Batam Objective Research design Result Analyzing levels in Type II DM and condition of buccal and gingival cytology Giemsa stain and Periodic Acid Schiff (PAS) Analytical observational study with a cross sectional approach, involving 16 respondents with (DM) who underwent glucose level checks using Point of Care Testing (POCT) Observation of buccal cells showed that 10 people had normal cells .
,5%) and 6 people had mild demage .
,5%).
In gingival cells, 8 people had normal cells .
%) 6 people had mild cell demage .
,5%), and 2 people had moderate cell demage .
,5%).
Examination of epithelial cells using PAS staining showed normal condition in 10 people .
,5%), slight demage in 3 people .
,8%), and moderate demage in 3 people .
,8%).
There was No.
significant relationship between blood glucose levels and abnormalities of the buccal mucosa and gingiva .
=0.
105 foe buccal, p=0.
151 for gingiv.
There was a significant correlation in epithelial Page 185 ZONA KEDOKTERAN VOL.
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Evaluation periodontal status in obese and non-obese type II diabetic patients Ae a cross sectional study (SriChinthu et al.
Evaluating periodontal status in obese and nonobese type II diabetes patients.
Analytical research with a cross sectional approach, the study population subjects divided into three different groups.
Periodontal Status Differences between Chronic Periodontitis Patient with and Without Type 2 Diabetes Mellitus, (Nadhia Anindita Harsas.
Robert Lessang.
Yuniarti Soeroso, 2.
To assess the periodontal status of type II DM and non-diabetic Periodontal status:
periodontal pocket
attachment loss
(CAL)
To assess the disease in type II DM patients in North India.
Analytical observational study with a cross sectional approach, involving 97 subjects with type II DM and 97 subjects without type II DM, at Periodontics Clinic.
Dental Hospital.
Faculty of Dentistry.
University of Indonesia during Prevalence Periodontal Disease in Type 2 Diabetes Mellitus Patients: A Cross-sectional Study, (Monika Singh.
Vivek Kumar Bains.
Rajesh Jhingran.
Ruchi Srivastava & Shubhash Chandra Maurya, 2.
Assessment periodontal health among patients with diabetes mellitus: a retrospective study, (Masitah et al.
, 2.
Oral health status among 10-15years old type 1 diabetes Universitas Batam Batam Batam Analytical observational study with a cross sectional approach, involving 427 respondents from type II DM patients at the outpatient clinic of the Department of Periodontology.
Saraswati Dental College.
Lucknow, and Dr.
Ram Manohar Lohia Combined Hospital.
Gomti Nagar.
Lucknow.
Assessing cross-sectional periodontal health retrospective patients was conducted at with DM.
Saveetha Dental College and Hospital, using medical records diagnosed with DM, aged over 30 years with more than 6 remaining teeth.
Assessing oral Analytical health status and observational study knowledge among with a case control children and young approach in 175 cells stained with PAS .
=0.
The average gingival index scores in group 1, group 2, and group 3 were 1,58, 1,54, and 1,25.
Periodontal status showed increased periodontal pockets in the obese diabetic group .
,4%), followed by the non-obese diabetic .
,66%), and the obese non-diabetic group .
%).
Clinical attachment loss (CAL) was severe in the obese diabetic group .
,7%), followed by non-obese diabetic .
,9%) and non-obese diabetic .
,3%) Periodontal status in T2DM subjects had a higher value compared to subjects without T2DM.
The periodontal status that has the highest value is clinical attachment loss (CAL), while gingival recession has the lowest There were significant differences in pocket depth .
=0.
=0.
, and clinical attachment loss (CAL) .
=0.
in subjects with type II DM compared to subjects without type II DM .
value < 0.
More than 95% of type II DM patients experience periodontal 27,1% of respondents had good oral hygiene, 68,8% fair, and 3,9% poor.
The prevalence of severe periodontitis in respondents with good, fair, and poor oral hygiene status was 0,8%, 17%, and 29,4%.
The prevalence of severe periodontitis in respondents with good, adequate, and poor oral hygiene status with poor glycemic control .
lycated hemoglobin >8%) was 2,5%, 28,1%, and 30,7%.
