Periodontal status of diabetic and non-diabetic men: effects of smoking, glycemic control, and socioeconomic factors

Correlation of periodontal inflamed surface area with glycated hemoglobin, interleukin-6 and lipoprotein(a) in type 2 diabetes with retinopathy

BACKGROUND

The two-way relationship between periodontitis and type 2 diabetes mellitus (T2DM) is well established. Prolonged hyperglycemia contributes to increased periodontal destruction and severe periodontitis, accentuating diabetic complications. An inflammatory link exists between diabetic retinopathy (DR) and periodontitis, but the studies regarding this association and the role of lipoprotein(a) [Lp(a)] and interleukin-6 (IL-6) in these conditions are scarce in the literature.

AIM

To determine the correlation of periodontal inflamed surface area (PISA) with glycated Hb (HbA1c), serum IL-6 and Lp(a) in T2DM subjects with retinopathy.

METHODS

This cross-sectional study comprised 40 T2DM subjects with DR and 40 T2DM subjects without DR. All subjects were assessed for periodontal parameters [bleeding on probing (BOP), probing pocket depth, clinical attachment loss (CAL), oral hygiene index-simplified, plaque index (PI) and PISA], and systemic parameters [HbA1c, fasting plasma glucose and postprandial plasma glucose, fasting lipid profile, serum IL-6 and serum Lp(a)].

RESULTS

The proportion of periodontitis in T2DM with and without DR was 47.5% and 27.5% respectively. Severity of periodontitis, CAL, PISA, IL-6 and Lp(a) were higher in T2DM with DR group compared to T2DM without DR group. Sig-nificant difference was observed in the mean percentage of sites with BOP between T2DM with DR (69%) and T2DM without DR (41%), but there was no significant difference in PI (P > 0.05). HbA1c was positively correlated with CAL (r = 0.351, P = 0.001), and PISA (r = 0.393, P ≤ 0.001) in study subjects. A positive correlation was found between PISA and IL-6 (r = 0.651, P < 0.0001); PISA and Lp(a) (r = 0.59, P < 0.001); CAL and IL-6 (r = 0.527, P < 0.0001) and CAL and Lp(a) (r = 0.631, P < 0.001) among study subjects.

CONCLUSION

Despite both groups having poor glycemic control and comparable plaque scores, the periodontal parameters were higher in DR as compared to T2DM without DR. Since a bidirectional link exists between periodontitis and DM, the presence of DR may have contributed to the severity of periodontal destruction and periodontitis may have influenced the progression of DR.

Are Inflamed Periodontal Tissues Endogenous Source of Advanced Glycation End-Products (AGEs) in Individuals with and without Diabetes Mellitus? A Systematic Review

Advanced glycation end-products (AGEs) are heterogeneous compounds formed when excess sugars condense with the amino groups of nucleic acids and proteins. Increased AGEs are associated with insulin resistance and poor glycemic control. Recently, inflamed periodontal tissues and certain oral bacteria were observed to increase the local and systemic AGE levels in both normoglycemic and hyperglycemic individuals. Although hyperglycemia induced AGE and its effect on the periodontal tissues is known, periodontitis as an endogenous source of AGE formation is not well explored. Hence, this systematic review is aimed to explore, for the first time, whether inflamed periodontal tissues and periodontal pathogens have the capacity to modulate AGE levels in individuals with or without T2DM and how this affects the glycemic load. Six electronic databases were searched using the following keywords: (Periodontitis OR Periodontal disease OR Periodontal Inflammation) AND (Diabetes mellitus OR Hyperglycemia OR Insulin resistance) AND Advanced glycation end products. The results yielded 1140 articles, of which 13 articles were included for the review. The results showed that the mean AGE levels in gingival crevicular fluid was higher in individuals with diabetes mellitus and periodontitis (521.9 pg/mL) compared to healthy individuals with periodontitis (234.84 pg/mL). The serum AGE levels in normoglycemic subjects having periodontitis was higher compared to those without periodontitis (15.91 ng/mL vs. 6.60 ng/mL). Tannerella forsythia, a common gram-negative anaerobe periodontal pathogen in the oral biofilm, was observed to produce methylglyoxal (precursor of AGE) in the gingival tissues. Increased AGE deposition and activate of AGE receptors was noted in the presence of periodontitis in both normoglycemic and hyperglycemic individuals. Hence, it can be concluded that periodontitis can modulate the local and systemic levels of AGE levels even in absence of hyperglycemia. This explains the bidirectional relationship between periodontitis and development of prediabetes, incident diabetes, poor glycemic control, and insulin resistance.

