Diabetes

DIABETES SUPPORT GROUP
DAVID L. BURNS D.D.S.
JANUARY 7, 2004

M a y a C lin ic

A n In ter view W ith R o b ert R izz a, M .D .

W H S : W h a t is diab etes ? bu t it's n ot r ea lly n ecessa r y; th e th era p y is
D r. R izza : D ia b ete s is a d is ea s e in w h ich you r b lood sa m e. 8
s u ga r (glu cos e ) con ce n tra tion is high e r tha n n orm a l.
W H S : C a n dia be te s be p re ve n te d ?
T h e s e high le ve ls ca n occu r a n y- tim e du rin g th e d a y.
A h igh le vel e arly in the m ornin g is re ferre d to as a D r. R izz a: Y es. G en era lly, you ca n pr even
h igh fa stin g glu - cos e . W he n it's h igh a fte r you e at a typ e 2 d ia betes if you sta y lea n an d fit. T h
m e a l, it's re fe rre d to a s a high p os tpran d ia l glu cos e . . you r bod y h a s th e a bility to p r od u ce en ou
in su lin for you r n eed s. .W ith typ e 1 , it's m
com p lica ted . T h is is a disea se in w h ich yo
W H S : W h a t's the diffe re n ce b e tw e e n typ e 1 a n d d ev elop a n tibod ies or som e im - m un e
ty pe 2 dia b ete s? a bn orm alities ag a in st th e beta cells in you
D r. R izz a: T h ey'r e d iffer en t d isea se pr ocesse s. In p an cr ea s. B u t in ter estin g ly, ever ybod y w h
typ e 1 (for m erly ca lled ju ven ile or in su lin - th ese im m un e a bn orm alities d oesn 't n eces
d ep en d en t d ia betes) you r bod y d estr o ys a ll th e d ev elop t yp e 1 d ia betes. F or ex a m - ple, if
in su lin -secr etin g cells (beta cells) in you r h a ve an id en tical tw in w h o h a s
p an cr ea s. T h is is believ ed to be a d isord er of you r typ e 1 d ia betes, you on l y h a ve a p pr ox im a
in tern al im m un e system . .In typ e 2 (for - m er ly p er cen t ch an ce of g ettin g th e d isea se, too.
ca lled a d u lt-on set or n on in su lin -d ep en - d en t tested th e a un ts, un cles, br oth er s, sis- ter s,
d ia betes) you r p an cr ea s m ak es in su lin , bu t n ot m oth er s an d fa th er s of p eop le w ith typ e

A n In ter view W ith R o b ert R izz a, M .D .

W H S : W h a t is diab etes ?

D r. R izza : D ia b ete s is a d is ea s e in w h ich you r b lood
s u ga r (glu cos e ) con ce n tra tion is high e r tha n n orm a l.
T h e s e high le ve ls ca n occu r a n y- tim e du rin g th e d a y.
A h igh le vel e arly in the m ornin g is re ferre d to as a
h igh fa stin g glu - cos e . W he n it's h igh a fte r you e at a
m e a l, it's re fe rre d to a s a high p os tpran d ia l glu cos e . .

W H S : W h a t's the diffe re n ce b e tw e e n typ e 1 a n d
ty pe 2 dia b ete s?
D r. R izz a: T h ey'r e d iffer en t d isea se pr ocesse s. In
typ e 1 (for m erly ca lled ju ven ile or in su lin -
d ep en d en t d ia betes) you r bod y d estr o ys a ll th e
in su lin -secr etin g cells (beta cells) in you r
p an cr ea s. T h is is believ ed to be a d isord er of you r
in tern al im m un e system . .In typ e 2 (for - m er ly
ca lled a d u lt-on set or n on in su lin -d ep en - d en t
d ia betes) you r p an cr ea s m ak es in su lin , bu t n ot
en ou g h for you r bod y's n eed s. T h at can be
be ca u se you r bod y n eed s a lot of in sulin , w h ich is
r eferr ed to a s in sulin r esistan ce, or it cou ld be
be ca u se you r bod y h a s gr ea t d ifficu lty s ecr etin g
in su lin . T h er e's a lw a ys a ba lan ce betw een h ow
m u ch in su lin you r bod y m a k es ver su s h ow m u ch
you r

