diabetes

DIABETES SUPPORT GROUP

DAVID L. BURNS D.D.S.

JANUARY 7, 2004

M aya C lin ic

A n In terview W ith R obert R izza, M .D .

W H S: W ha t is diabetes?

D r. R izza : D iabetes is a d isease in w h ich you r b lood

sugar (glucose) concen tra tion is higher than norm al.

T hese high leve ls can occu r any- tim e du ring the day.

A h igh level early in the m orning is re ferred to as a

h igh fasting glu - cose . W hen it 's h igh a fte r you eat a

m ea l, it 's re fe rred to as a high postprand ia l glucose . .

W H S: W ha t's the diffe rence be tween type 1 and

type 2 diabete s?

D r. R izza: T h ey're d ifferen t d isea se processe s. In

typ e 1 (form erly ca lled juven ile or in su lin -

depen den t d iabetes) you r bod y destroys a ll th e

in su lin -secretin g cells (beta cells) in you r

pan creas. T h is is believed to be a d isorder of you r

in tern al im m un e system . .In type 2 (for - m er ly

ca lled adu lt-on set or n on in su lin -depen - den t

d iabetes) you r pan creas m akes in su lin , bu t n ot

en ough for you r bod y's n eeds. T h at can be

because you r bod y n eeds a lot of in sulin , w h ich is

referred to a s in sulin resistan ce, or it cou ld be

because you r bod y h as grea t d ifficu lty secretin g

in su lin . T h ere 's a lw ays a ba lan ce betw een h ow

m uch in su lin you r bod y m akes versus h ow m uch

your

bod y n eeds. F or exam ple, you r bod y m akes a

cer tain am oun t of in sulin . B u t if you 're over -

w eigh t or you 're seden tary, you r bod y n eeds

m ore. Y our blood sugar goes up because you

can 't secrete a s m uch in sulin a s you n eed . O n th e

oth er han d, you cou ld have a gen etic abn orm a lity

in th e w a y you secrete in su lin , so even th ough

you 're lean an d fit, you still m ay n ot have qu ite

en ough , an d you r blood sugar goes up . T h is is

w h y you m ay see a th in older adu lt w ith type 2

d iabetes or a very h eavy youn g person w ith typ e

2 d iabetes. .

bu t it's n ot rea lly n ecessa ry; th e th erapy is still th e

sam e. 8

W H S: C an diabe te s be p reven ted?

D r. R izza: Y es. G en era lly, you can preven t

typ e 2 d iabetes if you stay lean an d fit. T h at w ay

your bod y h as th e ability to p roduce en ough

in su lin for you r n eeds. .W ith type 1 , it 's m ore

com plica ted . T h is is a disea se in wh ich you

develop an tibod ies or som e im - m un e

abn orm alities aga in st th e beta cells in you r

pan creas. B u t in terestin g ly, ever ybod y w h o h as

th ese im m un e abn orm alities doesn 't n ecessa rily

develop type 1 d iabetes. F or exam - ple, if you

have an iden tical tw in w h o h as

typ e 1 d iabetes, you on ly have approx im a tely a 50

percen t ch an ce of gettin g th e d isease, too. If you

tested th e aun ts, un cles, broth ers, sis- ter s,

m oth ers an d fa th ers of peop le w ith type

1 d iabetes, you 'd fin d tha t m an y h ave an tibod ies

again st th eir beta cells, w h ich says th is destructive

p rocess is going on , yet th ey n ever get diabetes.

T h e problem w e h ave w ith type

1 d iabetes is tha t w e don 't kn ow h ow to p re- dict

w h o is goin g to go on to develop th e disea se and

w h o isn 't. .W e believe tha t som e oth er process is

goin g on . B esides a gen etic pred isposition ,

perh aps an en vironm en tal tr igger is n ecessa ry or

som e oth er in itia tin g

Ifactor th at carries th e d isease process forw ard ,

resu ltin g in diabetes. .

W H S: W ha t is p re -diabe te s?

