Precautions That Can Help Catch Breast Cancer in Its Earlier Stages Essay Example for Free

Precautions That Can Help Catch Breast Cancer in Its Earlier Stages Essay Specific Purpose: To inform the audience of how simple steps can help them catch breast cancer in its earlier stages before it is too late. Central Idea/ Thesis: Through the help of mammograms, self-examinations, and funding you can find a way to either detect breast cancer in its earlier stages or possibly be able to prevent it all together. Introduction I. â€Å"Each year, about 192,000 women and 1,900 men in the United States are diagnosed with invasive breast cancer. And each year, nearly 40,000 women and 440 men die from invasive breast cancer.† (U.S News, 2010) II. Breast Cancer is something that many people love to avoid. I grew up in a family where it quickly became a big part of our lives. My great grandmother’s life was nearly taken due to breast cancer. Her struggle through the process made me want to provide information on how helpful breast check up’s could be. III. There are many ways you can stay up to date on what is going on with your health in regards to breast cancer. Lots of medical equipment and funding have become very helpful in the fight against breast cancer. IV. Today I will inform you of all the options men and women have that are available to them to help in the early detection and possibly the prevention of breast cancer. I will explain how mammograms, self-examinations, and funding make it possible to fight the cause. (Let’s begin by first discussing mammograms) Body I. What is a mammogram? A. Mammograms are used to look for breast cancer in women who don’t have any symptoms B. Mammograms can help to reduce the number of death among the women ages 40-70 C. Some mammograms can give false-negative and false-positive results. D. Many men have breast symptoms, including enlarged or painful breast tissue, but the majority does not need a mammogram, say researchers from Mayo Clinic Cancer Center. E. It can lead to an early detection of breast cancer. F. Finding cancer early does not always reduce the chance of dying G. The Radiation exposure of a mammogram can be harmful H. What do Doctors suggest about mammograms? I. A recommendation was made that you should be getting them every 1 to 2 years, if you are a woman over the age of 40 J. Talk to your health care provider about when you should start getting them if you have a family history. K. Best method is high quality screening mammograms (Moving forward I would like to discuss another option that is available in the prevention of breast cancer) II. Self-Examination A. Self-examinations are convenient B. Self-examinations can be done in the comfort of your own home. C. It helps you to become familiar with what you are looking for. D. Male breast self-examination (MBSE) is to be performed each month. (Stephan, 2008) E. Mark the date for your male breast self-exam on your calendar. This will help you stay on track and reduce anxiety about normal breast changes. F. Not every cancer can be found through doing a self-examination (con) G. It builds a foundation that you can set at home on your own to get to know your own body.(pro) H. Tips for preforming self-examinations 1. Get in the habit of doing you self-examination in a regular (for men it should be monthly). 2. If you are doing a self-exam remember that you shouldn’t panic if you think you feel a lump. 3. Become familiarized with the different areas of your breast (Finally, we will take a look at how funding makes all these medical advances possible) III. Funding for the cure A. Funding and Foundations make a lot of the medical advances they are making in breast cancer possible. 1. Susan G. Komen is one of the most famous foundations known to the Breast cancer world. a. Susan G. Komen is a foundation dedicated to Nancy G. Brinker’s sister. b. In 1982, the promise Nancy prompted her to begin her work Susan G. Komen for the Cure and they launched the global breast cancer movement. c. `She launched a whole new perspective on breast cancer. d. Susan G. Komen is one of the leading foundations. B. There are lots of other outlets that provide funding for breast cancer a. Plenty of marathons raise money for Breast Cancer b. Locally we have the Donna finish with Breast Cancer c. The National Marathon to Finish Breast Cancer. 26.2 with Donna is the only marathon in the country that is dedicated exclusively to raising funds for breast cancer research and care (Scanlan, 2012) (In conclusion) Conclusion I. I hope that after explaining how mammograms, self-examinations, and funding for breast cancer can give you a better insight on preventative precautions you can take. II. I hope that in closing this speech you take with you some bit of knowledge about this very important issue and maybe even apply it to your everyday life. Even the men in the room can spread this message to the women in your life and other men that you care about, be mindful of your health and always remember that it is better to know then to live in the shadows, because of fear.