b od y n eed s. F or ex am ple, you r bod y m a k es a
cer tain a m oun t of in sulin . B u t if you 'r e over -
w eig h t or you 'r e sed en tar y, you r bod y n eed s
m or e. Y ou r blo od su g ar g oes u p beca u se you
ca n 't secr ete a s m u ch in sulin a s you n eed . O n th e
oth er h an d, you c ou ld h a ve a g en etic a bn or m a lity
in th e w a y you secr ete in su lin , so even th ou gh
you 'r e lean an d fit, you still m a y n ot h a ve q u ite
en ou g h , an d you r blood su g ar g oes u p . T h is is
w h y you m a y see a th in old er a d u lt w ith typ e 2
d ia betes or a ver y h ea v y you n g p er son w ith typ e
2 d ia betes. .

W H S : W h ic h ty pe is m o st like ly to a ffec t a d ult
wom en?

D r. R izz a: M ost a d ult w om en w h o h a ve d ia-
bete s h a ve typ e 2 . T h at's n ot to sa y th at you ca n 't
d ev elop t yp e 1 a s an a d ult. In fa ct, a bou t 1 0
p er cen t to 15 p er cen t of a d u lts w h o d evelop
d ia betes h a ve typ e 1 . C erta in tests can be u sed to
h elp d eter m in e w h ich typ e you h a ve,

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 ex a m - ple, if you h a ve an id en tica l tw in w h o
has
typ e 1 d ia betes, you on l y h a ve a p pr ox im a tely a 5 0
p er cen t ch an ce of g ettin g th e d isea se, too. If you
tested th e a un ts, un cles, br oth er s, sis- ter s,
m oth er s an d fa th er s of p eop le w ith typ e
1 d ia betes, you 'd fin d th a t m an y h a ve an tibod ies
a g ain st th eir beta cells, w h ich sa ys th is d estr u ctive
p r ocess is g oin g on , yet th ey n ever g et dia betes.
T h e pr oblem w e h a ve w ith typ e
1 d ia betes is th a t w e d on 't kn ow h ow to p r e- dict
w h o is g oin g to g o on to d evel op th e disea se an d
w h o isn 't. .W e believe th a t som e oth er pr oces s is
g oin g on . B esid es a g en etic pr ed isp osition ,
p erh ap s an en vir on m en tal tr igg er is n ecessa r y or
som e oth er in itia tin g
I fa ct orth at carries th e d isea se pr ocess for w a r d ,
r esu ltin g in dia betes. .

W H S : W h a t is p re -dia be te s?

D r. R izz a: Pr e-dia betes is a term th at im p lies th at
you h a ve cer tain fa ctor s th a t p la ce you a t h igh risk
o f p r ogr essin g to d ia betes. F or in stan ce, a n or m a l
fa stin g blood su g ar is 8 0 to 1 00 . Y ou h a ve
d ia betes if you r fa stin g blood su g a r is m or e th an
1 2 6 . B u t if you h a ve a blood su g ar th at's betw een
1 0 0 an d 1 2 5, you d on 't h a ve d ia betes yet, bu t
clea rly you r
blo od su g a r is alr ea d y a bn orm al. T h is is w h en
you r d octor m a y sa y you 'r e pr e-d ia betic. H a vin g a
blo od su g a r in th is pr e-d ia betes
I ran g e p uts you a t a ver y h igh risk of p r ogr ess-
in g to d ia betes u n less you d o som eth in g
a bou t it, su ch a s lose w eig h t an d ex er cise. Y ou

m a y n ot h a ve fa lle n off th e sid e of a cliff, bu t you 're
ge ttin g p re tty clos e to th e e d ge . .