D r. R izza: Pre-diabetes is a term th at im p lies th at

you h ave cer tain factors tha t p lace you a t h igh risk

o f p rogressin g to d iabetes. F or in stan ce, a n orm a l

fa sting blood sugar is 80 to 100 . Y ou h ave

d iabetes if you r fa stin g blood suga r is m ore than

126 . B u t if you h ave a blood sugar th at's betw een

100 an d 125, you don 't have d iabetes yet, bu t

clea rly you r

blood suga r is already abn orm al. T h is is w h en

your doctor m ay say you 're pre-d iabetic. H avin g a

blood suga r in th is pre-d iabetes

I ran ge puts you a t a very h igh risk of p rogress-

in g to d iabetes un less you do som eth in g

abou t it, such a s lose w eigh t and exercise. Y ou

W H S: W hich type is m ost like ly to a ffec t adult

w om en?

D r. R izza: M ost adult w om en w h o h ave d ia-

bete s have typ e 2 . T h at's n ot to say th at you can 't

develop type 1 a s an adult. In fact, abou t 10

percen t to 15 percen t of adu lts w h o develop

d iabetes have typ e 1 . C erta in tests can be u sed to

h elp determ in e w h ich type you h ave,

S tiP P 4 :$ M E N T T O JANUARY 2004

A n In terview W ith R obert R izza, M .D .

W H S: W ha t is diabetes?

D r. R izza : D iabetes is a d isease in w h ich you r b lood

sugar (glucose) concen tra tion is higher than norm al.

T hese high leve ls can occu r any- tim e du ring the day.

A h igh level early in the m orning is re ferred to as a

h igh fasting glu - cose . W hen it 's h igh a fte r you eat a

m ea l, it 's re fe rred to as a high postprand ia l glucose . .


W H S: W ha t's the diffe rence be tween type 1 and

type 2 diabete s?

D r. R izza: T h ey're d ifferen t d isease processes. In

typ e 1 (form erly ca lled juven ile or in su lin -

depen den t d iabetes) you r bod y destroys a ll th e

in su lin -secretin g cells (beta cells) in you r

pan creas. T h is is believed to be a d isorder of you r

in tern al im m un e system . .In type 2 (for - m er ly

ca lled adu lt-on set or n on in su lin -depen - den t

d iabetes) you r pan creas m akes in su lin , bu t n ot

en ough for you r bod y's n eeds. T h at can be

because you r bod y n eeds a lot of in sulin , w h ich is

referred to a s in sulin resistan ce, or it cou ld be

because you r bod y h as grea t d ifficu lty secretin g

in su lin . T h ere's a lw ays a ba lan ce betw een h ow

m uch in su lin you r bod y m akes versus h ow m uch

your


cer tain am oun t of in sulin . B u t if you 're over -

w eigh t or you 're seden tary, you r bod y n eeds

m ore. Y our blood sugar goes up because you

can 't secrete a s m uch in sulin a s you n eed . O n th e

oth er han d, you cou ld have a gen etic abn orm a lity

in th e w a y you secrete in su lin , so even th ough

you 're lean an d fit, you still m ay n ot have qu ite

en ough , an d you r blood sugar goes up . T h is is

w h y you m ay see a th in older adu lt w ith type 2

d iabetes or a very h eavy youn g person w ith typ e

2 d iabetes. .

W H S: W hich type is m ost like ly to a ffec t adult

w om en?

D r. R izza: M ost adult w om en w h o h ave d ia-

bete s have typ e 2 . T h at's n ot to say th at you can 't

develop type 1 a s an adult. In fact, abou t 10

percen t to 15 percen t of adu lts w h o develop

d iabetes have typ e 1 . C erta in tests can be u sed to

h elp determ in e w h ich type you h ave,

typ e 2 d iabetes if you stay lean an d fit. T h at w ay you r bod y h as th e ability to p roduce en ough in su lin for

you r n eeds. .W ith type 1 , it's m ore com plica ted . T h is is a disea se in w h ich you develop an tibod ies or som e

im - m un e abn orm a lities aga in st th e beta cells in you r pan creas. B u t in teresting ly, ever ybod y w h o has th ese

im m un e abn orm alities doesn 't n ecessa rily develop type 1 d iabetes. F or exam - ple, if you

W H S: C an diabe te s be p reven ted?

D r. R izza: Y es. G en era lly, you can preven t

WHS: Can diabetes be prevented?

Dr. Rizza: Yes. Generally, you can prevent type 2 diabetes if you

stay lean and fit. That way your body has the ability to produce

enough insulin for your needs. With type 1, it’s more complicated.