Fluctuating Prices and Declining Income of Farmers

Fluctuating Prices and Declining Income of Farmers INTRODUCTION Farming is the growing of crops and the rearing of animals. Major agricultural products include; fish, cereals, cattle, vegetables, oilseed, poultry, potatoes, sheep. Farming contributed  £5.6 billion to the UK economy in 2006. In the last 25 years, farming in Britain has transformed a lot. Farming provided employment for quite a number of people, but nowadays, with the help of machinery and equipment, and the problems associated with farming, only a few people remain on the farm. The total labour force employed in agriculture in the UK is 541,000, of whom 190,000 are employees and the remaining 351,000 are self-employed farmers, partners, directors and spouses. Overall, 1.8% of the UKs workforce is directly employed in farming .The UK food chain accounts for almost 8% of the total economy (RuSource, 2008). However, farmers have always faced problems such as Increasing population growth, water logging and salinity, converting the arable land into non-agricultural uses, high cost of production, fluctuating prices, declining income, increased tax etc. But this article will focus mainly on why farmers have been facing fluctuating prices and declining income over the years. PRICE AND AGRICULTURE Price is the amount of money needed to purchase something or the quantity of payment or compensation for something. A price fluctuation is a change in the price market. Agricultural experts and businesspeople have blamed fluctuating commodity prices, difficult capital accesses and poor development of downstream industries for poor performance of the countrys agricultural industry. Some of the causes of price fluctuations in agriculture includes; seasonal change in supply which is adversely affected by natural or climatic factors, lack of finance, use of crude implements, seasonal shortage of demand, etc. The market structure of a farm which is perfect competition also affects the price. The market structure is such that the farmer cannot influence the price. The price is determined purely by the forces of demand and supply. According to PT Perkebunan Nusantara (PTPN) IV executive director Dahlan Harahap,   fluctuating prices influenced the agricultural industrys performances because most of the companies relied on their revenues on exports. Several major commodities which are mostly exported include crude palm oil (CPO) (77 percent exported), rubber (83 percent), cacao (86) and coffee (70). INCOME AND AGRICULTURE Income is the consumption and savings opportunity gained by an entity within a specified time frame, which is generally expressed in monetary terms. However, for households and individuals, income is the sum of all the wages, salaries, profits, interest payments, rents and other forms of earnings received in a given period of time. For firms, income generally refers to net-profit: what remains of revenue after expenses have been subtracted. Farmers have faced declining income over the years due to high cost of production and low return to investment. According to Dahlan, high bank interest is one of the factors impeding the countrys agricultural industry. Indonesia, he added, sets the highest bank interest rate in Southeast Asia. This however affects farmers income. UK farming incomes are defined at the industry level by a measure known as Total Income from Farming (TIFF) and at the farm level by a measure known as Net Farm Income. Both measures have exhibited long term decline since the 1960s, reaching a low point in 2000 with average Net Farm Income at just  £8700. Governments of many countries have felt it expedient to intervene in agricultural markets, and have resorted to different forms of controls and subsidies. These have often led to the accumulation of vast surpluses, which have sometimes rotted in storage and sometimes been sold abroad at subsidized prices. The theory of demand and supply can be used to understand why farmers face fluctuating price and declining since Price is a reflection of supply and demand. DEMAND AND SUPPLY IN AGRICULTURE The agricultural sector is a very unique sector in economics because it displays characteristics in terms of the demand for and the supply of its goods not seen in any other sector. The principal characteristics of demand are that it is both income and price inelastic and it has high dependency on population and tastes which cause demand to be static in both the short and the long run. On the other hand supply is very volatile in the short run due to extraneous factors because supply is a biological process though in the long run due to technological advances we tend to observe an increasing trend. Also, because agricultural