The association between periodontal disease and metabolic syndrome among outpatients with diabetes in Jordan

Association between components of metabolic syndrome and periodontitis: a systematic review and meta-analysis

OBJECTIVES

To evaluate the role of metabolic syndrome (MetS) components in the association with periodontitis (PE) (#CRD42020218310).

MATERIALS AND METHODS

A systematic electronic search was performed in PUBMED, Scielo and Lilacs databases up to April 2022. Cross-sectional, case-control, and cohort studies presenting data on the association between MetS and PE in the adult and elderly populations were included. A random effect meta-analysis was performed to determine association effect estimates. Results interpretation followed the assessment of methodological quality (Joana Briggs Institute tool) together with the certainty of evidence (GRADE approach).

RESULTS

This review included 52 studies, totalling 140,434 participants, and 38 studies were meta-analyzed. Association between PE and MetS was observed (OR_adj from 1.27 to 1.90; PR_ajd = 1.19; RR_adj from 1.10 to 1.37) (low and very low certainty of evidence). Hyperglycaemia (OR = 1.18), HDL (OR = 1.16), obesity (OR = 1.08), and hypertension (OR = 1.11) were associated with PE, except triglycerides (low and very low certainty of evidence). There was a dose-response gradient between the number of MetS components and PE, with a gradual increase in the effect magnitude for 1 (OR = 1.14), 2 (OR = 1.52), 3 or more (OR = 1.79), and 4 or 5 components (OR = 2.02) (low to high certainty of evidence).

CONCLUSIONS

MetS was associated with PE, with a dose-response gradient between the number of MetS components and the occurrence of PE, with an increasing effect magnitude according to an increasing number of components.

CLINICAL RELEVANCE

Periodontal examination should be part of a comprehensive propaedeutic approach of MetS patients, particularly those presenting a great number of components.

Metabolic syndrome and periodontitis among adults: The 2018 Indonesia National Health Survey

Aim

This study aimed to examine the association between metabolic syndrome (MetS), its components, and periodontitis among Indonesian adults.

Materials and Methods

Cross‐sectional data from the 2018 Indonesia National Health Survey (Riskesdas) was analysed. The sample included dentate individuals aged 35 years or older for whom complete information was available on components of MetS and periodontitis, including bleeding on probing (BOP) (N = 13,356), pocket depth (PD) (N = 13,273), and clinical attachment loss (CAL) (N = 13,000). Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated with negative binomial regression models.

Results

The prevalence of MetS was 41.0%. The prevalence of individuals having at least one tooth with BOP, one tooth with PD ≥4 mm, or one sextant with CAL ≥4 mm was 74.9%, 40.7%, and 40.6%, respectively. No associations were observed between MetS and BOP, PD, or CAL, but hyperglycaemia was constantly positively associated with BOP (RR = 1.06; 95% CI 1.01–1.11), PD (RR = 1.13; 95% CI 1.03–1.23), and CAL (RR = 1.15; 95% CI 1.08–1.23).

Conclusions

Our findings support the potential influence of hyperglycaemia on periodontitis. Incorporating oral disease prevention strategies into the management of systemic diseases could be beneficial for reducing the burden of these diseases in Indonesia.

Association Between Periodontitis and Metabolic Syndrome in Females: A Systematic Review and Meta-analysis

Background:

Metabolic syndrome (MetS) and periodontal diseases (PDs) have shown a bidirectional and vice versa relationship. Hence, this study aimed to identify the extent and magnitude between MetS and PDs in females.

Materials and Methods:

A published literature was explored by considering case–control, cross-sectional, and cohort studies that involved patients with measurements of MetS and PD. Ovid MEDLINE, EMBASE, LILACS, and Cochrane Library databases were used for the search. This study examined the relationship between the MetS and PD among females.