This is a disease in which you develop antibodies or some immune

abnormalities against the beta cells in your pancreas. But interesting-

ly, everybody who has these immune abnormalities doesn’t necessarily

develop type 1 diabetes. For example, if you

F or exam - ple, if you h ave an iden tica l tw in w h o

has

typ e 1 d iabetes, you on ly have approx im a tely a 50

percen t ch an ce of gettin g th e d isease, too. If you

tested th e aun ts, un cles, broth ers, sis- ter s,

m oth ers an d fa th ers of peop le w ith type

1 d iabetes, you 'd fin d tha t m an y h ave an tibod ies

again st th eir beta cells, w h ich says th is destructive

p rocess is going on , yet th ey n ever get diabetes.

T h e problem w e h ave w ith type

1 d iabetes is tha t w e don 't kn ow h ow to p re- dict

w h o is goin g to go on to develop th e disea se and

w h o isn 't. .W e believe tha t som e oth er process is

goin g on . B esides a gen etic pred isposition ,

perh aps an en vironm en tal tr igger is n ecessa ry or

som e oth er in itia tin g

Ifactor th at carries th e d isease process forw ard ,

resu ltin g in diabetes. .

W H S: W ha t is p re -diabe te s?

D r. R izza: Pre-diabetes is a term th at im p lies th at

you h ave cer tain factors tha t p lace you a t h igh risk

o f p rogressin g to d iabetes. F or in stan ce, a n orm a l

fa sting blood sugar is 80 to 100 . Y ou h ave

d iabetes if you r fa stin g blood suga r is m ore than

126 . B u t if you h ave a blood sugar th at's betw een

100 an d 125, you don 't have d iabetes yet, bu t

clea rly you r

blood suga r is already abn orm al. T h is is w h en

your doctor m ay say you 're pre-d iabetic. H avin g a

blood suga r in th is pre-d iabetes

I ran ge puts you a t a very h igh risk of p rogress-

in g to d iabetes un less you do som eth in g

abou t it, such a s lose w eigh t and exercise. Y ou

m a y not have fa llen off the side of a cliff, bu t you 're

ge tting p re tty close to the edge . .

W H S: W ho shou ld be sc reened fo r d iabe te s?

D r. R izza: T h e A m erican D iabetes A ssocia tion

(A D A ) says tha t ever yon e, par ticu larly th ose w h o

are overw eigh t, sh ou ld be screen ed for diabetes

ever y th ree yea rs beg inn in g a t age 45 . T estin g

sh ou ld be m ore frequen t for peop le w h o are

overw eigh t w h o a lso h ave oth er risk factors such

as a fam ily h istory o f d iabetes, a seden tary

lifestyle, h igh blood p ressure, an d h igh

ch olesterol and tr iglycer ide levels. 8

W H S : W h a t te sts a re do n e to sc reen fo r dia b ete s?

D r. R izza: T w o tests are m ost often d on e. O n e is

a sim p le blood test ca lled a fa stin g blood su g ar .

T h is test is ea sier an d fa ster to p er form . If you r

resu lt is greater th an 1 2 6, th en it in di- ca tes

d iabetes. T h e oth er test is ca lled a tw o- h ou r

g lu cose toleran ce test. In th a t test you 're g iven a

sw eet liq u id to dr in k an d th en tw o h ou rs later a

blo od su g a r test is d on e. If th e resu lt is greater

th an 2 0 0, th en you h ave d ia - betes. T h e A D A

recom m en d s a fa stin g blood su g a r test fir st, bu t if

you 're a t h igh risk of d iabetes -or th e resu lts of

you r fa stin g test are abn orm al -you r d octor m ay

con sid er d oin g a tw o-h ou r glu cose toleran ce test.

8

W H S : W h a t a re the treatm ents fo r dia be te s?

D r. R izza: T reatm en t for d iabetes is m ean t to

restore th e ba lan ce betw een in su lin n eed an d

in su lin ava ilability. W e star t w ith lifestyle

m od ifica tion -losin g w eig h t an d ex ercisin g. If

you can accom p lish th ese, you can dram a tica lly

d ecrease h ow m u ch in su lin you r bod y req u ires, so

you m a y n eed to d o n oth in g

m ore. O f cou rse, th is is ea sier sa id th an d on e.

M an y p eop le n eed to tak e m ed ica tion s for

d iabetes. T h ere are th ree m a jor cla sses of m ed -

ica tion s -pills th a t m ak e you secrete m ore in su lin ,

p ills th a t m ak e th e liver prod u ce less g lu cose, an d

p ills th a t m ak e in su lin w ork bet- ter. In su lin is

u sed w h en p ills aren 't en ou gh to k eep blo od su g ar

in th e n orm al ran g e. .

