Periodontal disease among adult, new-immigrant, Chinese Americans in Boston with and without diabetes -- a brief communication

Epidemiologic relationship between periodontitis and type 2 diabetes mellitus

Background

To systematically review the epidemiologic relationship between periodontitis and type 2 diabetes mellitus (T2DM).

Methods

Four electronic databases were searched up until December 2018. The manual search included the reference lists of the included studies and relevant journals. Observational studies evaluating the relationship between T2DM and periodontitis were included. Meta-analyses were conducted using STATA.

Results

A total of 53 observational studies were included. The Adjusted T2DM prevalence was significantly higher in periodontitis patients (OR = 4.04, p = 0.000), and vice versa (OR = 1.58, p = 0.000). T2DM patients had significantly worse periodontal status, as reflected in a 0.61 mm deeper periodontal pocket, a 0.89 mm higher attachment loss and approximately 2 more lost teeth (all p = 0.000), than those without T2DM. The results of the cohort studies found that T2DM could elevate the risk of developing periodontitis by 34% (p = 0.002). The glycemic control of T2DM patients might result in different periodontitis outcomes. Severe periodontitis increased the incidence of T2DM by 53% (p = 0.000), and this result was stable. In contrast, the impact of mild periodontitis on T2DM incidence (RR = 1.28, p = 0.007) was less robust.

Conclusions

There is an evident bidirectional relationship between T2DM and periodontitis. Further well-designed cohort studies are needed to confirm this finding. Our results suggest that both dentists and physicians need to be aware of the strong connection between periodontitis and T2DM. Controlling these two diseases might help prevent each other’s incidence.

Association between type 1 diabetes and periodontal health

PURPOSE

We assessed periodontal status in patients with type 1 diabetes and healthy individuals in relation to their glycemic control, smoking and inflammatory biomarkers.

MATERIAL/METHODS

Periodontal status was examined in 107 patients with diabetes and 40 controls, using Oral Hygiene Index (OHI), Community Periodontal Index (CPI) and tooth number. CPI values of 0-2 and 3-4 were classified as non-periodontitis and periodontitis, respectively. Blood samples were analyzed for glucose, HbA1c, CRP, fibrinogen, interleukin-1 and tumor necrosis factor-alpha (TNF-α).

RESULTS

Periodontitis was found in 15.0% of the controls and 57.9% of diabetic patients, including 40.0% of these with good metabolic control (GMC) and 59.5% of those with poor metabolic control (PMC). Severe periodontitis was more frequent in the PMC than in the GMC group and in the controls (26.0% vs. 20.0% vs. 5.0%). The PMC patients had lower number of sextants with CPI 0 and higher number of sextants with CPI 3 and CPI 4 as well as lower tooth number in comparison with the controls. The patients with periodontitis had higher TNF-α (p<0.001) and OHI (p<0.001) than the patients without periodontitis. The number of sextants with CPI 0 correlated negatively with fibrinogen and TNF-α levels, whereas the number of sextants with CPI 3 correlated positively with TNF-α and fasting glucose level.

CONCLUSIONS

There is good evidence that type 1 diabetes increases the risk of periodontal disease. Our results suggest that poor metabolic control of diabetes together with smoking and inadequate oral hygiene increase the risk of severe periodontal destruction in patients with type 1 diabetes.

Effect of diabetes on periodontal status of a population with poor oral health

OBJECTIVE

Diabetes is a global health problem and its prevalence is increasing worldwide. The objective of the study was to investigate the effect of diabetes on the periodontal status of a Pakistani population with poor oral hygiene.

MATERIAL AND METHODS

Eighty-eight individuals with diabetes and 80 non-diabetic individuals were recruited from a disadvantaged district in Karachi, Pakistan. The group with diabetes comprised 50 males and 38 females, and the non-diabetic group 43 males and 37 females. All underwent clinical and radiographic examination.

RESULTS

The average numbers of teeth in the diabetes and non-diabetes groups were 24 and 26, respectively. The odds ratio (OR) for missing or fewer teeth was 2.3 times higher for diabetics than for non-diabetics (CI 1.32-4.14; p<0.001). Diabetic patients had more sites with plaque than did non-diabetics (OR 1.96, CI 0.99-3.88; p<0.056). Moderate to severe periodontitis was significantly more prevalent among diabetic patients (p<0.01).

CONCLUSION

In this disadvantaged population with poor oral hygiene, diabetes has had a strongly negative influence on oral health: diabetic patients have fewer teeth, more plaque, and a higher prevalence of moderate to severe periodontal disease than non-diabetics.