Total of 200 diabetes patients, 116 patients experienced gingivitis and The prevalence of both gingivitis and periodontitis was higher among patients in the age group 45-54 years and in men than in women.
The association between age and periontal status was found to be statistically significant with p value= 0.
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mellitus children and Bengaluru, (Geetha et al.
, 2.
adolescents using children aged 10-15 Community years with T1DM and Periodontal Index 175 non-diabetic and the carious controls at Bangalore teeth/ missing teeth/ Diabetes Hospital.
filled teeth index (DMFT/dmf.
Gingival crevicular fluid biomarkers in type 1 diabetes mellitus: A caseAe control study, (Sereti et al.
, 2.
Comparing Analytical Gingival crevicular observational study fluid (GCF) levels with a case control of interleukin 8 (IL- approach matrix subjects with TIDM metalloproteinase 8 in the Diabetology (MMP-.
, and Unit of the Geneva advanced glycated- University Hospital, products and (AGE.
in a group subjects.
Samples of type I diabetes were tested for IL-8 (T1D) subjects and and MMP-8 using a healthy controls.
detection system and for AGEs ELISA.
Comparative among diabetic and non-diabetic davangere city: A cross-sectional study, (Yavagal & L, 2.
Assess cross-sectional the comparative and was conducted among of subjects aged 25-64 periodontal disease years, consisting of among diabetic and 210 diabetic subjects non-diabetic and 300 non-diabetic populations aged subjects in Davangere 25-64 years in City.
Community Davangere City.
Periodontal Index (CPI) and loss of attachment (LOA) are periodontal status.
Comparing caries A retrospective study and gingival status with a case-control in patients with method using clinical TIIDM and healthy data from 60 TIIDM children to improve patients understanding and healthy patients aged attention of patients under 10 years with TIIDM TIIDM towards oral health.
Department Endocrinology.
ChildrenAos Hospital.
Capital Institute of Pediatrics.
Comparison Caries and Gingival Status in Patients with Type 2 Diabetes Healthy Children, (Wang et al.
, 2.
Universitas Batam Batam Batam There were more patients with bleeding and calculus in the diabetes group than in the control The difference between the diabetes group and the control group was statiscally significant .
=0.
the mean number of DMFT/dmft was less in diabetics .
,07A0.
26A0.
compared with the control group .
1A0.
84A0.
, respectively.
Overall, oral health knowledge was higher in diabetes patients .
3A1.
compared with controls .
5A1.
TIDM subjects showed more gingival plaque and inflammation as well as more sites with bleeding on probing compared with controls.
GCF levels of IL-8.
MMP-8, and AGEs were not significantly different between the two groups.
Further analysis of GCF markers in younger (<40 year.
and older (Ou40 significant differences between younger diabetics and controls or between older diabetics and When groups were divided according to glycemic status (HbA1c 6.
1-8, and >8%), no significant differences could be identified for any biochemical There was highly signigficant relationship between diabetes status and periodontal status .
<0.
the severity of periodontal disease was higher among diabetics than non-diabetics .
<0.
The prevalence of dental plaque (DP) .
,67%) and moderate to severe PD .
%) in the diabetic group was significantly higher compared to the healthy group .
,33% and 23,33%) .
,25, 95% CI .
,96, 1,.
P<0.
The prevalence of caries and CA was also significantly higher in the diabetic group .
% vs.
21,67%,
2,88 vs.
, and the incidence of gingivitis was higher .
,33% vs.
16,67%) .
,93, 95% CI .
,38, 2,.
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Periodontal health in a cohort of subjects with type 1 diabetes (Roy et al.
, 2.
Osteocalcin levels in gingival crevicular patients with and Diabetes Mellitus, (Wildan et al.
, 2.
Severity Periodontal Status in Type I and Type II Diabetes Mellitus, (Batool et al.
, 2.
Assessment of Oral Hygiene.
Gingival.
Universitas Batam Batam Batam P<0.
Meanwhile, the diabetic group showed significantly higher PI .
,31A0,.
GCBI .