Prevalence of Bone Loss in Mandibular Future Abutment Teeth among Diabetic and Non-Diabetic Patients: A Retrospective Case-Control Study

Objective:

This study aimed to compare the prevalence of bone loss in lower permanent premolars and canines, which can serve as abutments for future prostheses, among diabetic and non-diabetic patients.

Materials and Methods:

In this retrospective case-control study, records of patients who visited the dental clinics of Imam Abdulrahman Bin Faisal University were used. Inclusion criteria were the presence of a complete periodontal chart, full mouth radiographs, and past medical history (presence of DM, hypertension, and/or coronary heart disease). The criteria for exclusion were the reporting of malignancy, pregnancy, breastfeeding, or taking of the medications that affect bone turnover, periodontal surgery within the past year, absence of radiographs with good quality, and antibiotic use within 3 months prior to the dental visit. Demographical data, including gender and age, past medical history (diabetic state), and periodontal diagnosis, were collected. The severity of periodontal disease, radiographic bone loss (RBL), and its pattern were also assessed.

Results:

Out of 400 records, 363 patient files were included. Of those, almost 36% were males and 64% were females. The patients’ age was ranging from 16 to 82 years. About 34% of the patients were diagnosed with generalized periodontitis while 22% had localized periodontitis. With regards to the severity of the cases, the prevalence was equally distributed between mild (37%) and moderate periodontitis (38%), while 25% were diagnosed with severe periodontitis. A total of 22% of the patients were diabetic, which showed an increase in the severity of bone loss by an average of 31% across the selected teeth (mandibular canines and premolars). The pattern of bone loss was higher in the mandibular incisors, followed by the canines and the premolars. Multiple regression models showed that non-diabetics were significantly less likely to have bone loss in all the selected teeth and the male patients had 2 times the likelihood of having bone loss. Although the mandibular canines have the highest root length in the mandible, they were the most affected by bone loss in diabetic patients with periodontitis.

Conclusion:

Results of this study suggested that mandibular premolars were the teeth least affected by bone loss in both, diabetic and non-diabetic groups. Therefore, they can be considered the most suitable teeth to be used as abutments for the future prosthesis.

Estimation of Serum Procalcitonin (ProCT/PCT) Levels in Periodontally Healthy Individuals and Chronic Periodontitis Patients with Type II Diabetes Mellitus – An Original Research

Aim:

The present study aimed to estimate the serum procalcitonin (PCT) levels in periodontally healthy individuals and chronic periodontitis patients with Type II diabetes mellitus (DM).

Materials and Methods:

Forty-five male subjects aged 25–60 years were enrolled in the study and grouped as Group I (healthy), Group II (chronic periodontitis), and Group III (chronic periodontitis with Type II DM). Clinical parameters (dental plaque scores, bleeding scores, probing pocket depth, and loss of attachment) and glycemic parameters (random blood sugar and glycated hemoglobin levels) were recorded. Serum procalcitonin levels were analyzed using Raybio^® Human Procalcitonin Enzyme-Linked Immunosorbent Assay kit using the sandwich technique. All the data obtained were tabulated and analyzed using SYSTAT 12 statistical software. Kruskal–Wallis test was applied to compare the mean scores between the three study groups, and Spearman's ρ correlation coefficient was used to find out the association.

Results:

Serum procalcitonin levels were markedly increased in periodontitis group when compared to the healthy group. The mean serum levels of procalcitonin in Group I, Group II, and Group III were 22.52 pg/ml, 64.23 pg/ml, and 185.86 pg/ml, respectively. The variation in the procalcitonin levels was statistically significant at P < 0.001.

Conclusion:

The expression of procalcitonin in serum was increased to eightfold in the periodontitis group with diabetes in comparison to the healthy group, which shows that periodontal disease can cause the release of procalcitonin.