products are perishable and because the production period is long, supply will be inelastic so producers will have to supply in the short run even at very low prices. Another characteristic of supply is its atomistic structure and asset fixity. These basically imply that there will be a large number of insignificant producers and that most agricultural asset will be fixed. These have various implications for prices which are very unstable in the short run and in the long run present a declining trend. Similarly farm incomes tend to be unstable in the short run and converge in the long run though it must be noted that this is also due to extensive government subsidisation of agriculture. DEMAND Demand  refers to how much (quantity) of a product or service is desired by buyers. The quantity demanded is the amount of a good that a consumer is willing and able to buy at a given price over a given period of time. Demand curve is a graph showing the relationship between the price of a good and the quantity of the good demanded over a given time period. Price is measured on the vertical axis; quantity demanded is measured on the horizontal axis The law of demand states that the quantity of a good demanded per period of time will fall as price rises and will rise as price falls, other things being equal (ceteris paribus). Demand on price and income According to Richard and Chrystal (2007); Agricultural production is subject to large variations resulting from factors that are beyond human control. For example, bad weather reduces output below that planned by farmers while exceptionally good weather pushes output above planned levels. Inelastic demand De E Elastic demand D1 Price Inelastic demand P0 Elastic demand Quantity 0 q1 q0 q3 Unplanned changes in output . Figure 3.1 Unplanned fluctuations in output (Richard and Chrystal 2007) Because farm products often have inelastic demands, large price fluctuations causes unplanned changes in production which in turn affects farmers income. Stabilization of agricultural prices: Farmers are allowed to sell their whole crop each year. When production unexpectedly exceeds normal output, the government buys in the market. It allows price to fall, but only by the same proportion that production has increased. When production unexpectedly falls short of normal output, the government enters the market and sells some of its stocks. It allows price to rise, but only by the same proportion that production has fallen below normal. Thus, as farmers encounter unplanned fluctuations in their output, they encounter exactly offsetting fluctuations in prices, so that their revenues are stabilized. In effect, the government has converted the elasticity of demand from being inelastic to being unitary. With a unit elasticity the total revenue of sellers does not change as quantity changes, because given percentage changes in quantity are offset by equal percentage changes of price but in the opposite direction. Figure 3.2 Income stabilization (Richard and Chrystal 2007) Income stabilization is achieved by allowing prices to fluctuate in inverse proportion to output Appropriate government intervention in agricultural markets can reduce price fluctuations and stabilize producers revenues.

Venus Essay -- essays research papers

Venus, the second planet from the Sun, is the hottest world in the solar system. It is blanketed by a thick atmosphere that heats its surface like the inside of a greenhouse. But with a surface temperature of almost 900 degrees Fahrenheit (480 C), this place is no garden! Other than its atmosphere, Venus is so similar to Earth that it is sometimes called Earth's sister planet. Its diameter and mass are almost identical to Earth's. Why, then, is it so hot? The "greenhouse effect" on Venus is caused by its atmosphere. Energy from the Sun passes through the atmosphere to the planet's surface, where it is absorbed and reradiated at longer wavelengths (as heat). Venus' atmosphere traps these longer wavelengths so they cannot escape into space. The trapped heat builds up, so the planet grows hotter and hotter. The same thing happens in an automobile on a hot day. Sunlight comes through the windows and warms the inside of the car, but the heat is trapped. Even though Venus' orbit brings it closer to Earth than any other planet, its blanket of clouds kept much of Venus a mystery. But space probes sent by the Soviet Union and the United States, as well as studies with ground-based radar, have allowed astronomers to "see" the surface of Venus for the first time. The first exploration of Venus by radar was in 1962. It revealed that Venus spins backward on its axis. If you could stand on the surface of Venus, and if you could see the Sun through the cloud cover, i...