W H S : W h o sh o u ld b e sc re e ne d fo r d ia be te s?
D r. R izz a: T h e A m erican D ia betes A ssocia tion
(A D A ) sa ys th a t ever yon e, par ticu larly th ose w h o
ar e over w eig h t, sh ou ld be scr een ed for dia betes
ev er y th r ee yea r s beg in n in g a t a g e 4 5 . T estin g
sh ou ld be m or e fr eq u en t for p eop le w h o ar e
o ver w eig h t w h o a lso h a ve oth er risk fa ctor s su ch
a s a fa m ily h istor y o f d ia betes, a sed en tar y
lifest yle, h igh blood p r essur e, an d h igh
ch olester ol an d tr iglycer id e levels. 8

W H S : W h a t te sts a re do n e to sc re e n fo r dia b ete s?
D r. R izz a: T w o tests ar e 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 for m . If you r
r esu lt is gr eater th an 1 2 6, th en it in di- ca tes
d ia betes. T h e oth er test is ca lled a tw o- h ou r
g lu cose toler an ce test. In th a t test you 'r e g iven a
sw eet liq u id to dr in k an d th en tw o h ou r s later a
blo od su g a r test is d on e. If th e r esu lt is gr eater
th an 2 0 0, th en you h a ve d ia - betes. T h e A D A
r ecom m en d s a fa stin g blood su g a r test fir st, bu t if
you 'r e a t h igh risk of d ia betes -or th e r esu lts of
you r fa stin g test ar e a bn orm al -you r d octor m a y
con sid er d oin g a tw o-h ou r glu cose toler an ce test.
8

W H S : W h a t a re the tre atm e nts fo r dia be te s?
D r. R izz a: T r eatm en t for d ia betes is m ean t to
r estor e th e ba lan ce bet w e en in su lin n eed an d
in su lin a va ila bility. W e star t w ith lifest yle
m od ifica tion -losin g w eig h t an d ex er cisin g. If
you ca n a ccom p lish th ese, you ca n dram a tica lly
d ecr ea se h ow m u ch in su lin you r bod y r eq u ir es, so
you m a y n eed to d o n oth in g
m or e. O f cou r se, th is is ea sier sa id th an d on e.
M an y p e op le n eed to ta k e m ed ica tion s for
d ia betes. T h er e ar e th r ee m a jor cla sses of m ed -
ica tion s -pills th a t m a k e you se cr ete m or e in su lin ,
p ills th a t m a k e th e liver pr od u ce less g lu cos e, an d
p ills th a t m a k e in su lin w or k bet- ter. In su lin is
u sed w h en p ills ar en '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 h a t n ew tr ea tm en ts ar e o n th e h o rizo n ? D r.
R izza : T h e re are a va riety o f n e w trea t- m e nts b ein g
s tu died , s om e of th e m a t M a yo. A ll the on es
m e n tion e d h e re a re in a d va n ce d sta ge s of tes tin g an d
m a y b e rea d y w ithin the n e xt on e to thre e ye a rs. .O n e
m e d icine com e s from a ga s trointe stin al h orm on e ca lle d
G LP1,

Ith e h or m on e th a t tells you r pan cr ea s th at food is
com in g an d to g et r ea d y to secr ete in su lin . T h is
m ed icin e is r em ark a ble beca u se it stim u - lates
in su lin secr etion , it in h ibits glu ca g on - th e
h orm on e th a t r aises blo od su g ar -an d it d ela ys th e
ra te a t w h ich food em p ties fr om you r stom a ch , so
th e m ed icin e can ea se in to you r blood str ea m . B u t
w h a t's par ticu larly en cou r a g in g is th a t G L P l
m a k es you secr ete in su lin on ly w h en you r blo od
su g ar is h igh ,
so th e risk of g ettin g low blo od su g ar (h yp o-
g lycem ia ) is n eg lig ible. .T h e pr oblem w ith

th e G L P h orm on e is th a t it on ly la sts for a bou t a
m in ute or tw o an d th en is ra p idly d eg r a d ed . B u t
w h a t's bein g d evelop ed n ow a r e an a log s to th e
h orm on e, in oth er w or d s, sim ilar su b- stan ces th a t
ar en 't d egr a d ed so q u ick ly. .In oth er stu dies, a
d r ug is bein g d evelop ed th a t in h ibits th e en z ym e
th at d egra d es G L P . S o r ath er th an givin g you
G L P , you w ou ld ta k e a pill to bo ost you r bod y's
n a tura l G L P , g ivin g you th e sa m e effe ct o f
stim ulatin g in su lin secr etion . .S tu dies ar e bein g
d on e to fin d bet- ter w a ys o f d eliver in g in su lin
th an b y g ivin g you r self in jection s ever y d a y. O n e
sh ow in g pr om ise is in sulin th a t you in h ale. S om e
d a ta sa y it w or k s fin e, bu t n ow th e q u estion is
w h eth er it'll be sa fe for lon g -term u se. .