,45A0,.
AL .
,62A 0,47 m.
, and TL .
,85A0,17 m.
, with obvious differences compared with the .
,92A0,21, 0,86A0,23, 1,65A0,46 0,36A0,08 m.
,46, 95% CI .
,33, 5,.
, p<0.
Evaluate Cohort study in a group There periodontal health of TIDM subjects, 50 differences between two groups in and oral health people with TIDM .
mean PD.
CAL, and mean number using men and 20 women.
of sites with PD >4mm that bleed on gingival index (GI), mean age: 35,2 year.
Subjects with diabetes had index, were recruited from the significantly more plaque and pocket depth (PD).
Diabetology Unit of the gingival inflammation and more bleeding on probing Geneva University sites with BOP compared to control (BOP), and clinical Hospital.
Further analysis of younger (<40 year.
and older (>40 (CAL), and record year.
subjects revealed significant self-reported differences in GI between younger healthy subjects and controls.
behaviors related to dental care.
assess Analytical OC levels in the TIIDMP group octeocalcin (OC) observational study were lower with an average of levels in gingival with a case control 0,369A0,140, while the non-DM crevicular fluid in approach, using periodontitis group had levels of crevicular 0,664A0,141.
with fluid taken from 20 uncontrolled type periodontitis patients II DM and non- with type II DM DM patients.
(TIIDMP) and 20 non-DM periodontitis patients and analysis of OC levels using the Osteocalcin ELISA Kit at the UGM Prof.
Soedomo Dental and Oral Hospital and the KORPAGAMA Family Doctor Clinic.
Comparing cross-sectional Of the 89 patients with type I DM, of descriptive study of 60 patients scored 1 according to the periodontal status 178 patients with type I CPITN assessment .
leeding on in patients with and type II DM from probing, indicating periodontal type I and type II the diabetes clinic of diseas.
In comparison, of the 89 Liaquat University patients with type II DM, 51 Hospital (Hyderaba.
patients scored 3 according to the was assessed to record CPITN .
eaning findings, pathological pocket depth .
periodontal disease and indicating a higher severity of severity with the help periodontal The Community relationship between the CPITN Periodontal Index of score was significant with both Treatment Need types of DM .
value = 0.
(CPITN) index.
To assess oral A case-control study There hygiene, gingival of 80 children .
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Periodontal Health, and Teeth Eruption Type 1 Diabetic Saudi Children, (Mandura et al.
and periodontal permanent teeth in children with type I DM and healthy children with type I DM and 40 healthy childre.
aged 6-12 years, was clinically examined using the hygiene index.
Loe and Silness gingival (CAL), and Logan and Kronfeld tooth eruption stage.
Association between and oral health in children with type 1 diabetes mellitus, (Ferizi et al.
, 2.
Analyzing metabollic control on saliva, dental plaque, gingival inflammation, and caries-causing bacteria in saliva.
Comparison of the inflammatory states gingival crevicular fluid in periodontitis patients with or diabetes mellitus, (Xu et al.
, 2.
To compare the state in gingival (GCF) patients with or without TIIDM Evaluation Periodontal Status Amongst Diabetic Patients Visiting Private Determining periodontal status needs using the Community Epidemiological case-control study in children with type I DM .
children with control (HbA1c < 7,5%) and 46 children with poor metabolic control (HbA 1c >7,5%).
Oral status was evaluated using the Decay.
Missing, and Filled Teeth indeks for permanent teeth (DMFT), plaque indeks and gingival Case control study on GCF volume, total IL-17, visfatin, 100 samples divided and RANKL/OPG ratio in GCF and into 20 subjects with their concentrations in serum were periodontal higher .
<0.
in the CP and DC conditions (Group H ), groups compared with the H group.
with These values were also higher periodontitis (Group .
<0.
in the DC group compared CP), and 40 subject with the CP group, except for with periodontitis and visfatin in GCF and IL-17 in serum.
type II DM .
roup DC).
At sample sites with pocket depth Fasting blood glucose (PD)Ou3mm.
GCF volume.