The Correlation Between Music and Math: A Neurobiology Perspective :: Biology Essays Research Papers

The Correlation Between Music and Math: A Neurobiology Perspective I remember the first time I heard the statement  ¡Ã‚ ° Did you know that listening to classical music enhances your mathematical abilities? ¡Ã‚ ± I was both intrigued and excited, intrigued because I did not understand how music and math, two seemingly unrelated subject could possibly affect each other. I was also excited because I began to view classical music as some kind of magical potion that would transform my math skills from decent to extraordinary. When I had the opportunity to write this web paper, I immediately jumped into the topic of music and math. The questions that I wish to answer throughout this paper are; does listening to music really help you do better in math? If so, which part of the brain is controlling the correlation between math and music? In addition, how does music stimulate the brain in a way that enhances mathematical abilities? It turns out that there is much evidence that supports the positive effects of music on one ¡Ã‚ ¯s ability to do math. Most research shows that when children are trained in music at a young age, they tend to improve in their math skills. The surprising thing in this research is not that music as a whole is enhancing math skills. It is certain aspects of music that are affecting mathematics ability in a big way. Studies done mostly in children of young age show that their academic performance increases after a certain period of music education and training. One particular study published in the journal  ¡Ã‚ °Nature ¡Ã‚ ± showed that when groups of first graders were given music instruction that emphasized sequential skill development and musical games involving rhythmn and pitch, after six months, the students scored significantly better in math than students in groups that received traditional music instruction. (1) The result of this study posed another important question. How does this type of music that emphasized sequential skills, rhythmn and pitch manage to improve children's ability to do math? It turned out that there are two distinguished types of reasoning, spatial temporal (ST) reasoning and Language analytical (LA) reasoning. LA reasoning would be involved in solving equations and obtaining a quantitative result. ST reasoning would be is utilized in activities like chess when one needs to think ahead several moves. The effect of music on math sometimes termed the Mozart effect. The Mozart effect gain its name after the discovery that listening to Mozart's compositions, which is very sequential, produces a short-termed enhancement of spatial-temporal reasoning.

Classical and Post-Classical Hollywood Cinema Essay -- History Hollywo

Classical and Post-Classical Hollywood Cinema INTRODUCTION During the course of this essay it is my intention to discuss the differences between Classical Hollywood and post-Classical Hollywood. Although these terms refer to theoretical movements of which they are not definitive it is my goal to show that they are applicable in a broad way to a cinema tradition that dominated Hollywood production between 1916 and 1960 and which also pervaded Western Mainstream Cinema (Classical Hollywood or Classic Narrative Cinema) and to the movement and changes that came about following this time period (Post-Classical or New Hollywood). I intend to do this by first analysing and defining aspects of Classical Hollywood and having done that, examining post classical at which time the relationship between them will become evident. It is my intention to reference films from both movements and also published texts relative to the subject matter. In order to illustrate the structures involved I will be writing about the subjects of genre and genre transformati on, the representation of gender, postmodernism and the relationship between style, form and content. Classical Hollywood Classical Hollywood is a tradition of methods and structures that were prominent American cinema between 1916 and 1960.Its heritage stems from earlier American cinema Melodrama and to theatrical melodrama before that. Its tradition lives on in mainstream Hollywood to this day. But what is it? Classic narrative cinema is what Bordwell, Staiger and Thompson (The classic Hollywood Cinema, Columbia University press 1985) 1, calls â€Å"an excessively obvious cinema†1 in which cinematic style serves to explain and not to obscure the narrative. In this way it is made up of motivated events that lead the spectator to its inevitable conclusion. It causes the spectator to have an emotional investment in this conclusion coming to pass which in turn makes the predictable the most desirable outcome. The films are structured to create an atmosphere of verisimilitude, which is to give a perception of reality. On closer inspection it they are often far from realistic in a social sense but possibly portray a realism desired by the patriarchal and family value orientated society of the time. I feel that it is often the black and white representation of good and evil that creates such an atmosphere of predic... ... ed (BFI, 1990) we read †¦ â€Å"contrary to all trendy journalism about the ‘New Hollywood’ and the imagined rise of artistic freedom in American films, the ‘New Hollywood’ remains as crass and commercial as the old†¦Ã¢â‚¬  Bibliography 1.  