W H S : W h a t o th e r im p o rtan t fac ts w o u ld y o u like o u r
re a d e rs to k n o w a b o u t?
D r. R izz a: Y ou h ear so m u ch a bou t all th e ba d
h ealth con seq u en ces of d ia betes. A n d it's tr u e th at
d ia betes is th e n um ber on e cau se of k id - n ey
d isea se, blin dn ess, am p uta tion s, h eart d isea se
an d m or e. H o w e v er , th ese con seq u en ces h a p p en
on ly w h en d ia betes is un tr ea ted . If you tr eat you r
d ia betes p r op erly, k eep you r blood su g ar n or m a l,
k eep you r blood p r essur e n orm al an d k eep you r
blo od lip id s n orm al, you 'r e g oin g to be fin e. .

W H S : W h a t's y o u r h o pe fo r the .futu re o f dia b ete s
c a re ?
D r. R izz a: O f cou r se, th e ultim a te g oa l is to cur e
d ia betes. U n til th en , m y h op e for th e fu tur e is th a t
ev er yon e w ill be a ble to h a ve a ccess to th e ver y
be st car e for th eir dia betes. D ia betes r eq u ir es a
p ar tn er sh ip betw e en p eo- p le, th eir ph ysicia n s an d
oth er h ealth car e pr ovid er s. W e h a ve m eth od s
a va ila ble n ow th at can n orm a liz e a lm ost
ev er yb od y's blo od su g a r s. B u t you n eed to w or k
tog eth er a s a tea m to m a k e th e m ost of th ese
m eth od s. .

C en ter piece

E nam el
D e n tin
P u lp O ra l h e a lth c a re is im p o rta n t th ro u g h o u t a ll th e s ta g e s o f

y o u r life . H o w e v e 1 ; s e v e ra l c o n -

d itio n s a s s o c ia te d w ith a g in g c a n le a d to m o u th
C ro w n
a n d g u m d is e a s e . In a d d itio n , d e n ta l d is e a s e is

n o w c o n s id e re d a c o n trib u tin g fa c to r fo r s o m e c a s e s o f h e a rt

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

u n co n tro lle d d ia b e te s.
Root

A cc or d in g to th e S ur g eon H ea lth y teeth an d g um s w ou ld n 't r em ain
G en era l's r ep ort "O ra l H ea lth in h ealth y for lon g w ith ou t saliva . It's secr eted fr om
A m erica ,1 I th e g lan d s th r ou gh ou t you r m ou th . It h elp s clean you r
h ealth of you r m ou th r eflects you r m ou th an d teeth , aid s in sw a llow - in g, an d
g en era l h ealth an d w ell- con ta in s en z ym es th a t aid d ig estion an d h elp
Bone C e m e n tum
N e rv e a n d
bein g . H o w e ver , ora l h ealth is often con tr ol in fection .
b lo o d s up p ly o ver look ed an d un d er em ph a siz ed. A lm ost ever yon e is su scep tible to g u m d is-
ea se an d tooth d eca y. H o w e ver , som e fa ctor s m a y
N a tur a l look of tee th a n d g um s in cr ea se you r risk . T h ese in clu d e la ck of
Y ou r m ou th is p erh ap s th e m ost m u ltifun c- tion a l flu or id ated w a ter, p oor d iet, fr eq u en t sn a ck in g on
T h e s u r fa c e o f a sw eets, h er ed ity an d toba cc o u se.
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 obvi ou s ar e bitin g , ch ew in g
h e a lth y c r o w n is P la y in g h ost to b a c te ria
an d sw a llow in g fo od . T h e m ost im p or tan t tools in
th is pr oces s ar e you r teeth . Y ou r m ou th , lik e m an y oth er p arts of you r bod y,

A c c o r d in g to th e S u r g e o n
G e n e ra l's r e p o rt " O ra l H e a lth in
A m e ric a ” I th e
,1
h e a lth o f y o u r m o u th r e fle c ts y o u r
g e n e ra l h e a lth a n d w e ll-
b e in g . H o w e v e r , o ra l h e a lth is o fte n
o v e r lo o k e d a n d u n d er e m p h a s iz e d .

