Medical and dental collaborations in Tokushima University Hospital and Tokushima Dental Association. COI Disclosure 2015/9/25.

Transcription

1 Medical and dental collaborations in Tokushima University Hospital and Tokushima Dental Association Toshihiko Nagata Department of Periodontology and Endodontology, Institute of Biomedical Sciences, Tokushima University Graduate School 1 COI Disclosure Speaker: Toshihiko Nagata The speaker has no financial conflict of interest to disclose concerning this presentation. Tokushima city Population: 21,18 (201) The capital city of Tokushima prefecture Tokushima city Tokushima station Bizan Naruto whirlpoors Kobe Kyoto Osaka Tokyo Yoshino river Fukuoka Tokushima Awa-odori Puppet theater 3 1

2 Number of case/0,000 people /9/2 Mortality rate due to DM in Tokushima prefecture Japanese average Tokushima citizens (from Home page of Tokushima prefecture) Diabetes (DM) mortality rates of Tokushima prefecture have been worst one in Japan for recent 14 years. Although Campaign for decreasing DM has been performed in Tokushima prefecture, the worst record is continuing. 4 Tokushima University Hospital, Medical hospital building Tokushima University Hospital, Dental hospital building Pf. Funaki In Tokushima University Hospital, Clinical Research Center for Diabetes and Diabetes Therapeutics and Research Center were established in 2007 and 20 for the purpose of the decrease of diabetes patients in Tokushima prefecture. Pf. Matsuhisa Signs of DM-improvement in Tokushima prefecture Downward trend in Tokushima despite an upward trend nationally Mortality rate due to diabetes (Number of cases per 0,000 people) Prevalence of diabetes in Tokushima (over 40 years old) decrease % 2.0% 20.0% 1.0%.0% DM 有病者予備群 IGT 24.7% 22.% 13.9% 11.% decrease.0%.8% 11.0% 0.0% 2003 H1 20 H22 National 2002 : 22.% 2007: 29.% increase 0 Tokushima 徳島 Kagoshima 鹿児島 Fukushima 福島 鳥青茨取森城 Tottori Aomori Ibaragi 0 Tokushima 徳島 岩手 Iwate 鳥取 Tottori 青森 Aomori 香川 Kagawa 富山 Toyama 2

3 Alveolar bone loss (%) Number of tooth loss 201/9/2 <In terms of dental science> Two important points concerning the relationship between diabetes and periodontal disease 1. Diabetes patients easily suffer from periodontitis and its condition tend to be severe. 2. The presence of periodontitis affects glycemic control of diabetes patients. Diabetes Periodontitis Two-way relationship 7 Diabetes-associated periodontitis A 42-y-old man. Type 2 diabetes A 0-y-old man. Type 2 diabetes Severe gingival inflammation Multiple gingival abscess Marked bone resorption Delay of wound healing 8 Alveolar bone loss and tooth loss in patients with diabetes and nephropathy (Collaboration study with Kawashima Hospital in Tokushima) 40 * * * 0 DM DM+HD HD Mean ± SE *P<0.0 0 DM DM+HD HD Mean ± SE *P<0.0 DM + HD patient DM: Outpatients with diabetes (n = 1) DM+HD: Dialysis patients with DM-nephropathy (n = 32) HD: Dialysis patients with renal diseases (n = 84) 9 3

4 First visit Periodontal therapy of a diabetic patient #1 ( year-old woman:type 2 diabetes hypertension breast cancer) After the initial therapy The change of HbA1c level before and after periodontal therapy HbA1c 08//30 7 EXT 08/11/21 7EXT 09/2/4 4 EXT Rate of PD> 4mm 27.% Rate of BOP 40.0% Rate of PD> 4mm 7.4% Rate of BOP 29.% Average HbA1c.2 Average HbA1c.4 11 First visit Periodontal therapy of a diabetic patient #2 (7 year-old woman:type 2 diabetes, RA, hypertension, endocarditis) After the initial therapy 4

5 Bacteria number TNF-a concentration HbA1c /9/2 The change of HbA1c level before and after periodontal therapy HbA1c 09// RP) Antibiotics 09/8/ EXT Rate of PD>4 mm 1.7% Rate of BOP 38.% Rate of PD> 4mm 11.% Rate of BOP 11.% Average HbA1c. Average HbA1c.2 HbA1c level decreased parallel to the number of bacteria in periodontal pockets ( N ) 12 Periodontal pockets Before treatment * After treatment (pg/ml) Before treatment * After treatment Blood contents Number of bacteria TNF-a HbA1c (%) * 12 8 Before treatment After treatment ( * P < 0.0, Wilcoxon s rank test) (Iwamoto et al, J Periodontol, 2001) Treatment of periodontitis is associated with HbA1c reduction. (Meta-analysis) Effect of Periodontal Treatment on Glycemic Control of Diabetic Patients. A systemic review and meta-analysis. Diabetes Care 33: , 20. Studies described a research population of type 2 diabetic patients in whom glycemic control improved after periodontal therapy compared with the control group. (0.40% reduction of HbA1c after the therapy) 1

