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Background: With effective antiretroviral therapy, people with HIV (PWH) are living longer and aging; the majority of PWH in the United States are now over the age of 50 and in women have gone through the menopause transition. Menopause potentiates skeletal bone loss at the spine, hip, and radius in PWH. The alveolar bone which surronds the teeth is different than long bones because it is derived from the neural crest. However, few studies have assessed the oral health and alveolar bone in middle aged and older women with HIV. Therefore, the objective of this study was to evaluate periodontal disease and alveolar bone microarchitecture in postmenopausal women with HIV. Methods: 135 self-reported postmenopausal women were recruited (59 HIV-, 76 HIV + on combination antiretroviral therapy with virological suppression) from a single academic center. The following parameters were measured: cytokine levels (IFN-γ, TNF-α, IL-1β, IL-2, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p70, IL-13, IL-17 A, OPG, and RANKL) in gingival crevicular fluid, bleeding on probing, probing depth, clinical attachment loss, number of teeth present, alveolar crestal height, and alveolar bone microarchitecture. Results: The mean age of participants was 57.04+/-6.25 years and a greater proportion of women with HIV were black/African American (HIV + 68.42%, HIV- 23.73%; p < 0.001). There was no significant difference in bleeding on probing (p = 0.17) and attachment loss (p = 0.39) between women who were HIV infected vs. HIV uninfected. Women with HIV had significantly higher RANKL expression in Gingival Crevicular Fluid (HIV + 3.80+/-3.19 pg/ul, HIV- 1.29+/-2.14 pg/ul ; p < 0.001), fewer teeth present (HIV + 17.75+/-7.62, HIV- 22.79+/-5.70; p < 0.001),), lower trabecular number (HIV + 0.08+/-0.01, HIV- 0.09+/-0.02; p = 0.004) and greater trabecular separation (HIV + 9.23+/-3.11, HIV- 7.99+/-3.23; p = 0.04) compared to women without HIV that remained significant in multivariate logistic regression analysis in a sub-cohort after adjusting for age, race/ethnicity, smoking status, and diabetes. Conclusion: Postmenopausal women with HIV have deterioration of the alveolar trabecular bone microarchitecture that may contribute to greater tooth loss. [ABSTRACT FROM AUTHOR]

Objectives. We explored the association between diabetes mellitus and oral disease in a low-socioeconomic-status urban population. Methods. Dental records of 150 adults with diabetes and 150 nondiabetic controls from the dental clinic at Columbia University in Northern Manhattan matched by age and gender were studied. Results. There was a 50% increase in alveolar bone loss in diabetic patients compared with nondiabetic controls. Diabetes, increasing age, male gender, and use of tobacco products had a statistically significant effect on bone loss. Conclusions. Our findings provide evidence that diabetes is an added risk for oral disease in this low-income, underserved population of Northern Manhattan. Oral disease prevention and treatment programs may need to be part of the standards of continuing care for patients with diabetes [Am J Public Health. 2004;94: 755-758) [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes in New Zealand is reaching epidemic proportions, with serious implications for oral health. We investigated the attitudes, beliefs, and practices of New Zealand (NZ) general dental practitioners (GDPs) with respect to the management of patients with diabetes and contrasted the NZ findings with those from a similar survey of GDPs in the Northeast United States (NE US) conducted in 2002. Methods: A nationwide postal survey was conducted of NZ dentists. A random sample was selected from the 2005 New Zealand Dental Register. Responses were received from 437 dentists (response rate: 64.5%). Results: The sample was representative. Most GDPs participated in the assessment and discussion phases of managing patients with diabetes, but the prevalence of more hands-on activities (such as testing) was considerably lower. Three-quarters of dentists asked new patients about their type of diabetes. Just over two in five respondents believed that their evaluation and/or management of the patient with diabetes were hindered by the lack of continuing education opportunities. Almost one-third of dentists were unwilling to screen for diabetes using a finger-stick test, and only 2.6% overall had ever done so. There were only minor differences between NZ and NE US dentists. Conclusion: Given the increasing numbers of patients with diabetes (known and unknown), there is a need for NZ and US dentists to be more involved in their active management. [ABSTRACT FROM AUTHOR]

The author reflects on periodontal infections and diabetes mellitus in the U.S. She states that the puzzle of the periodontal infections-diabetes relationship is large, and due to the multi-factorial, complex aetiopathogenesis of both disease entities involved, it is a difficult one to solve. More, better-informed, coordinated and focused effort is necessary in order to add the many missing pieces and hopefully make some difference in the lives of those affected.

Focuses on the association of diabetes mellitus with the increase morbidity and mortality in the U.S. Complications of blindness and renal failure; Impairment of cellular structure; Progression of periodontal diseases.

Objectives: We measured and contrasted general dentists' and periodontists' involvement in 3 areas of managing diabetic patients-assessment of health status, discussion of pertinent issues, and active management of patients--and identified and contrasted predictors of active management of diabetic patients., Methods: We conducted a cross-sectional mail survey of random samples of general dentists and periodontists in the northeastern United States during fall 2002, using lists from the 2001 American Dental Directory and the 2002 American Academy of Periodontology Directory. Responses were received from 105 of 132 eligible general dentists (response rate=80%) and from 103 of 142 eligible periodontists (response rate=73%)., Results: Confidence, involvement with colleagues and medical experts, and professional responsibility were influential predictors of active management for periodontists (R2=0.46, P<.001). Variables pertaining to patient relations were significant predictors for general dentists (R2=0.55, P<.001)., Conclusions: Our findings permitted us to assess and compare general dentists' and periodontists' behavior in 3 realms--assessment of diabetic patients' health status, discussion of pertinent issues, and active management of diabetic patients--and to identify components of potentially effective targeted interventions aimed at increasing specialists' and generalist dentists' involvement in the active management of diabetic patients.