Results:

Of the initial 4150 titles screened, a total of 37 reported papers were eligible for quantitative review. A gender-wise analysis of the findings revealed a crude odds ratio (OR) of 1.385 [95% confidence interval (CI): 1.043–1.839, I² = 94.61%, P < 0.001] for the females relative to the average OR of 1.54 (95% CI: 1.39–1.71, I² = 90.95%, P < 0.001). Further subgroup analysis for directionality in females revealed the crude ORs of 1.28 (95% CI: 0.91–1.79, I² = 96.44%, P < 0.001) for the relationship between PD and MetS, whereas an OR of 2.12 (95% CI: 0.78–5.73, I² = 88.31%, P < 0.001) was found between MetS and PDs.

Conclusion:

This study lacks convincing proof of a link between MetS and PDs in females when compared with an overall association between MetS and PDs. Directionality indicated higher odds of linking between MetS and PD than PD and MetS among females. Further longitudinal and treatment trials are needed to confirm the association among females.

Relationship between periodontal diseases and newly-diagnosed metabolic syndrome components in a sub-Saharan population: a cross sectional study

Background

Oral health is a frequently ignored aspect of global health in sub-Saharan patients. Periodontitis, a very frequent oral disease has been proven to be associated to development of the metabolic syndrome. This study aims to evaluate the relationship between periodontal disease and metabolic syndrome components in a sub-Saharan population.

Methods

We performed a cross sectional study in 3 Yaounde hospitals. Consenting adults aged 21 years and above were recruited. Participants who presented with a tooth loss of at least 50% or any condition which could alter values of biological and periodontal parameters (tobacco smoking, pregnancy, chronic kidney disease, cancer) were excluded. Metabolic syndrome elements (glycaemia, arterial pressure, HDL cholesterol, abdominal circumference, triglycerides) and periodontal variables were recorded (plaque and gingival index of Silness and Loe, periodontal pocket depth and clinical attachment loss). These variables were compared using Fisher’s exact Test and odds ratio calculated with 95% confidence intervals.

Results

The prevalence of periodontitis and metabolic syndrome were 43.4% and 10.8% respectively. Age (37.75 ± 13.25, P < 0.001) and poor accessory brushing methods were associated risk factors for development of periodontal disease. Sub-Saharan sindividuals with periodontitis had increased odds of having obesity (OR 11.1 [95% CI 3.97–31.03], P < 0.001) and low HDL (OR 4.58 [95% CI 1.79–11.70], P = 0.001)

Conclusion

Our findings suggest an association between periodontal disease and metabolic syndrome in Sub-Saharan subjects. Increasing age and poor accessory brushing methods are associated risk indicators.

Periodontal Diseases and the Risk of Metabolic Syndrome: An Updated Systematic Review and Meta-Analysis

Background: Periodontitis and metabolic syndrome (MetS) are two major global health problems that are widely prevalent in the world, although the former is a common infection in developing countries and the latter is a non-infectious but prevalent disease in developed countries. This study aims to provide an updated review on the existence and magnitude of the relationship between periodontal disease and the risk of MetS. Methods: We searched the PubMed, Web of Science, ScienceDirect, Chinese National Knowledge Infrastructure, and Wanfang databases for original studies assessing the association between periodontitis and MetS published before August 2019. We calculated the pooled crude and adjusted odds ratios (ORs) together with the 95% confidence intervals (95% CIs) to estimate the strength of this association. Subgroup analysis was performed by considering the diagnostic method or the country where the studies were performed. Results: We identified 43 potentially eligible articles for this systematic review, including 32 cross-sectional studies, eight case-control studies, and three cohort studies. Among them, 39 articles presented enough information to be included in the meta-analysis. The pooled crude and adjusted ORs were 1.99 (95% CI: 1.75-2.25) and 1.46 (95% CI: 1.31-1.61), respectively. Subgroup analysis showed a consistent relation stratified by either the diagnostic method or the country where the studies were performed. The pooled OR was 1.68 (95% CI: 1.41-2.00) for Japan, 1.75 (95% CI: 1.31-2.34) for the USA, 1.81 (95% CI: 1.35-2.42) for Korea, and 2.29 (95% CI: 1.53-3.41) for China. Conclusion: Our results provide compelling evidence for the association between periodontitis and MetS. Patients with periodontal disease are a critical screening population for MetS. We also recommend that people exhibiting components of MetS should receive a periodontal check-up and pay attention to their oral health.