6 Guidelines Periodontal therapy in diabetic patient from Japanese Society of Periodontology First edition Second revised edition A poster published in medical associations To diabetic patients: When diet- and physical-trainings are not effective, it is necessary to doubt the possibility of periodontal disease. (Recommendation to check in dental office.) Common risk factors (Aging,Smoking,Stress etc.) Diabetes Two-way relationship Periodontitis Weakened immune system Delayed wound healing Increased infection susceptibility Reduced local defense functions Insulin resistance appears in various cells in the body Diabetic patients easily suffer from periodontitis Local factors invade in systemic circulation Local factors Periodontpathic bacteria Lipopolysaccharide (LPS) Interleukin TNF-a Prostaglandins Periodontitis affect diabetic conditions 18

7 Periodontitis affect sysytemic conditions Diabetes Periodontitis Infectious endocarditis Cardio and Cerebral vascular diseases Low-birth-weight baby Aspiration pneumonitis Rheumatoid arthritis Chronic nephritis Diabetes seminar Diabetes-periodontitis seminar for patients with diabetes and their family (Tokushima University Hospital) 20 Oral Care Center in Tokushima University Hospital Oral care for medical admission patients before and after their medical surgery. 21 7

8 The effects of bedside oral care to patients before systemic surgeries Oral care shorten the hospitalization Oral Surgery Cardiovascular Surgery Digestive Surgery Pediatrics Hematology Tokushima newspaper: The location of Anan city, Tokushima prefecture Tokushima Anan (Population:7,000) 23 Medical and dental collaboration for diabetic patients in Anan city NHK Evening network Oral health protects systemic condition 24 8

9 Dentists introduce dental patients to medical doctors NHK Evening network Oral health protects systemic condition 2 Clinical meeting by medical doctors, dentists, nurse and public health nurses Dentists Medical doctors Public health nurses Nurse NHK Evening network Oral health protects systemic condition The introduction of patients, who show diabetic symptom, from dentists to medical doctors may be a good way for the increase of medical examination rate in diabetes. 2 Data was obtained from 8 dental patients (mean age 70.0). Patients with high CPI score tend to have high HbA1c. 9

10 Close to 20% of dental patients were found to have pre-diabetes as a result of dental-office screening ( MEDPAGE TODAY) The introduction of patients, who show diabetic symptom, from dentists to medical doctors may be a good way for the increase of medical examination rate in diabetes 28 Dentists may have a chance to find diabetic patients who do not know their glycemic conditions 1. Dentists recommend them to check in medical clinic from the health examination data and periodontal examination data. (The trial in Anan city) 2. Use of glucose-meter in dental office. 3. Study on the dental specific determination method for the screening of glycemic conditions 29 The study on the diagnosis of diabetic periodontitis using gingival crevicular fluid (GCF) 1) GCF collection using a paper strips (Less-invasive method) 2)Dilution of GCF with PBS-based solution GCF paper Dilution to PBS Dulbecco s PBS(-)(Nissui) 0.9mM CaCl mM MgCl 2 H 2O Centrifuge GCF extraction Measurement of GCF volume 3) Determination of marker proteins (ELISA) 30

11 Results 1 Glycated albumin (GA) and calprotectin (CPT) in GCF were determined. High GA levels were detected in diabetic patients (DM and DM-P). High CPT level were detected in periodontitis patients (P and DM-P). Diagnostic markers H DM P DM-P Total GA (μg/site) * * GA concentration (μg/μl) * * Total CPT (ng/site) ** 23.4 ** CPT concentration (μg/μl) * Statistically significant difference from H, P (P<0.01). ** Statistically significant difference from H,DM (P<0.01). 2 There was a positive correlation between GA in GCF and HbA1c and GA in blood. 3 GA in GCF Diabetic marker CPT in GCF Periodontitis marker ( J. Periodontol 8: 17-17, ) The determination of GA and CPT from GCF is useful for the diagnosis of diabetic periodontitis. ( J. Periodontol 8: 17-17, 2014 ) Medical and dental collaborations for the diagnosis of diabetes and periodontitis Introduction of doubtful patients Correct diagnosis of diabetes Determination of biomarkers such as GA and CPT Diagnosis of diabetic periodontitis (Screening of diabetic condition) Non-invasive sampling Early finding of diabetes Inhibition of diabetic complications 33 11

12 Collaborators Tokushima Univ Hospital Clinical Research Center for Diabetes Pf. Funaki M Drs. Shikama Y Bando Y Hiroshima Y Tokushima Univ Diabetes Therapeutics and Research Center Pfs. Matsuhisa M Matsumoto T Tokushima Univ Hospital, Dept of Oral Medicine Pf. Azuma M Drs. Aota K Yamamura Y Kawashima Hospital Tokushima Tokushima University Graduate School Department of Periodontology and Endodontology (Tokushima University Hospital, Dept of Periodontology) Drs. Kido J Ohishi K Naruishi K Ninomiya M Drs. Inagaki Y Horibe M Yoneda S Mihara C Drs. Bando M Nakajima Y Sakamoto E Murat H Drs. Ikuta T Kajiura Y Shinohara H Hashimoto M Ms. Shimada. Drs. Shima K Mizuguchi J Komatsu M Bando T Tokushima Teishin Hospital Dr. Saio H Tokushima Dental Association Dr. Okamoto Y 34 12