N a tur a 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 obvi ou s ar e 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 pr oces s ar e you r teeth .
E a ch of you r teeth -m ost p eop le d evel op 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 cr ow n . T h e p or tion h id d en belo w
th e g um lin e is th e r oot. T h e sur - fa ce o f a h ealth y
cr ow n is cover ed w ith en a m - el, a th in la yer of
ca lcified m aterial th at's th e h ar d est su bstan ce in
th e bod y. T h e ou ter sur- fa ce of th e r oot is cover ed
b y cem en tu m . T h e p eriod on tal liga m en t, a
con n ective tissu e, bin d s r oot cem en tum to th e
b on e th a t for m 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 surr oun d s th e h ollow tooth cor e (ca lled th e p ulp
ca n a l or r oot ca n a l), an ar ea w h er e n er ve en d in g s
an d blood ves sels sen si- tiz e an d n our ish th e tooth .
N er ves a n d vessels feed in to th e p ulp can al
th r ou g h an op en in g at th e r oot tip.
F irm , pin k g um s (gin g iva ) surr oun 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 ba ck u n d ern eath itself. T h is cr eates
ar ou n d ea ch tooth a sn ug gr oov e ca lled th e
g in g iva l su lcu s.

H ea lth y teeth an d g um s w ou ld n 't r em ain
h ealth y for lon g w ith ou t saliva . It's secr eted fr om
g lan d s th r ou gh 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 en z ym es th a t aid d ig estion an d h elp
con tr ol in fection .
A lm ost ever yon e is su scep tible to g u m d is-
ea se an d tooth d eca y. H o w e ver , som e fa ctor s m a y
in cr ea se you r risk . T h ese in clu d e la ck of
flu or id ated w a ter, p oor d iet, fr eq u en t sn a ck in g on
sw eets, h er ed ity an d toba cc o u se.

P la y in g h ost to b a c te ria
Y ou r m ou th , lik e m an y oth er p arts of you r bod y,
is h ost to ba cteria. T h ese ba cter ia con - ver t som e
o f th e su g ar s an d car boh yd r a tes you ea t in to a cid .
T h e ba cter ia an d a cid s th ey for m becom e p a rt of
th e stick y d ep osit - ca lled d en ta l p la q u e -th at
clin g s to th e sur - fa ce o f you r teeth .
In ad d ition to ba cteria, p la q u e is com p osed o f
sa liva an d fo od p ar ticles. O ver tim e, p la q u e can
h ar d en an d for m a d ifficu lt-to-r em ove su bsta n ce
ca lled tartar { ca lcu lu s).

D ep en d in g on w h er e p la q u e an d tartar for m ,
th e y m a y ca u se:
T o o th d ec a y (c a rie s) -D eca y is a ba cterial dis-
ea se o f teeth an d th e pr im ar y ca u se of to oth loss.
It is th e r esu lt of th r ee in ter a ctin g fa ctor s: ba cteria
g r ow th , dietar y su g ar an d a vu ln er a - ble tooth
su r fa ce. T h e d eca y-p r od u cin g a cid th a t for m s in
p la q u e a tta ck s th e m in er als in
th e tooth 's ou ter en am el sur fa ce. T h e er osion
ca u sed b y th e p la q u e lea d s to tin y op en in g s
{ ca vities) in th e en a m el, w h ich you m a y n ot
n otice in itially. T h e fir st sign of d eca y m a y be
a sen sa tion of p a in w h en you ea t som eth in g sw eet,
ver y c old or ver y h ot. O n ce th e en am el is
p en etr ated , th e un d er lyin g softer d en tin

G in g iv itis -T h is m ild , ear ly for m of g u m disea se
ca n ca u se h ea lth y, p in k g um s to bec om e r ed ,
sw ollen , ten d er an d pr on e to bleed in g.
T h e sw ellin g an d ten d ern ess a ssocia ted w ith
g in g ivitis is ca u sed by you r im m un e system 's
in fla m m ator y r esp on se to p la q u e or tartar bu ild up
a lon g you r gu m lin e. G in g ivitis often
is p ain less an d g oes u n n oticed . If un ch eck ed ,
g in g ivitis can lead to p eriod on titis, a m or e seriou s
d isea se.

