The influence of diabetes mellitus on periodontal tissues: a pilot study

Abstract

Purpose: The purpose of this study was to preliminarily evaluate the influence of diabetes mellitus (DM) on periodontal tissue without establishment of periodontitis.

Methods: Seven-week-old db/db mice were used for the diabetic experimental group and systematically healthy mice of the same age were used as controls. After 1 week of acclimatization, the animals were sacrificed for hard and soft tissue evaluation. The pattern of bone destruction was evaluated by stereomicroscope evaluation with alizarin red staining and radiographic evaluation by microscopic computerized tomography images. Histological evaluation was performed with hematoxylin and eosin stain for evaluation of soft tissue changes.

Results: In both stereomicroscope evaluation and radiograph image analysis, aggressive form of bone destruction was observed in diabetic animals when compared to the systematically healthy controls. In histological evaluation, apical migration of junctional epithelium with slight inflammatory cell infiltration was observed with disarrangement of connective tissue fibers.

Conclusions: Within the limits of this study, diabetic animals presented distortion in periodontal attachment and an aggressive bone loss pattern when compared to the healthy controls, suggesting that DM has an independent effect on periodontal tissue destruction irrespective of the presence or absence of periodontal disease.

Keywords: Diabetes mellitus; Inflammation; Periodontal disease.

Figure 1

Stereomicroscope images of buccal and lingual aspects of control (A, B) and diabetic (C, D) animals. Note the ruffled and nibbled bone surface at the alveolar crest area (arrow) in the diabetic animals, whereas a relatively smoother surface can be observed in the control animals (Alizarin-red stain, ×400).

Figure 2

Three-dimensional reconstructed micro-computerized tomography images of buccal (left) and lingual (right) aspects of the control (upper row) and diabetic (lower row) animals. Alveolar bone loss was observed from the cemento-enamel junction level of the tooth in both groups with slightly more loss in the diabetic animals. The margin of the crestal bone and the overall surface of the alveolar bone presented a ruffled and nibbled appearance when compared to the controls.

Figure 3

The overall histological image of the control animal. Junctional epithelium was located at the cemento-enamel junction level. Parallel and well organized fiber attachments were observed below the epithelium with minimal inflammatory cell infiltration (A) H&E stain, ×200, (B) H&E stain, ×400.

Figure 4

Higher magnification images of the oral epithelium of control (A) and diabetic (B) animals. The epithelium consisted of four definite layers with a thicker keratin layer in the diabetic group. The height of the dermal papilla was generally similar and there was no specific difference between the control and diabetic animals (H&E stain, ×400).

Figure 5

The overall histological image of the diabetic animal. Apical migration of junctional epithelium below the cemento-enamel junction was observed with distortion of fiber attachments. Slight inflammatory cell infiltration was observed in the connective tissue (A) H&E stain, ×200, (B) H&E stain, ×400.

Figure 6

Higher magnification images of alveolar bone region of control (A) and diabetic (B) animals. Parallel fiber attachments between cementum and alveolar bone were observed. There was no specific pathological change in either control or diabetic animals (H&E stain, ×400).