Ã‚  Ã‚  Ã‚  Ã‚  Bordwell, Staiger and Thompson (The classic Hollywood Cinema, Columbia University press 1985) 2.  Ã‚  Ã‚  Ã‚  Ã‚  Bordwell, Thompson Film Art, An Introduction ,7th ed (Mcgraw Hill, 2004) 3.  Ã‚  Ã‚  Ã‚  Ã‚  Pam Cooke(ed) The Cinema Book,1st ed (BFI, 1990) 4.  Ã‚  Ã‚  Ã‚  Ã‚  Susan Hayward Cinema Studies The Key Concepts(, Routledge, 1999) 5. Jill Nelmes (ed) An introduction to film studies 3rd edition (Routeledge, 2003) Filmography TOUCH OF EVIL (Orson Welles, USA, 1958) Dracula (Tod Browning, Universal, US, 1931) Doctor Jekyll and Mr Hyde (Rouben Mamoulian, Paramount, US, 1931) The War of the Worlds (Byron Haskin, Paramount, US, 1953) Invasion of the body snatchers (Don Siegel, Allied Artists, US, 1955) Psycho (Alfred Hitchcock, Shamley, US, 1960) Night of the Living Dead (George A. Romero, Image Ten, US 1968) The Shining (Stanley Kubrick, Warner, US 1980) Taxi Driver (Martin Scorsese, Columbia, US, 1976) Blue velvet (David Lynch, De Laurentis, US, 1986)

Alternative energy or carbon sequestration

Since the beginning of civilization, man has always tried to resource his surrounding for his own benefits and needs. In the early times, man sufficed his need for energy by using wood in terms of fire for cooking and other purposes.As and when the technology started developing we started venturing into the field of advanced sciences for extracting maximum energy for population needs. Fossil fuels have been the greatest source of energy that has been exploited for a very long time. But in the time of growing population and global warming reaching new peaks every year, the time for alternative process of energy has come.One of the major challenges faced by today’s world is the sequential balancing between the impact on the climate and nature due to global warming and the immediate requirement of sufficing energy needs to vast and demanding population. To wriggle out of this situation, consideration has to be given on alternatives that can balance the equation and be beneficial for a longer term. Carbon sequestration is one of the latest technologies that have been put to use for the very same purpose. It is a process which would greatly reduce the carbon emission from high industrial belts and would to a great extent decelerate the process of global warming.The system or its principle works on two stages; first is capturing the carbon dioxide from the environment and then storing in soil or oceans. However this technology or this scientific innovation is pretty much new and the process of capturing carbon dioxide is on far later stages than the technological advancement on the process of storing it. The primary stage of capturing works on the simple principle of photosynthesis in plants. The carbon dioxide is taken by plants from the environment and it gives out oxygen back to the atmosphere.The carbon that is left within the plant is amalgamated into biomass and is very promptly released into the soil. It is estimated that there is a lot of carbon in the soil compared to the environment and due to which the concept of carbon sequestration seems validated when it transfuses carbon deep in the soil. The following will give evidence on the amount of carbon already existing in the soil, due to natural integration: ‘According to the FAO the carbon content of dry land soils is estimated to be 4 tons/hectare. Carbon content ranges between 7 tons and 24 tons in normal (non-depleted) soils, depending on the climate zone and vegetation’.(Courtesy: Eco preservation society, â€Å"Carbon Sequestration and Storage in Soils Could Solve Global Warming†. June 19, 2008. Retrieved on November 27, 2008 from http://ecopreservationsociety. wordpress. com/2008/06/19/carbon-sequestration-and-storage-in-soils-could-solve-global-warming/? referer=sphere_related_content/) The technology of capturing carbon works on similar principle of photosynthesis where the carbon dioxide is taken into capture by the utilization of the syn gas on reac tors and coal emitting industries. This reaction takes place before the carbon dioxide is mixed with the atmosphere.Capturing of the carbon can also be done in two stages and i. e. pre combustion capture and post combustion capture. The process of carbon capturing is still in its novice stages and has