Neutrophil activities in adolescents with type I diabetes mellitus depending on periodontal state

Abstract

The effect of systemic diseases on the periodontal state has been studied in a number of researches . Type 1 diabetes mellitus (T1DM) has long been called “juvenile diabetes” and today is considered the most common type of endocrine diseases in adolescents . Recent studies showed that T1DM patients are at higher risk of developing periodontal diseases than non-T1DM individuals , and periodontal disease is one of the early manifestations of diabetes in oral cavity of children. Neutrophils have a lot of activities to form the initial response against pathogenic insults: adherence and migra- tion, degranulation and release of inflammatory mediators, phagocytosis and apoptosis ; also they represent the most of leukocytes of gingival crevice . Clinical stud- ies have reported that the neutrophil activities impaired in blood and crevicular fluid in the adults with periodontitis. Furthermore, impaired chemotaxis, phago- cytosis and increased production of free radicals were confirmed in blood of the diabetic patients . Increased level of glucose in saliva and crevicular fluid in di- abetes strengthens proliferation of periodontopathic bacteria. To phagocytize bacteria of dental biofilm neutrophils can use both oxygen-dependent and oxygen-independent means . The recent review points to the strengthening of superoxide generation in the patients with periodontitis associated with diabetes mellitus due to both hyperglycemia and periodontitis . However, the overproduction of intracellular superoxide not only defends, but attacks periodontal tissues . The nitroblue tetrazolium test is one of the methods to find release of superoxide radicals by stimulated and non-stimulated neutrophils. Nitroblue tetrazolium is easily phagocytized by cells and reduced to formazan with the hexose monophosphate shunt activation . Unstimulated neutrophils from diabetic patients produce a great amount of superoxide anions and reduced NBT more efficiently. Neutrophils migrate from crevicular fluid or periodontal pocket into the oral cavity and can be evaluated in oral rinses. To the best of our knowledge, no report about the evaluation of the phagocytic activity of neutrophils and the NBT test in oral rinse of adolescents with periodontal disease associated with T1DM.