Correlation of periodontal inflamed surface area with glycemic status in controlled and uncontrolled type 2 diabetes mellitus

BACKGROUND

The bidirectional link between periodontitis and diabetes mellitus (DM) has been established. Periodontitis causes systemic inflammatory burden through inflammatory mediators. The currently utilized tools [clinical attachment loss (CAL) and probing pocket depth (PPD)] are linear measurements, that do not exactly quantify the inflammatory burden of periodontitis. Periodontal inflamed surface area (PISA) quantifies the surface area of bleeding pocket epithelium and estimates the inflammatory burden. Studies relating to the periodontal status of diabetic patients with and without microvascular complications are scarce. This study assessed the proportion of periodontitis and correlation of PISA with glycemic status in controlled, uncontrolled type 2 DM (T2DM) with and without microvascular complications.

AIM

To assess the proportion of periodontitis and correlation of PISA with glycemic status in controlled, and uncontrolled T2DM with and without microvascular complications.

METHODS

This study comprised 180 T2DM patients. Based on glycated hemoglobin (HbA1c) levels, they were grouped into: (1) Controlled T2DMgroup: (HbA1c ≤ 7%); (2) Uncontrolled T2DM group: (HbA1c > 7%) without microvascular complications; and (3) Uncontrolled T2DM group: (HbA1c > 7%) with microvascular complications. Each group comprised 60 patients. All patients were assessed for periodontal parameters (Bleeding on Probing, PPD, CAL, Oral hygiene index simplified and PISA), and systemic parameters (HbA1c, fasting plasma glucose and post prandial plasma glucose).

RESULTS

The proportion of periodontitis among controlled T2DM group, uncontrolled T2DM group without microvascular complications, uncontrolled T2DM group with microvascular complications was 75%, 93.4% and 96.6% respectively. Extent and severity of periodontitis were high in the uncontrolled T2DM group. A significant positive correlation was found between PISA and HbA1c among all patients (r = 0.393, P < 0.001). The dose–response relationship between PISA and HbA1c was observed. An increase of PISA with 168 mm² was associated with a 1.0% increase of HbA1c.

CONCLUSION

High proportion and severity of periodontitis, and increased inflamed surface area in uncontrolled T2DM may have contributed to the poor glycemic control and microvascular complications.

Porphyromonas gingivalis induces entero-hepatic metabolic derangements with alteration of gut microbiota in a type 2 diabetes mouse model

Periodontal infection induces systemic inflammation; therefore, aggravating diabetes. Orally administered periodontal pathogens may directly alter the gut microbiota. We orally treated obese db/db diabetes mice using Porphyromonas gingivalis (Pg). We screened for Pg-specific peptides in the intestinal fecal specimens and examined whether Pg localization influenced the intestinal microbiota profile, in turn altering the levels of the gut metabolites. We evaluated whether the deterioration in fasting hyperglycemia was related to the changes in the intrahepatic glucose metabolism, using proteome and metabolome analyses. Oral Pg treatment aggravated both fasting and postprandial hyperglycemia (P < 0.05), with a significant (P < 0.01) increase in dental alveolar bone resorption. Pg-specific peptides were identified in fecal specimens following oral Pg treatment. The intestinal Pg profoundly altered the gut microbiome profiles at the phylum, family, and genus levels; Prevotella exhibited the largest increase in abundance. In addition, Pg-treatment significantly altered intestinal metabolite levels. Fasting hyperglycemia was associated with the increase in the levels of gluconeogenesis-related enzymes and metabolites without changes in the expression of proinflammatory cytokines and insulin resistance. Oral Pg administration induced gut microbiota changes, leading to entero-hepatic metabolic derangements, thus aggravating hyperglycemia in an obese type 2 diabetes mouse model.

Effect of Conventional Periodontal Treatment (Scaling and Root Planing) on Type-2 Diabetic Patient with Moderate Generalized Chronic Periodontitis: A Clinical Study

Background:

The aim is to assess the effect of periodontal therapy and scaling and root planing (SRP) on the metabolic control in Type 2 diabetes mellitus (DM) patients with chronic periodontitis based on the estimation of glycated hemoglobin (HbA1c).