W H S : W hat new trea tm en ts are on the horizon? D r.

R izza : T here are a va riety o f new trea t- m ents being

studied , som e of them a t M ayo. A ll the ones

m en tioned here a re in advanced stages of tes ting and

m a y be ready w ithin the next one to three years. .O ne

m ed icine com es from a gas trointestinal horm one ca lled

G LP 1 ,

Ith e h orm on e tha t tells you r pan creas that food is

com in g an d to get ready to secrete in su lin . T h is

m ed icin e is rem arkable because it stim u- lates

in su lin secretion , it inh ibits glucagon - th e

h orm on e tha t raises blood sugar -an d it delays th e

ra te a t w h ich food em p ties from you r stom ach , so

th e m ed icin e can ease in to you r bloodstream . B u t

w h a t's par ticu larly en cou rag ing is tha t G L P l

m akes you secrete in su lin on ly w h en you r blood

sugar is h igh ,

so th e risk of getting low blood sugar (h ypo-

g lycem ia ) is n eg lig ible. .T h e problem w ith

th e G L P h orm on e is tha t it on ly la sts for abou t a

m in ute or tw o an d th en is rap idly deg raded . B u t

w h a t's bein g developed n ow a re ana logs to th e

h orm on e, in oth er w ords, sim ilar substan ces tha t

aren 't degraded so qu ick ly. .In oth er studies, a

d rug is bein g developed tha t inh ibits th e en zym e

th at degrades G L P . S o rath er th an giving you

G L P , you w ou ld take a pill to boost you r bod y's

na tura l G L P , g ivin g you th e sam e effect o f

stim ulating in su lin secretion . .S tudies are bein g

don e to fin d bet- ter w a ys o f deliver in g in su lin

th an by g ivin g you rself in jection s ever y da y. O n e

sh ow in g prom ise is in sulin tha t you inh ale. S om e

da ta say it w orks fin e, bu t n ow th e question is

w h eth er it'll be sa fe for lon g -term use. .

W H S: W ha t o ther im portan t fac ts wou ld you like our

readers to know abou t?

D r. R izza: Y ou h ear so m uch abou t all th e bad

h ealth con sequen ces of d iabetes. A n d it 's true th at

d iabetes is th e n um ber on e cause of k id - n ey

d isease, blin dn ess, am puta tion s, h eart d isea se

an d m ore. H ow ever , th ese con sequen ces happen

on ly w h en d iabetes is un trea ted . If you treat you r

d iabetes p roperly, keep you r blood sugar n orm a l,

keep you r blood p ressure n orm al an d keep you r

blood lip id s n orm al, you 're goin g to be fin e. .

W H S: W ha t's your hope fo r the .futu re o f diabete s

care?

D r. R izza: O f cou rse, th e ultim a te goa l is to cure

d iabetes. U n til th en , m y h ope for th e fu ture is tha t

ever yon e w ill be able to h ave access to th e very

best care for th eir diabetes. D iabetes requ ires a

par tn ersh ip betw een peo- p le, th eir ph ysician s and

oth er h ealth care providers. W e h ave m eth ods

ava ilable n ow th at can n orm a lize a lm ost

ever ybod y's blood suga rs. B u t you n eed to w ork

togeth er a s a team to m ake th e m ost of th ese

m eth ods. .

C en terpiece

E nam elD en tin

P u lp O ra l h e a lth ca re is im p o rta n t th ro u gh o u t a ll the s tag e s o f

yo u r life . H o w e ve 1 ; se vera l co n-

d it io n s a sso c ia te d w ith a g in g ca n le a d to m o u th

C ro w n

a n d g u m d ise a se . In a d d itio n , d e n ta l d ise a se is

n o w co n s id e re d a con tr ib u tin g fa c to r fo r so m e ca se s o f h e a rt

d ise a se , p n e u m o n ia , s tro ke a n d

Bone

N e rv e a n d

b lo o d s up p ly

T h e surface of a

Root

A ccord in g to th e S urgeon

G en era l's report "O ra l H ea lth in

A m erica ,1 I th e

h ealth of you r m ou th reflects you r

gen era l h ealth and w ell-

bein g . H ow ever , ora l h ealth is often

over look ed an d un derem phasized.

