Behavioral Aspects A positive correlation between the metabolic control of diabetes and the occurrence of oral pathologies may be related, besides the biological factors, to certain psychological features of the patients. diabetes on periodontal health, indicate a higher risk of periodontitis Thiolutin in children with type 1 diabetes. As for the association of diabetes and dental caries, the results of the studies are inconsistent. However, it was found that some risk factors for dental caries are either more or less prevalent in the diabetic population. Despite an extensive research in this area we have to acknowledge that many questions have remained unanswered. There is a need for continued, thorough research in this area. 1. Introduction 1.1. Diabetes: Definition and Current Classification Diabetes mellitus is a common term for a group of chronic metabolic diseases, the basic feature of which is hyperglycemia. Currently, classification of diabetes by Thiolutin ADA (American Diabetes Association) is being used, which emphasizes etiology of the disease (Table 1) [1]. Table 1 Classification of diabetes by ADA [1]. IType 1 diabetesImmune mediatedIdiopathic In vitroa direct negative effect of hyperglycemia and hypoglycemia on periodontal cells has been demonstrated. Hyperglycemia has also an indirect adverse effect, stimulating immune system cells to release inflammatory cytokines [30]. Recently, a number of studies have been published dealing with biochemical principles of periodontal damage in diabetes. 2.2. Impaired Immune Response in Diabetes and Periodontitis Hyperglycemia caused by diabetes mellitus can Edn1 alter immune system in many ways. First of all, it increases salivary concentration of glucose as well as its concentration in gingival crevicular fluid. This increased availability of glucose in the environment of oral cavity increases proliferation of periodontopathic and cariogenic bacteria and increases oral inflammation. Presence of elevated levels of proinflammatory mediators in the gingival crevicular fluid of periodontal pockets of poorly controlled diabetics, compared to nondiabetics or well-controlled diabetics, resulting in significant periodontal destruction with an equivalent bacterial challenge has been shown [31C33]. Thiolutin Hyperglycemia caused by diabetes mellitus can lead also to microangiopathy. Endothelial cells lining blood vessels use more glucose than usually and form more glycoproteins on their surface and basement membrane grows thicker and weaker. The vessel walls become thick and weak and vessels bleed easily and leak proteins. These vascular changes in periodontium decrease polymorphonuclear cells functions such as chemotaxis, adherence, phagocytosis and migration, oxygen utilization, and antigens elimination leading to progression of periodontitis. Hyperglycemia also increases the formation of advanced glycation end-products. The overexposure of proteins (such as collagen) or lipids to aldose sugars induces nonenzymatic glycation and oxidation. These glycosylated products can create complex molecules, reducing collagen solubility and increasing levels of proinflammatory mediators responsible for the degradation of connective tissues. Changes to collagen metabolism result in accelerated degradation of both nonmineralized connective tissue and Thiolutin mineralized bone [32, 34]. The interaction of advanced glycation end-products with target cells, such Thiolutin as macrophages, via cell-surface polypeptide receptors stimulates the production of cytokines and matrix metalloproteinases, including collagenases and other connective tissue-degrading enzymes [31]. Monocytes from diabetics have shown a hyperresponsive phenotype with overexpression of proinflammatory mediators such as interleukin-1Streptococcus mutansStreptococcus mutansStreptococcus mutansand lactobacilli in healthy and diabetic individuals [21, 45, 52] and higher proportion of diabetics with high levels ofStreptococcus mutansin the saliva compared to the control group [26]. As for the levels ofCandidaspecies in the oral cavity, there are reports of not only no differences between the diabetic and healthy children [45, 52] but also higher levels in the diabetics versus the healthy population [26, 57]. With respect to inconsistent findings, more microbiological studies are needed to clarify potential differences between healthy and diabetic children. 2.6. Diet A recommended diet for children with type 1 diabetes corresponds to traditional rules of rational nutrition. The intake of fat and in some cases also of proteins should be restricted, but according to the recent nutritional recommendations the intake of carbohydrates should be up to 50C60% of the daily calorie consumption. Eating sugars should result from the complicated sugars mainly, fiber and starch, whereas drinks and foods saturated in basic sugars, which create a elevated postprandial glycemia considerably, ought to be excluded [4]. The regularity of daily foods.