Materials and Methods:

A prospective, comparative, clinical study was performed on 50 patients suffering from Type 2 DM with moderate, generalized chronic periodontitis. Type 2 moderately controlled diabetic patients with HbA1c values within the range of 6%–8% were selected. The parameters recorded were gingival index, plaque index, sulcus bleeding index, probing pocket depth, clinical attachment level, and HbA1c. The recordings were done at baseline and 6 months after SRP procedures.

Results:

Reductions in all the clinical parameters were observed and were found to be statistically significant (P < 0.05).

Conclusion:

SRP resulted in a statistically significant reduction in the clinical parameters and HbA1c. Hence, periodontal treatment should be included in the management of diabetic patients.

Clinical implications of age and sex in the prevalence of periodontitis in Korean adults with diabetes

The present study was performed to assess the risk factors for periodontitis in Korean adults with diabetes. Data from the Korean National Health and Nutrition Examination Survey of the Korean population, conducted between January 2012 and December 2014 were used in the investigation. The presence of periodontitis in participants with diabetes in association with demographic variables and the anthropometric characteristics of the participants was investigated. Multiple logistic regression analyses were used to assess the associations between periodontitis and age, sex, diabetic control and duration of diabetes, following adjustment for confounding factors. The odds ratio of periodontitis was higher in individuals ≥65 years old compared with individuals <65 years old (1.152). The odds ratio of periodontitis was significantly higher in males compared with females (1.774). The number of patients with moderate and severe periodontitis differed significantly between different age groups. The present study revealed that age, sex and oral health behavior are risk indicators for periodontitis in patients with diabetes. The present study suggests that that an increased age, being male and engaging in poor oral health behavior increases the risk of periodontitis in participants with diabetes.

Are selected IL-1 polymorphisms and selected subgingival microorganisms significantly associated to periodontitis in type 2 diabetes patients? a clinical study

Background

We evaluated the periodontal conditions in patients with type 2 diabetes mellitus compared to metabolically healthy controls, and determined whether periodontal interleukin genotypes and microorganisms differed between participants with and without type 2 diabetes mellitus.

Methods

From April 2011 to July 2012, we prospectively enrolled healthy controls and patients with type 2 diabetes mellitus. Evaluation included assessment of medical and periodontal findings. We also recorded the presence of several interleukin gene variants and specific microorganisms, both available through commercially available diagnostic kits. Statistical significance was tested by the chi-square test and student’s t-test.

Results

We enrolled 52 patients with type 2 diabetes mellitus and 52 healthy controls. Compared with controls, periodontal disease was significantly more severe in patients with type 2 diabetes mellitus for the following: plaque index, bleeding on probing, pocket probing depth, clinical attachment loss, severe periodontal destruction (i.e., clinical attachment loss ≥ 5 mm), and number of teeth. However, statistical analysis failed to detect significant differences with respect to the periodontal-related interleukin genotypes (p ≥ 0.58) or the selected oral microbiota (p ≥ 0.15).

Conclusion

Based on these results, it may be assumed that chronic periodontitis in patients with type 2 diabetes mellitus is most strongly associated with inadequate oral hygiene. Periodontal interleukin genotypes and differences in oral microbiota seem to play a subordinate role.

Impact of glycemic control on oral health status in type 2 diabetes individuals and its association with salivary and plasma levels of chromogranin A

OBJECTIVE

To evaluate the effect of glycemic control status in type 2 diabetes mellitus (T2DM) individuals on clinical oral health indicators and to compare the concentrations of plasma and salivary chromogranin A (CHGA) among nondiabetic subjects and T2DM patients, exploring their associations.

DESIGN

In this cross-sectional study, 32 patients with controlled T2DM, 31 with poorly controlled T2DM and 37 nondiabetic subjects underwent a clinical and periodontal examination. CHGA concentrations were determined in saliva and plasma with ELISA.

RESULTS

Poorly controlled T2DM group exhibited significantly higher mean buffering capacity, plaque index and bleeding on probing than other groups (P<0.05). No difference was found to DMFT (decayed, missed and filled teeth) index between groups. Sites with clinical attachment loss (CAL) of 4 and 5-6mm were significantly higher in both diabetic groups compared to control group (P<0.05). Poorly controlled T2DM group had significantly higher sites with CAL ≥ 7 mm than other groups (P=0.001). Significantly higher plasma and salivary CHGA levels were found in T2DM groups (P<0.05). In both diabetic groups, probing depths 5-6mm and CAL 5-6mm were associated with higher salivary CHGA concentration (P<0.05).