IL-17, (FBG) and HbA1c visfatin, and RANKL/OPG ratio in were the DC and CP groups were higher GCF .
<0.
compared with the H volume and serum group, and also higher in DC group levels of interleukin compared with the CP Group, both (IL) 17, visfatin, and with PDOu3mm.
The inflammatory the ratio of RANKL state in GCF was positively .
eceptor activator of correlated nuclear factor-kappa B inflammation and both were positively correlated with FBG.
osteoprotegerin (OPG) were measured.
Cross sectional study The age group of 56-65 years of 102 diabetic patients showed the worst periodontal status in the out patients clinic among all groups and required the of a private dental highest periodontal treatment.
This clinic in Ahmedabad, group of diabetic patients is more Universitas Batam Batam Batam healthy children regarding oral hygiene and gingival health.
Most children had poor oral hygiene .
,5% in the case group and 60% in the control grou.
, with fairly good gingival health .
% in the case group and 55% in the control Children with DM had significantly more periodontitis .
=0.
compared to healthy Teeth in advanced eruption stages were significantly higher in DM children compared to control subjects .
=0.
048 in stage V and p=0.
003 in stage VI).
The diabetic group with poor metabolic control had significantly higher DMFT index, plaque index, and gingival index, as well asa more colonies and higher risk of Streptococcus Lactobacillus compared to children with good metabolic control .
<0.
The level of diabetic metabolic control did not affect salivary flow rate .
>0.
The majority of both groups, both with good and poor metaboliccontrol, brushed their teeth once a day and visited the dentist only when necessary .
,3%).
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Dental Clinic in Ahmedabad Using CPITN, (Patel et al.
, 2.
The between Type 1 diabetes mellitus and periodontal diseases, (K.
Sun et al.
Periodontal Status of Type 2 Diabetic Patients Attending UNRWA Health Centers in Gaza Governorates, (Alqedra & Aljeesh.
Effect of diabetes periodontal health status, salivary flow rate and salivary pH in patients with chronic periodontitis, (Ibraheem et al.
Universitas Batam Batam Batam Periodontal Indeks Treatment Needs (CPITN) indeks in Analyzing population-based study in Taiwan, with a follow-up period of 14 years, to investigate the risk of periodontal diseases (PD.
in TIDM patients.
Evaluating periodontal status in TIIDM patients visiting UNRWA health centers in the GAZA Strip.
To determine and periodontal health diabetic and nondiabetic patients screened by a single susceptible to the development of examiner based on destructive forms of periodontal WHO criteria, using a disease.
Periodontitis mouth mirror and periodontal disease that is found to CPITN probe.
occur more frequently than gingivitis in patients with TIIDM.
Cohort study TIDM patients showed an increased newly risk of PDs compared to non TIDM patients individuals .
HR 1,.
TIDM
with TIDM from 1998 patients who visited the emergency Participants room more than twice per year had consisted of 4248 a higher aHR of 13,0 for developing patients in the TIDM PDs, and the aHR for PDs in TIDM cohort and 16992 patients who were hospitalized individuals in the non more than twice per year was 13,2.
TIDM cohort.
Cross-sectional 4% of participants did not analytical study of experience gingival bleeding, with 406 TIIDM patients an average number of teeth without through gingival bleeding of .
, random experiencing gingival bleeding of sampling from 5 .
, and not present for bleeding UNRWA health test of .
2,4% of participants Basic method did not have periodontal pockets, tools from the World with an average number of teeth Health Organization without periodontal pockets of (WHO) were used to .
, having 4-5 mm pockets of cllect data and assess .
, having 6 mm or more oral health.
pockets of .
, and not present for pocket measurement of .
Gingival bleeding was statiscally significantlyassociated with gender and frequency of toothbrushing, but there was no statiscally significant bleeding and periodontal pockets, social demographics.
HbA1c levels and duration of diabetes.
Case control study on All clinical periodontal parameters 70 patients divided into were highest in group 1 compared three groups: Group 1 with groups 2 and 3.
Comparison consisted of 25 patients between pairs of groups revealed with type II DM and significant differences between chronic periodontitis, groups 1 and 2 for plaque index.