P e rio d o n titis -T h is is an a d van ced sta g e of g u m
d isea se th at m a y d e vel op w h en plaq u e an d tartar
ex ten d ben ea th you r g um lin e. G ra d ua lly, you r
g u m s w ith dra w fr om ar ou n d you r teeth . P ock ets
o f in fection can for m in
th is d ar k, a irless r eg ion an d d estr oy tissu e an d
you r tooth sock ets (a lveola r bon e). L eft un tr eated ,
in volv ed teeth even tua lly lo osen an d fa ll ou t.
C h r on ic p eriod on tal disea se is th e lead in g ca u se of
tooth loss in old er ad u lts.

R isk fa c tor s w ith a g e, g e n d er
S om e or a l con d ition s ar e un iq u e to w om en at
sp ecifi c p h a ses of th eir lives d u e to sev er a l fa c-
tor s, in clud in g h orm on es. F or exa m ple, d ur in g
m en op a u se, you m a y n otice d iscom for t in you r
m ou th , in clud in g dr y 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
s yn d r om e). Y ou m a y a lso n otice alter - ation s in
ta stes, su ch a s sa lty, p ep p er y or sou r .

. C er ta in disea ses th at a ffe ct th e ora l ca v- ity a lso
ar e m or e com m on in w om en . A n d, th e old er you
ar e, th e gr eater you r risk of d evelop in g d isea ses
o f th e m ou th . A m on g th e fa c- tor s th a t m a y a ffe ct
you r or a l h ealth ar e:

D ia b ete s -T h is con dition p u ts you a t gr eater risk
o f d ev elop in g p eriod on tal disea se an d oth er
in fection s. It in cr ea ses even m or e if you r dia betes
is p oor ly c on tr olled . T h at's beca u se d ia betes m a y
w ea k en th e r esistan ce of you r g u m tissu e to
ba cter ial in fection an d pla qu e.
In ad d ition , or al in fection m a k es blood g lu - cose
levels h ar d er to con tr ol.

O ste o p o ro sis -R esea r ch er s su sp ect a lin k be-
tw e en th e loss of b on e m in er al d en sity w ith
oste op or osis an d p er iod on ta l d isea se. L osin g
d en sity in th e bon es th a t h old you r teeth in pla ce
m a y h elp sp eed th e d eg en era tive p r o- cess of
p er iod on ta l d isea se. O steop or osis a lso m a y m a k e
a g ood d en tur e fit d ifficu lt.

M e d ic atio n s -S om e dr u g s -su ch a s an tid e-
p r essan ts an d certain blo od pr essu r e dr ug s - can
lea d to dr y m ou th , w h ich in cr ea ses you r
risk of g u m pr oblem s an d tooth loss.

W e a r a n d tea r -A s you g et old er , you m a y n otice
th at you r m ou th feels dr ier an d you r g um s h a ve
p u lled ba ck (r eced ed } . Y ou r teeth m a y d a rk en
sligh tly a n d bec om e m or e brittle an d br ea ka ble.

M ak in g th e e ffor t
A d va n ces in d en tal tech n olog y -su ch a s g en etic
testin g for or al disea se or d eca y r isk an d th e
a bility to in itia te th e gr ow th of n ew teeth , bon e
an d tissu e -m a y som ed a y p la ya p r om in en t r ole in
d en tistr y. H o w e ver , da ily or a l h yg ien e com bin ed
w ith r eg u lar d en ta l visits -a sk you r d en tist h ow
o ften -is still th e best w a y to in cr ea se 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 g u m s m a y h elp to r eflect m or e th an a
h ealth y sm ile. It m a y h elp to r eflect a h ealth ier
you . 8

60y ear o ld me morial pre sentat ion

Car iology &
Per iodont ology
Pr es en ted b y K. Ta mak i
2003.03.12 .
Academy of Template Research
Department of Dental & Oral Surgery
Wakayama Medical University

CAVITIES AND PERIODONTAL
DISEASE

Dental Plaque & Periodontal
Disease

ADVANCED PERIODONTAL
D I S E A S E

Diabetes

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