been categorized in forms of storage procedures. Carbon can be stored in oceans in a liquid storage procedure; it can be stored real deep in saline formations and already utilized gas fields. The advantage of storing it in exhausted gas fields is that carbon helps retrieve the little percentage of fossil fuels which was out of reach becomes and due to this sequestration process it very much possible.Also there is a procedure which is minimally used, in which it can just be stored in a solid form. However to survive in this planet with depleting natural energy resources, a cleaner form of energy is very much the immediate necessity. The crisis of fuel can be only understood from the fac t that one of the major reasons of the world today going to recession is because of high fuel prices. Not only we are losing from an energy perspective but this depletion is causing havoc in the financial markets alongside bringing down economies.The most surprising aspect of the world is that even when we had the biggest source of energy no proper advancement is done in the field of solar energy. The sun has the biggest potential to run the entire planet on the energy its providing yet only little development have been done in the field of solar energy. The sun’s energy can be basically converted into photovoltaic energy or can be put in terms of cells where the energy can be stored and then utilized. This technology makes the solar energy more producible in terms of a cleaner energy and gives an edge over all the sources of energy.To add to the advantage, solar tracking devices can be adjusted with the solar panels, so that maximum solar energy can be grasped in terms of in tensity and the solar panels can integrate themselves to a degree where the sun is at its highest. NASA uses this technology for hovering satellites around earth and if this energy is used in more periodic and systematic way, it can challenge any source of energy to its fullest. The following highlights the advantage of solar energy in terms of market and competitive edge over countries rich in oil:‘This would automatically boost the market for renewable energy. Even countries with conventional energy reserves would lose their current cost advantages’ (Courtesy: Hermann Scheer, and Andrew Ketley, â€Å"The Solar Economy: Renewable Energy for a Sustainable Global Future†. Page 307. Retrieved on November 27, 2008. Published by Earthscan, 2004) The wind energy is also another source of clean energy. But this energy gets its limitations as it is suppose to have wind run at least 14 miles per hour for it to produce energy.Also unlike solar energy which can be used in cars, with the help of solar panels, it would become tedious for wind energy to be implemented. For this world to have an alternative it is better first to focus on an alternate form of energy especially in the lines of solar energy over carbon sequestration. The major reason behind it is carbon in the end has to be released in the atmosphere with the cutting of forests and tilling of agricultural land. Also when carbon storing is done in water it increases the chances of acidification of water by a huge margin, making the storage process more vulnerable.Also if carbon sequestration is done on a natural basis by the mean of planting more trees than it becomes a very slow process and the following can shed light on this issue: ‘Trees grow very slowly, although the potential to sequester carbon is very large, the actual carbon sequestration rate on an annual basis is very small especially for temperate climate found in climatic zones like Canada’. (Courtesy: Jagtar S. Bha tti, R Lal, M. J. Apps, M A Price, â€Å"Climate Change and Managed Ecosystems†. Page-99. Retrieved on November 27, 2008.Published by CRC Press, 2006) The fact that solar energy should be more emphasized than carbon sequestration is that both the technologies haven’t reached their required advancement, and the amount of time taken to reach the pinnacle of the technology would approximately take the same time, which makes an alternative form of energy a better and viable option for top recommendation than a technology that is only going to rotate carbon from the atmosphere into soil or ocean, which in the end might get recycled back in the atmosphere.Reference: 1) Eco preservation society, â€Å"Carbon Sequestration and Storage in Soils Could Solve Global Warming†. June 19, 2008. http://ecopreservationsociety. wordpress. com/2008/06/19/carbon-sequestration-and-storage-in-soils-could-solve-global-warming/? referer=sphere_related_content/ 2) Hermann Scheer, and And rew Ketley, â€Å"The Solar Economy: Renewable Energy for a Sustainable Global Future†. Page 307. 2008.Published by Earthscan, 2004 3) Jagtar S. Bhatti, R Lal, M. J. Apps, M A Price, â€Å"Climate Change and Managed Ecosystems†. Page-99. Published by CRC Press, 2006 4) Jeffrey Gordon, â€Å"Solar Energy: The State of the Art†. International Solar Energy Society. Published by Earthscan, 2001 5) Thomas E Lovejoy, Lee Hannah, â€Å"Climate Change and Biodiversity†. Published by TERI Press 6) http://www. fossil. energy. gov/programs/sequestration/