C e m e n tum

u n co n tro lle d d iab e te s.

h ea lth y cr o w n is

ena m el, a th in la yer

covered w ith

N atura l look of tee th an d gum s

Y our m ou th is perh aps th e m ost m u ltifun c- tiona l

par t of you r bod y. O f you r m ou th 's m an y

fun ction s, th e m ost obvious are biting , ch ew ing

an d sw a llow in g food . T h e m ost im por tan t tools in

th is process are you r teeth .

E ach of you r teeth -m ost peop le develop 32 of

th em -can be d ivided in to tw o par ts. T h e visible

por tion is th e crow n . T h e por tion h idden below

th e gum lin e is th e root. T h e sur - face o f a h ealth y

crow n is covered w ith enam - el, a th in layer of

ca lcified m aterial th at's th e hardest substan ce in

th e bod y. T h e ou ter surface of th e root is covered

by cem en tum . T h e periodon tal ligam en t, a

con n ective tissue, bin ds root cem en tum to th e

bon e tha t form s th e tooth socket.

B en ea th th e enam el an d cem en tum lies th e

bod y of th e inn er tooth (den tin ). D en tin is softer

th an en am el an d cem en tum , bu t h arder than bon e.

It surroun ds th e h ollow tooth core (ca lled th e pulp

cana l or root cana l), an area w h ere n erve en d in gs

an d blood vessels sen si- tize an d n our ish th e tooth .

N erves an d vessels feed in to th e pulp can al

th rough an open in g at th e root tip.

F irm , pin k gum s (gin g iva ) surroun d a h ea lth y

tooth . A t th e edge of you r gum lin e, you r gum

tissue fold s back un dern eath itself. T h is creates

aroun d each tooth a sn ug groove ca lled th e

g in g iva l su lcus.

m aterial that 's th e

of ca lcified

hardest substan ce

in the hum an body.

H ea lth y teeth an d gum s w ou ldn 't r em ain

h ealth y for lon g w ith ou t saliva . It's secreted from

glan ds th rough ou t you r m ou th . It h elp s clean you r

m ou th an d teeth , aid s in sw a llow - in g, an d

con ta in s enzym es tha t aid d igestion an d h elp

con trol in fection .

A lm ost ever yon e is su scep tible to gum d is-

ease an d tooth decay. H ow ever , som e factors m ay

in crease you r risk . T h ese in clude lack of

fluor idated w a ter, poor d iet, frequen t snack in g on

sw eets, h ered ity an d tobacco u se.

T he ou te r su rface

of th e root is

cem en tum , w hich

covered by

isn 't a s h ard

P lay in g h ost to b ac teria

Y our m ou th , like m an y oth er parts of you r bod y,

is h ost to bacteria. T h ese bacter ia con - ver t som e

of th e sugars and carboh ydra tes you ea t in to acid .

T h e bacter ia an d acid s th ey form becom e pa rt of

th e sticky deposit - ca lled den ta l p laque -th at

clin gs to th e sur - face o f you r teeth .

In add ition to bacteria, p laque is com posed o f

sa liva an d food par ticles. O ver tim e, p laque can

harden an d form a d ifficu lt-to-rem ove substan ce

ca lled tartar {ca lcu lu s).

D epen d in g on w h ere p laque an d tartar form ,

th ey m ay cause:

T oo th decay (carie s) -D ecay is a bacterial dis-

ease o f teeth an d th e pr im ary cause of tooth loss.

It is th e resu lt of th ree in teracting factors: bacteria

g row th , dietary sugar an d a vu ln era - ble tooth

su r face. T h e decay-p roducin g acid tha t form s in

p laque a ttacks th e m in erals in

th e tooth 's ou ter en am el sur face. T h e erosion

caused by th e p laque leads to tin y open in gs

{cavities) in th e enam el, w h ich you m ay n ot

n otice in itially. T h e fir st sign of deca y m a y be

a sen sa tion of pa in w h en you ea t som eth in g sw eet,

ver y cold or very h ot. O n ce th e en am el is

pen etrated , th e un der lyin g softer den tin

as en am el.

M A YO C L IN IC W O M E N 'S H E A L TH S O U R C E 4 JANUARY 2004

A ccord in g to th e S urg eon

G en era l's r ep ort "O ra l H ea lth in

A m erica ,1 I th e

h ealth of you r m ou th reflects you r

g en era l h ealth an d w ell-

bein g . H o w ever , ora l h ealth is often

o ver look ed an d un d erem ph asized.