Oral microbiota-induced periodontitis: a new risk factor of metabolic diseases

It has recently become evident that the periodontium (gingiva, desmodontal ligament, cementum and alveolar bone) and the associated microbiota play a pivotal role in regulating human health and diseases. The oral cavity is the second largest microbiota in the body with around 500 different bacterial species identified today. When disruption of oral cavity and dysbiosis occur, the proportion of strict anaerobic Gram-negative bacteria is then increased. Patients with periodontitis present 27 to 53% more risk to develop diabetes than the control population suggesting that periodontitis is an aggravating factor in the incidence of diabetes. Moreover, dysbiosis of oral microbiota is involved in both periodontal and metabolic disorders (cardiovascular diseases, dyslipidaemia …). The oral diabetic dysbiosis is characterized by a specific bacteria Porphyromonas, which is highly expressed in periodontal diseases and could exacerbate insulin resistance. In this review, we will address the nature of the oral microbiota and how it affects systemic pathologies with a bidirectional interaction. We also propose that using prebiotics like Akkermansia muciniphila may influence oral microbiota as novel therapeutic strategies. The discovery of the implication of oral microbiota for the control of metabolic diseases could be a new way for personalized medicine.

Relationship between dentition, anthropometric measurements, and metabolic syndrome in the elderly

Abstract Introduction Tooth loss is a health disorder of the elderly population that may lead to masticatory deficiency and nutritional risks, inducing the biochemical changes of metabolic syndrome (MS). Objective To verify the relationship among number of teeth, anthropometric measurements, and MS in a group of elderly people. Material and method The study was developed in Porto Alegre, RS, Brazil, and it was divided into three phases. The first phase collected information from the database of all project participants and the second one collected sociodemographic, anthropometric, and biochemical data. The third phase was divided into two other phases: first, oral health interviews were applied to the elderly (281 patients evaluated by telephone and 23 visited at home) and second, 45 patients were randomly selected and invited to validate the data obtained by telephone with oral clinical examinations performed by a trained dental surgeon. The sample consisted of 304 individuals. The data collected were tabulated and analyzed using statistical tests. Result Elderly women with severe tooth loss present a significantly higher risk of developing MS. Thus, the maintenance of natural teeth in the elderly is a protective factor for the syndrome. Conclusion The findings support the hypothesis that the oral health of individuals, expressed by the number of teeth, may compromise and increase the risk of MS in the elderly.

The association between periodontal disease severity and metabolic syndrome in Vietnamese patients

OBJECTIVE

To investigate the association between periodontal disease severity and metabolic syndrome (MetS) in a group of Vietnamese patients.

METHODS

A total of 412 participants (114 males, 298 females, average age 57.8 ± 5.7 years) including 206 patients with MetS and 206 participants without MetS were selected for this study. Information on sociodemographic characteristics, dental behaviours and smoking status was collected from a self-administrated questionnaire. Periodontal status including plaque index (PI), gingival index (GI) pocket depth (PD) and clinical attachment level (CAL) was recorded. Logistic regression analyses were used to evaluate the association between severity of periodontal disease and MetS with adjustments for related confounders.

RESULTS

The prevalence of moderate and severe periodontitis assessed by GI, PD and CAL was all significantly higher in the MetS group than in the control group and was significantly increased by a number of MetS components. Logistic regression, adjusted for confounders, showed that people with mean PI ≥2.51 or GI ≥1.01 or number of teeth with bleeding on probing of ≥20 teeth or PD ≥3.66 or CAL ≥3.66 showed a significant association with greater OR for MetS compared to counterparts (P < .05). The OR for MetS was 4.06 (95% CI 2.11-7.84) in severe periodontitis patients compared to non-periodontitis participants (P < .001).

CONCLUSION

Much severe and extensive periodontal disease was found in MetS participants and increased with number of MetS components. Participants with higher periodontal parameters had a higher risk of MetS.