Diabetes And Periodontal Disease

INTRODUCTIONDiabetes and periodontal disease are both highly prevalent in the general population. A disease of the metabolism, diabetes has far reaching effects in the body. It affects the body’s capacity to fight infections and regenerate. Periodontal disease, though limited to the oral cavity, can influence systemic health. The effect of diabetes on periodontal disease has been studied extensively in the past. Now, with the advent of periodontal medicine, the effects of periodontal disease on development and control of diabetes are under scrutiny. We shall be seeing the cyclic relationship of these two diseases, and how control of one can lead to improved control of the other.DIABETESDiabetes mellitus is a systemic disease with several major complications affecting both the quality and length of life. It is an endocrine disorder characterized by chronic hyperglycemia. Diminished insulin production, impaired action of insulin or both, lead to decreased transport of glucose to the tissues. This leads to an elevated blood sugar level.There are two types of diabetes, depending on the cause:Type 1 (insulin dependant diabetes mellitus) It is caused due to autoimmune destruction of the ÃŽ ² cells of the pancreatic Islets of Langerhans.Type 2 (non insulin dependant diabetes mellitus)It is caused by resistance of peripheral receptors to the action of insulin.Both types of diabetes are associated with many long term complications. These include nephropathy, retinopathy, and neuropathy, cardiovascular and cerebrovascular complications. Periodontitis is now considered to be the sixth complication of diabetes.It is also associated with poor wound healing and susceptibility to infections.PERIODONTAL DISEASEPeriodontal disease can be defined as ‘An inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms or groups of specific microorganisms, in a susceptible host, resulting in progressive destruction of the periodontal ligam ent and alveolar bone with pocket formation, recession or both.’Periodontitis is an ongoing process characterized by phases of destruction and quiescence. The destruction is influenced by many systemic factors like dietary deficiencies, hormonal balance and host defense. Condition like vitamin c deficiency, pregnancy, immune deficiency and diabetes affect periodontal disease.DIABETES AS AN AGGRAVATING FACTOR OF PERIODONTAL DISEASEThe oral manifestations of diabetes include mucositis, burning mouth, candidiasis, abscesses, gingival polyps and periodontal disease. Diabetes, when a complication of Periodontitis, acts as a modifying and aggravating factor in the severity of periodontal infection. Diabetics with periodontitis demonstrate more attachment loss, bone loss, and deeper probing pocket depths than non-diabetic individuals. The earlier the onset of diabetes, and the poorer the control, more is the susceptibility to periodontal disease. Also, when a diabetic individual con tracts periodontal disease, it is of a greater severity than in non-diabetic individuals.Change in the MicrofloraDiabetic individuals show elevated levels of glucose in the blood. This leads to elevated glucose levels in the gingival crevicular fluid (GCF). This changes the environment of the periodontal microflora. There is a qualitative change of micro-organisms between non-diabetic and diabetic individuals. Studies have shown an increase in the number of Capnocytophaga and Aggregatibacter actinomycetemcometans subgingivally in diabetic individuals.Microvascular Angiopathy:Diabetes leads to microvascular angiopathy, causing a compromised delivery of blood and nutrients to the periodontal tissues. There is a decrease in the removal of toxic metabolites from the tissues. There is a constant release of toxins from the plaque. Thus microangiopathy can cause tissue destruction.Collagen Turnover:Collagen metabolism is defective in diabetics. Hyperglycemia is associated with an increase in protease and collagenase activity. There is an increase in Accumulated Glycation End-products (AGEs). These AGEs cause cross-linkage of collagen fibers. These fibers, then, are not repaired or replaced. This causes decreased wound healing.Immune Response:Diabetes also leads to a diminished immune response. Diabetic abnormalities in immune response include impaired neutrophil chemotaxis, phagocytosis and adhesion. Certain protein factors in diabetic serum competitively bind neutrophil receptors, thereby preventing complement-mediated phagocytosis. The body’s defense system is thus undermined, predisposing to