Group 2 consisted of 25 gingival indeks, pocket depth, and patients with chronic clinical attachment level, and highly periodontitis without a significant differences for plaque history of systemic indeks and gingival indeks between disease, and Group 3 groups 2 and 3, and between groups consisted of 20 subjects 1 and 3.
Salivary flow rate and pH healthy were lower in group 1 compared and with groups 2 and 3.
Intergroup systemic comparison for salivary parameters with also showed significant differences periodontal parameters between groups 1 and 2, with No.
laque index, gingival significant differences between index, pocket depth, groups 2 and 3.
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Oral health-related quality of life in type 2 diabetic patients of Yogyakarta General Hospital, (Agustina et al.
Universitas Batam
Batam
Batam
Evaluating health-related quality of life
(OHRQoL) outpatients with type II DM, using the Geriatric Oral
Health
Assessment
Indeks (GOHAI) and Xerostomia
Inventory (XII]) Analytical observational study with a cross-sectional approach, involving 50 male outpatients outpatients with type
II DM (Aged 40-81
RSU
Yogyakarta.
A total of 49 .
,76%) subjects had low GOHAI scores and 33 .
,24%) high.
,12%) with and 4 .
,88%) without periodontal tissue abnormalities.
,34%)
with poor OH and 3 .
,66%) WITH good OH.
,73%) with coated tongue O50%.
>50% and 65 .
,27%) with coated tongue O50%.
,46%) with the number of teeth <20 and 48 .
,54%) with the number of teeth Ou20.
,56%) with xerostomia and 43 .
,44%) with normal status.
The nuber of teeth was significantly correlated with the proportion of GOHAI status in patients with type II DM .
=0.
type II DM patients with Ou20 teeth had a significantly higher proportion of high GOHAI status compared to <20 teeth the majority of outpatients with type II DM had poor OHRQoL as a reflection of oral conditions which were partly influenced by patients with <20 teeth.
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Inflammation and Damage to Periodontal Tissue One of the main effects of DM is increased inflammation in various body This condition occurs due to increased levels of TNF- (Rohani, 2.
DM causes increased expression of inflammatory cytokines in periodontal tissues, such as increased IL-1 and prostaglanddin E2 found in gingival crevicular fluid (GCF) in patients with type I and type II DM (Chung et al.
, 2.
Various studies have reported increased expression of TNF-.
IL-1.
IL-17.
IL-23, and IL-6 in the gingiva of patients with DM.
increased expression of these inflammatory cytokines causes increased blood vessel inflammatory cells, as well as increased bone resorption (Graves et al.
, 2.
Increased inflammation also induces greater production and activation of matrix metalloproteinases, connective tissue demage, and increased apoptosis of matrixproducing cells such as fibroblast and osteoblasts, thereby slowing the healing the production of antiinflammatory factors such as IL-4.
IL-10, and transforming growth factor- (TGF-), contribute to increased periodontal inflammation in diabetics.
Several antiinflammatory cytokines produced by T cells and M2 macrophages are reduced in decreased anti-inflammatory activity of peroxisome proliferator-activated receptor, inflammation and gingival changes in diabetics (SriChinthu et al.
, 2.
Other conditions resulting from the influence of chronic high glucose levels, trigger cytokine expression and responses to cytokine stimulation, including the production of reactive oxygen species (ROS).
High glucose levels in all tissues of people with DM causes an increase, which then contributes to cell and DNA demage and increased inflammation (Graves et al.
The interaction of AGEs with their receptors AGEs (RAGE) can stimulate the Universitas Batam Batam Batam production of ROS, triggering the expression of inflammatory cytokines (Alqedra and Aljeesh, 2.
Periodontal examination showed higher pocket depth and clinical attachment loss (CAL) levels in the DM group compared to the non-DM periodontitis group, indicating that periodontitis patients with DM experience more severe periodontal tissue demage (Patel et al.
Hyperglycemia in DM increases AGEs, which accelerate pro-inflammatory effects, thus affecting various body systems, including periodontal tissues.