Association between metabolic syndrome and periodontitis: a systematic review and meta-analysis

The aim of the present study was to evaluate the association between metabolic syndrome (MS) and periodontitis (PD), through a systematic review and meta-analysis. Original observational studies assessing the association between MS and PD in adults, published before May 11th (2017), were identified through electronic searches of MEDLINE, EMBASE and Cochrane Library databases. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used. For studies to be included, they had to mention the criteria used to diagnose MS and to have used at least one clinical measure to diagnose PD. There was no language restriction. Three reviewers independently identified eligible studies for possible inclusion in the systematic review and meta-analysis. The quality of the studies was evaluated by the Newcastle-Ottawa scale for observational studies. A random model meta-analysis was conducted. The strategies used to investigate heterogeneity were sequential analysis, subgroup analysis, univariate meta-regression and sensitivity analysis. Thirty-three studies met the inclusion criteria for the systematic review, and 26 had enough information to be included in the meta-analysis, totaling 52,504 patients. MS and PD were associated with an odds ratio of 1.38 (95%CI 1.26-1.51; I2 = 92.7%; p < 0.001). Subgroup analysis showed that complete periodontal examination (I2 = 70.6%; p < 0.001) partially explained the variability between studies. The present findings suggest an association between MS and PD. Individuals with MS are 38% more likely to present PD than individuals without this condition. Prospective studies should be conducted to establish cause and effect relations between MS and PD.

Correlation Between Metabolic Syndrome, Periodontitis and Reactive Oxygen Species Production. A Pilot Study

Background and Objective:

Metabolic syndrome (MetS) is associated with an increased risk of periodontitis even if the mechanism is unknown. Since both MetS and periodontitis are characterized by an alteration of inflammation status, the aim of this pilot study was to determine if differences in ROS metabolism of phagocytes isolated from (A) patients with MetS, (B) patients with both MetS and mild periodontitis, (C) healthy subjects and (D) normal weight subjects with mild periodontitis, were present.

Methods:

ROS metabolism was studied by a Chemiluminescence (CL) technique: the system was made up of luminol (100 nmol/L) and cells (1 × 10⁵) in the presence or absence of stimulus constituted by opsonized zymosan (0.5 mg). The final volume (1.0 mL) was obtained using modified KRP buffer. ROS production was measured at 25°C for 2 h, using an LB 953 luminometer (Berthold, EG & G Co, Germany). All the experiments were performed in triplicate.

Statistical Analysis:

All results are mean ± standard deviation (SD). The group of means was compared by the analysis of variance "(ANOVA)". A value of p < 0.05 was considered significant.

Results:

Results showed that basal ROS production (both from PMNs and from PBMs) of groups A, B and D was increased with respect to that obtained from group C (p <0.05).

Conclusion:

These results are congruent with literature data, although the actual clinical relevance of the phenomenon remains to be evaluated.

The association between oral hygiene and periodontitis: a systematic review and meta-analysis

Objective: Dental plaque accumulation and inadequate personal oral hygiene (OH) are known major risk factors of periodontitis. Nevertheless, the magnitude of their effects has not yet been the subject of a meta-analysis. Material and methods: The Medline and Scopus databases were searched up to May 2016. Observational studies were eligible if they assessed associations between OH and periodontitis in adult subjects. A multivariate random-effects meta-analysis was used to pool the effects of fair/poor OH versus good OH on periodontitis across studies. The associations between oral care habits and periodontitis were also assessed. Results: A total of 50 studies were eligible; 15 were used for pooling the effect of fair OH versus good OH and poor OH versus good OH on periodontitis, with pooled odds ratios (ORs) of 2.04 [95% confidence interval (CI): 1.65–2.53] and 5.01 (95% CI: 3.40–7.39), respectively. Eleven studies examined oral care habits measured according to toothbrushing regularity and dental visit frequency; pooled ORs of 0.66 (95% CI: 0.47–0.94) and 0.68 (95% CI: 0.47–0.98) were obtained, respectively. Conclusions: Fair to poor OH increases the risk of periodontitis by two- to five-fold. This risk can be reduced by regular toothbrushing and dental visits.