infections.Cytokine Regulation:Diabetics show an increase of inflammatory cytokines from monocytes/ polymorphonuclear leukocytes and reduction in growth factors from macrophages. This predisposes to chronic inflammation, tissue breakdown and diminished repair capacity. There is an increase in Interleukin1 (IL1) and Tumor necrosis factor ÃŽ ± (TNFÃŽ ±). These, in turn in crease the release of enzymes that destroy gingival connective tissue, and promote the formation of osteoclasts.Bone FormationDiabetes has also been found to impair the ability of new bone formation. It interferes with the process of coupling. This diminished capacity of new bone formation interferes with the ability of a diabetic individual to repair the loss of tissue that occurs in periodontal disease.Bacterial plaque is the primary etiologic factor of periodontal disease, but diabetes complicates periodontal disease by altering host response to plaque and reducing the ability to heal following surgery.PERIODONTAL DISEASE AS A MODIFYING FACTOR FOR DIABETESThe interrelationship between Periodontitis and diabetes provides an example of systemic disease predisposing to oral infection, and once that infection is established, the oral infection exacerbates systemic disease.Effects of Infection on Glycemic ControlGlycemic control is affected by all kinds of infections. Systemic bacteri al and viral infections cause a resistance in the peripheral tissue receptors to insulin.In case of periodontal disease, there is a persistent bacterial infection which acts in a manner similar to other systemic infections. The presence of severe periodontal disease worsens glycemic control. This effect is more pronounced in Gram negative infections.Insulin ResistancePeriodontal infection causes an increase in the levels of proinflammatory cytokines, like interleukin1 (IL1) and tumor necrosis factor ÃŽ ± (TNFÃŽ ±). Studies have demonstrated that TNFÃŽ ± suppresses insulin action via its specific receptor; hence, it exacerbates insulin resistance, producing an insulin resistance syndrome similar to that observed in diabetes. It initiates destruction of pancreatic beta cells leading to development of diabetes.Insulin resistance prevents glucose uptake into the tissues and increases the blood glucose level. The pancreas, thus, have to step up the production of insulin. This effect is s een in normal individuals as well as diabetics.Periodontitis, Diabetes and PregnancyPeriodontitis is particularly a problem in pregnant, diabetic women. Periodontitis causes an increase in biologic fluids, inducing labor. In this manner, it is associated with pre term, low birth weight babies. Diabetic women are more prone to Periodontitis than non diabetic women. They also tend to have more bone loss, more attachment loss and deeper pockets than non diabetic women. Diabetes, independently, also causes complications during childbearing.The effect of Periodontitis on the duration of pregnancy is exacerbated in diabetics.Periodontitis can also cause a loss of glycemic control in this crucial time. Thus, it is important that the periodontal health of pregnant, diabetic women be evaluated. Proper treatment modalities should be undertaken to avoid an unfavorable outcome.Treatment of Periodontitis in DiabeticsRecent evidence suggests that Periodontitis should be treated differently in dia betic individuals. Periodontal surgery and the resultant transient bacteremia can cause an up regulation of TNFÃŽ ±. This aggravates insulin resistance and upsets glycemic control. Thus Periodontitis in diabetic individuals should be treated non-surgically. The treatment of Periodontitis causes elimination of the bacterial challenge. This leads to a better tissue response to insulin. Normal tissue response is restored over time. Treatment of Periodontitis, thus, improves glycemic control. This is more apparent in patients with severe Periodontitis.CONCLUSIONPeriodontal disease is the result of a complex interplay of bacterial infection and host responses, and is often modified by various systemic diseases such as diabetes mellitus. Such diseases are capable of affecting the periodontium and/or the treatment of periodontal disease.On the other hand, recent research indicated that periodontitis too can influence the course of a systemic disease like diabetes.In order to understand the cellular/molecular mechanisms responsible for such a cyclical association, one must identify common physiological changes associated with diabetes and periodontitis that produce a synergy when the conditions coexist. When one of the diseases is under control, control of the other disease is facilitated.Not only is periodontal disease thereby affected by systemic diseases, but carefully managed periodontal therapy may also have a positive effect on the general health of patients with systemic diseases. Â