Several studies evaluating gingival status using gingival indeks, showed that gingival health was worse in obese and non-obese diabetic patients compared to non-diabetic obese patients (SriChinthu et al.
, 2.
Distribution of gingival status based on blood sugar control showed that the most severe cases were found in subjects with poor blood sugar control, namely 10 people .
,6%).
This condition occurs because poor blood sugar control greatly affects the health of gingival tissue in diabetics.
Uncontrolled diabetes causes demage to white blood cells, making teeth more susceptible to infection and increasing the risk of gingival problems to changes in gingival status (Zahrawi Astrie Ahkam.
Hasrini.
Amirah Maritsa.
Arfiah Jauharuddin, 2.
Damage to Periodontal Ligament Cells.
Osteoblasts, and Osteocytes DM causes a decrease in the number of periodontal ligament cells, osteoblasts, and osteocytes, and increases apoptosis which ultimately has an impact on gingival changes and regeneration of periodontal and bone tissue (Rohani, 2.
periodontal ligament cells.
DM reduces the number of fibroblasts that are important for the maintenance of periodontal structures.
Patients with type I DM have a 6-7 times higher risk of fracture with reduced bone mineral density, while patients with type II DM have a 1,5 times higher risk of fracture Page 192 ZONA KEDOKTERAN VOL.
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with decreased bone strength without reduced bone mineral density (Wildan et , 2.
DM significantly reduces bone formation, associated with decreased expression of transcription factors such as Runt-related transcription factor 2 (RUNX.
, the human homologue of the distal-less gene in drosophilia, and C-fos.
Diabetes reduces the number of bone-lining cells, osteoblasts and periodontal ligament fibroblast, and increases apoptosis of these AGE products may contribute to the decrease in osteoblast precursors seen in Diabetes also increases apoptosis of mesenchymal stem cells and periodontal ligament cells, and reduces differentiation of mesenchymal stem cells into osteoblasts (Agustina et al.
, 2022.
Rohani, 2.
Accumulation of AGEs in bone tissue also triggers osteoblast apoptosis and impairs bone regeneration.
RAGE
inhibitors have been shown to reduce TNF production and periodontal bone loss.
Increased binding between RAGE and AGE activates nuclear transcription factorB (NF-B), leading to increased expression of NF-B receptor activator ligand (RANKL), which mediates Accumulation of AGEs can also stimulate IL-6 which will reduce osteoblast proliferation and activity and increase osteoclast activity.
Another study explained that IL-6 reduces osteoblast formation and fuction, thereby reducing the number of osteoblasts in DM patients (Perraudin, 2.
High pro-inflammatory mediators in patients with DM increase lipid peroxidation and dyslipidemia resulting in High levels of TNF- increase the RANK/ osteoprotegrin (OPG) rasio causing increased bone resorption.
Chronic inflammation stimulates the expression of pro-apoptotic genes such as bcl-2-like protein (BAX) and decreases the expression of genes that stimulate osteoblast formation such as Fos antigen and RUNX2, resulting in more severe bone damage (Rapone et al.
, 2021.
Zahrawi Universitas Batam Batam Batam Astrie Ahkam.
Hasrini.
Amirah Maritsa.
Arfiah Jauharuddin, 2.
Periodontal Disease Poor glycemic control is associated with the onset and progression of gingivitis, periodontitis, and alveolar bone loss.
Periodontal disease has been reported to have a higher incidence and prevalence in patients with type I and type II diabetes.
The prevalence of severe periodontitis in diabetic patients compared to non-diabetics was found to be 59,6%: 39% (Rohani.
The most striking changes is uncontrolled diabetes are a decrease in the bodyAos defense mechanisms and an increased susceptibility to infection, leading to destructive periodontal disease.
Glucose content in gingival fluid and blood is higher in individuals with diabetes compared to those without diabetes, even though plaque scores and the GI are similar (Tabatabaei et al.
, 2.
Increased glucose in the gingival fluid and blood in diabetic patients can alter the microflora environment, triggering qualitative changes in bacteria that contribute to the severity of periodontal disease seen in patients with uncontrolled diabetes.