”

N a tura l look of tee th a n d g um s

Y ou r m ou th is p erh ap s th e m ost m u ltifun c- tion a l

p ar t of you r bod y. O f you r m ou th 's m an y

fu n ction s, th e m ost obviou s are bitin g , ch ew in g

an d sw a llow in g fo od . T h e m ost im p or tan t tools in

th is process are you r teeth .

E ach of you r teeth -m ost p eop le d evelop 3 2 of

th em -can be d ivid ed in to tw o p ar ts. T h e visible

p or tion is th e crow n . T h e p or tion h id d en belo w

th e g um lin e is th e root. T h e sur - face o f a h ealth y

crow n is covered w ith en am - el, a th in layer of

ca lcified m aterial th at's th e h ard est su bstan ce in

th e bod y. T h e ou ter surface of th e root is covered

b y cem en tu m . T h e p eriod on tal ligam en t, a

con n ective tissu e, bin d s root cem en tum to th e

b on e th a t form s th e tooth sock et.

B en ea th th e en am el an d cem en tum lies th e

b od y of th e in n er tooth (d en tin ). D en tin is softer

th an en am el an d cem en tum , bu t h ard er th an bon e.

It surroun d s th e h ollow tooth core (ca lled th e p ulp

can a l or root can a l), an area w h ere n erve en d in g s

an d blood vessels sen si- tiz e an d n our ish th e tooth .

N erves an d vessels feed in to th e p ulp can al

th rou g h an op en in g at th e root tip.

F irm , pin k g um s (gin g iva ) surroun d a h ea lth y

tooth . A t th e ed g e of you r gu m lin e, you r g um

tissu e fold s back u n d ern eath itself. T h is creates

arou n d each tooth a sn ug groov e ca lled th e

g in g iva l su lcu s.

H ea lth y teeth an d gum s w ou ldn 't r em ain

h ealth y for lon g w ith ou t saliva . It's secreted from

glan ds th rough ou t you r m ou th . It h elp s clean you r

m ou th an d teeth , aid s in sw a llow - in g, an d

con ta in s enzym es tha t aid d igestion an d h elp

con trol in fection .

A lm ost ever yon e is su scep tible to gum d is-

ease an d tooth decay. H ow ever , som e factors m ay

in crease you r risk . T h ese in clude lack of

fluor idated w a ter, poor d iet, frequen t snack in g on

sw eets, h ered ity an d tobacco u se.

P lay in g h ost to b ac teria

Y our m ou th , like m an y oth er parts of you r bod y,

is h ost to bacteria. T h ese bacter ia con - ver t som e

of th e sugars and carboh ydra tes you ea t in to acid .

T h e bacter ia an d acid s th ey form becom e pa rt of

th e sticky deposit - ca lled den ta l p laque -th at

clin gs to th e sur - face o f you r teeth .

In add ition to bacteria, p laque is com posed o f

sa liva an d food par ticles. O ver tim e, p laque can

harden an d form a d ifficu lt-to-rem ove substan ce

ca lled tartar {ca lcu lu s).

D epen d in g on w h ere p laque an d tartar form ,

th ey m ay cause:

T oo th decay (carie s) -D ecay is a bacterial dis-

ease o f teeth an d th e pr im ary cause of tooth loss.

It is th e resu lt of th ree in teracting factors: bacteria

g row th , dietary sugar an d a vu ln era - ble tooth

su r face. T h e decay-p roducin g acid tha t form s in

p laque a ttacks th e m in erals in

th e tooth 's ou ter en am el sur face. T h e erosion

caused by th e p laque leads to tin y open in gs

{cavities) in th e enam el, w h ich you m ay n ot

n otice in itially. T h e fir st sign of deca y m a y be

a sen sa tion of pa in w h en you ea t som eth in g sw eet,

ver y cold or very h ot. O n ce th e en am el is

pen etrated , th e un der lyin g softer den tin

G ing iv itis -T h is m ild , ear ly form of gum disea se

can cause h ea lth y, p in k gum s to becom e red ,

sw ollen , ten der an d pron e to bleed in g.

T h e sw elling an d ten dern ess a ssocia ted w ith

g in g ivitis is caused by you r im m un e system 's

in flam m atory respon se to p laque or tartar bu ildup

a lon g you r gum lin e. G ing ivitis often

is pain less an d goes unn oticed . If un ch ecked ,

g in g ivitis can lead to periodon titis, a m ore serious

d isease.

