Access to all articles, new health classes, discounts in our store, and more!
The Biology of the Endodontic Patient: I. Two Hour Postprandial Blood Glucose Frequency Distribution
Published in Journal of Oral Medicine, Vol. 23, No. 1, January 1968.
* * *
Introduction
“Diabetics tend to age more quickly because of obliterative endarteritis. There is impairment of nutrition and metabolic processes. Tissue repair is interfered with in diabetics…”
This quotation1 supports the well-established clinical observation that the periapical lesion cannot always be explained just on the basis of the identifiable local noxious factors (i.e., physical trauma, caries, deep restorations). Viewing the problem in an ecologic system, there is the possibility that host state may be contributing to the genesis and/or course of periapical pathosis. This, the first in a series of reports, is designed to analyze host resistance and susceptibility by means of one biochemical barometer. Subsequently, a series of studies will be released in which the biochemical profile will be compared with diverse characteristics of periapical pathosis.
Method of Investigation
A battery of biochemical tests was performed on 55 routine endodontic patients with roentgenographic evidence of periapical pathosis. The age distribution is summarized in Table I. For purposes of this report, only the two-hour postprandial (two hours after breakfast; approximately 9:00 A.M.) blood glucose (Somogyi-Nelson)2,3 will be considered.
Results
Table II summarizes the blood scores. According to conventional standards,4 60 to 100 mg. per cent is regarded as the physiologic limit. Utilizing this criterion, 14.5 per cent of these subjects demonstrate marginal hyperglycemia.
Discussion
As far as can be determined, there is no published information regarding the frequency of disturbance in carbohydrate metabolism among endodontic patients. It would seem in order to determine the extent of the problem in view of the fact that wound repair is adversely affected by a disturbance in carbohydrate metabolism. The evidence presented here, limited as it is, suggests that approximately one in seven endodontic patients may be marginally hyperglycemic on the basis of classical blood glucose criteria.
There are authorities who have indicated that the present blood glucose standards are unrealistic and, specifically, too broad.5,6 If one grants that a more realistic blood glucose range is 70 to 90 mg. per cent (and there is growing acceptance for this concept), then 47.2 per cent of these routine endodontic patients exhibited abnormal values. An attempt will be made in a subsequent report7 to test this hypothesis by considering the relationship of blood glucose to the possible causes of periapical pathosis in this same sample of patients.
Summary
- The general statement appears in the endodontic literature that there may be a correlation between diabetes mellitus and periapical pathosis. However, as far as can be determined, no attempt has been made to quantitate this relationship.
- Utilizing conventional blood glucose criteria of 60 to 100 mg. per cent two hours postprandially, 14.5 per cent of 55 routine endodontic patients exhibited marginal hyperglycemia.
- On the basis of more restricted standards of 70 to 90 mg. per cent, almost one-half of the group were, suggestively, hyperglycemic.
- A report to follow7 will analyze the two-hour postprandial blood glucose as it relates to the possible causes for periapical pathosis.
Grateful acknowledgement is made to Dr. J. B. Freedland of Charlotte, North Carolina for his counsel and assistance in the preparation of this report.
References Cited:
- Seltzer, S. and Bender, I. B.: The Dental Pulp: Biologic Considerations in Dental Procedures, Philadelphia, 1965, J. B. Lippincott Company, p. 62.
- Somogyi, M.: “Determination of Blood Sugar,” J. Biol. Chem., 160:69-73, 1945.
- Nelson, N.: “A photometric Adaptation of the Somogyi Method for Determination of Blood Sugar,” J. Biol. Chem., 153:375-380, 1944.
- Mosenthal, H. O. and Barry, E.: “Criteria for and Interpretation of Normal Glucose Tolerance Test,” Ann. Int. Med., 33:1175-1194, 1950.
- Krall, L. P.: “When is Diabetes?” Med. Clin. N. America, 49:893-904, 1965.
- Frethem, A. A.: “Clinics on Endocrine and Metabolic Disease. 10. Relations of Fasting Blood Glucose to Oral Glucose Tolerance Curve,” Proc. Staff Meet. Mayo Clinic, 38:110-115, 1963.
- Cheraskin, E., Ringsdorf, W. M., Jr., and Barrett, R. A.: “The Biology of the Endodontic Patient: II. Causes of Periapical Pathosis and Two-Hour Postprandial Blood Glucose.” (in preparation).