In patients with uncontrolled diabetes, polymorphonuclear granulocytes (PMN.
and monocytes/ macrophages are impaired, thus reducing the primary defense of PMNs against periodontal pathogens and increasing bacterial proliferation (Chung et al.
, 2024.
Costa et al.
, 2.
Mechanisms explaining increased susceptibility to periodontal disease include alterations in host defense responses .
uch as neutrophil dysfunctio.
, subgingival microbial flora, collagen structure and metabolism, vascularization, and gingival crevicular fluid, as well as heredity.
Several risk factors have been reported to make patients with DM more susceptible to the development of periodontal disease, including poor oral hygiene, poor metabolic control, longer duration of DM and smoking (Zahrawi Astrie Ahkam.
Hasrini.
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Amirah Maritsa.
Arfiah Jauharuddin.
Several studies have shown that periodontal disease has a negative impact on diabetes and treatment of periodontal disease has a positive effect on blood sugar Elimination of pathogens through treatment reduces inflammation which ultimately reduces insulin resistance, thus lowering glucose levels.
Therefore, there is a bidirectional relationship between periodontal disease and diabetes.
In the adult population, periodontal disease is the leading cause of tooth mobility and ultimately tooth loss (Costa et al.
, 2023.
Nadhia Anindita Harsas.
Robert Lessang.
Yuniarti Soeroso, 2.
Gingivitis Gingivitis is the early stage of periodontal disease, characterized by inflammation limited to the gingiva, gingiva bleeding and swollen gums, and can be treated with good oral hygiene (Batool et al.
, 2.
This disease can progress to periodontitis if left untreated, characterized by inflammation, loss of connective tissue, and irreversible destruction of periodontal tissue.
Several previous studies have identified diabetes as a risk factor for the prevalence of gingivitis (Nadhia Anindita Harsas.
Robert Lessang.
Yuniarti Soeroso.
Periodontitis Periodontitis is a chronic inflammatory disease characterized by demage to tooh-supporting structures such as the periodontal ligament and alveolar bone.
The prevalence of severe periodontitis is 10% to 15% in the general population (Stydle et al.
, 2.
periodontitis is known as a complication of DM, increasing the gingival response to bacterial plaque due to high glucose levels in GCF, neutrophil dysfunction, and changes in collagen metabolism Universitas Batam Batam Batam (Kudiyirickal & Pappachan, 2.
Inflammation of the periodontal tissues triggered by the long-term presence of subgingival biofilm .
ental plaqu.
This inflammatory mediators and the destruction of periodontal tissues.
most studied mediators include IL-1.
IL-6.
PGE2.
TNF-.
RANKL, and MMPs.
especially MMP-8.
MMP-9, and MMP-13, as well as T-cell regulatoru cytokines .
IL-12.
IL-.
and The complexity of the cytokine network in periodontal pathogenesis is becoming increasingly clear and it is recognized that there is significant heterogeneity in the This heterogeneity occurs not only between individuals, but also within individuals over time, and is influenced by genetic, epigenetic, and enviromental factors.
The sum of the periodontal tissues determines the pattern and rate of disease progression (Rohani, 2019.
Xu et al.
, 2.
CONCLUSION
Based on literature review of 21 articles, researchers concluded that changes in gingival status in patients with DM are caused by the interaction between hyperglycemia, increased oxidative stress, and immune system dysfunction that worsens inflammation and gingival tissue Increased free radical production, tissue healing due to vascularization dysfuction, and decreased collagen production exacerbate tissue damage, thereby increasing the risk of periodontal disease in diabetics.
Therefore, it is hoped that the public will be more concerned about implementing a healthy lifestyle, including increasing the frequency of physical activity, regulating diet by paying Page 194 ZONA KEDOKTERAN VOL.
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attention to the amount and frequency of food .
-3 times a da.
, and the type and time of meals.
In addition, it is important to reduce smoking habits and check blood sugar levels regu.
ary, especially for individuals over 45 years of age and those with a family history of diabetes, to prevent oral complications due to DM.
Medical personnel are also expected to continue to improve health services and be more active in providing education to ht public regarding risk factors and complications of DM.
REFERENCES