P eriodon titis -T h is is an advan ced stage of gum

disease th at m ay develop w h en plaque and tartar

ex ten d ben ea th you r gum lin e. G radua lly, you r

gum s w ith draw from aroun d you r teeth . P ockets

o f in fection can form in

th is dark, a irless reg ion and destroy tissue an d

your tooth sockets (a lveola r bon e). L eft un treated ,

in volved teeth even tua lly loosen an d fa ll ou t.

C h ron ic periodon tal disease is th e lead in g cause of

tooth loss in older adu lts.

In ad d ition , a sm a ll p ercen tag e of m en o- pau sal w om en m ay ex p er ien ce g u m in flam - m a tion (m en op au sal

g in g ivitis). T h is cau ses

R isk fa c tors w ith a g e, g en d er

S om e ora l con d ition s are un iq u e to w om en at

sp ecific p h ases of th eir lives d u e to sev era l fac-

tors, in clud in g h orm on es. F or exam ple, d ur in g

m en op au se, you m ay n otice d iscom for t in you r

m ou th , in clud in g dry m ou th an d bu rn - in g

sen sa tion s in th e gu m tissu e (bu rn in g m ou th

syn d rom e). Y ou m ay a lso n otice alter - ation s in

ta stes, su ch a s sa lty, p ep p ery or sou r .

. C er ta in diseases th at a ffect th e ora l cav- ity a lso

are m ore com m on in w om en . A n d, th e older you

are, th e greater you r risk of develop in g d iseases

o f th e m ou th . A m on g th e factors tha t m ay a ffect

you r ora l h ealth are:

D iabete s -T h is con dition pu ts you a t greater risk

o f develop in g periodon tal disease an d oth er

in fection s. It in creases even m ore if you r diabetes

is poor ly con trolled . T hat's because d iabetes m ay

w eaken th e resistan ce of you r gum tissue to

bacter ial in fection and plaque.

In add ition , oral in fection m akes blood g lu - cose

levels h arder to con trol.

O steoporosis -R esea rch ers su spect a lin k be-

tw een th e loss of bon e m in eral den sity w ith

osteop orosis an d per iodon ta l d isease. L osin g

den sity in th e bon es tha t h old you r teeth in place

m ay h elp speed th e degen era tive p rocess of

per iodon ta l d isease. O steoporosis a lso m ay m ake

a good den ture fit d ifficu lt.

M edications -S om e drugs -such a s an tide-

p ressan ts and certain blood pressu re drugs - can

lead to dry m ou th , w h ich in creases you r

risk of gum problem s an d tooth loss.

W ear and tear -A s you get older , you m ay n otice

th at you r m ou th feels dr ier an d you r gum s have

pu lled back (receded} . Y our teeth m ay da rken

sligh tly an d becom e m ore brittle an d breakable.

M ak in g th e e ffor t

A dvan ces in den tal techn olog y -such a s gen etic

testin g for oral disea se or deca y r isk an d th e

ability to in itia te th e grow th of n ew teeth , bon e

an d tissue -m ay som eda y p laya p rom in en t role in

den tistry. H ow ever , da ily ora l h yg ien e com bin ed

w ith regu lar den ta l visits -a sk you r den tist h ow

often -is still th e best w a y to in crease you r

ch an ces of a h ea lth y m ou th . C arin g for you r

m ou th an d gum s m ay h elp to reflect m ore than a

h ealth y sm ile. It m ay h elp to reflect a h ealth ier

you . 8

Cariology &Periodontology

2003.03.12.

Department of Dental & Oral SurgeryWakayama Medical University

Presented by K.Tamaki

Academy of Template Research

60year old memorial presentation

CARIES

C A V I T Y /A B S C E S S

STREPTOCOCCUS MUTANS

CAVITIES AND PERIODONTAL DISEASE

RADICULAR GRANULOMA

RADICULAR CYST

ALVEOLAR ABSCESS

A B S C E S S / R O O TCANAL THERAPY

TREATMENT

外傷歯

PERIODONTAL DISEASE

Dental Plaque & Periodontal Disease

ADVANCED PERIODONTALD I S E A S E

TARTAR/CALCULUS

INFECTIOUS ORGANISMS

INFECTION

diabetes

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