CONCLUSIONS

The findings revealed that T2DM patients were more prone to periodontal tissue damage than to caries risk. The results also provide some evidence that the degree of attachment loss deteriorates significantly with poor glycemic control in T2DM (CAL ≥ 7 mm). Moreover, the results suggest that high concentrations of salivary CHGA are associated with worse periodontal parameters and T2DM, and this could be related to the pathogenesis of both diseases.

A comparison of the periodontal status in patients with type 2 diabetes based on glycated haemoglobin levels and other risk factors

PURPOSE

The aim of this study was to compare the periodontal status in patients with type 2 diabetes based on glycated haemoglobin levels and other risk factors.

MATERIAL/METHODS

75 patients with DM2 were grouped according to glycemic control: 40 subjects with HbA1c<7.0% and 35 subjects with HbA1c≥7.0%. We performed measurements of HbA1c, C-reactive protein (CRP), Approximal Plaque Index (API), Gingival Severity Index (GSI), tooth mobility (TM) as well as periodontal parameters such as probing depth (PD) and clinical attachment level (CAL). Age, gender and duration of the disease were analyzed too.

RESULTS

No significant differences in PD, CAL, API, GSI and TM were found between the analyzed groups. HbA1c positively correlated with CRP (p=0.046) and the duration of DM2 (p=0.012) but not with the periodontal parameters. Patients' age was positively correlated with both the duration of DM2 (p=0.002) and CAL (p=0.034). Regardless of HbA1c, men had significantly worse periodontal parameters compared to women (respectively: PD 2.73mm vs. 2.18mm, p=0.01; CAL 3.84mm vs. 2.54mm, p=0.005; proportion of deep pockets 9.06% vs. 2.97%, p=0.01; proportion of teeth with grade 2 mobility 9.14% vs. 2.8%, p=0.02).

CONCLUSIONS

The selected group of patients attending the Diabetes Outpatient Clinic showed a similar periodontal status with regard to glycated haemoglobin levels and other risk factors except gender. Male gender turned out to be a significant risk factor for periodontal disease in patients with type 2 diabetes mellitus.

Histological investigation of the impact of streptozotocin-induced experimental diabetes on the healthy gingivae of rats

This study was aimed at the histological investigation of the impact of experimental diabetes on the healthy gingiva of rats. Thirty male Wistar rats were used in this study. The animals were randomly divided into two groups (n = 15) prior to the experiment. Group 1 experimental diabetes was created by streptozotocin injection in 15 rats. Group 2 comprised the control group (15 rats). On the 7th, 14th and 21st days after the induction of diabetes by streptozotocin, five animals from each group were euthanized by cardiac puncture. The gingiva of the maxillary left first molar tooth of the sacrificed animals was extracted for histological examination. Histological examination demonstrated that, when compared to the control group, the diabetes group displayed marked hyperkeratosis and parakeratosis of the gingival epithelium on day 21 post-induction. Furthermore, the diabetes group presented with an increased number of inflammatory cells and vasodilatation of the capillaries, in comparison to the controls. The overall evaluation of the findings obtained in this study suggested that diabetes alone could cause changes in the periodontium and affect periodontal health.

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.

Severity of periodontal disease in adult patients with diabetes mellitus in relation to the type of diabetes

BACKGROUND

The purpose of this study was to evaluate associations between diabetes mellitus - related factors and periodontal parameters among adult patients with diabetes mellitus, with respect to type of diabetes.

METHODS

Study participants were 179 randomly selected 18-62-year-aged patients with type 1 diabetes mellitus and 87 randomly selected 32-70-year-aged patients with type 2 diabetes. Metabolic control of diabetes was determined by the values of glycosylated haemoglobin (HbA1c). The periodontal status of all patients was evaluated by simplifying oral debris index (DI-S), probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL), and bleeding on probing (BOP). Data analysis was performed with respect to patients' age, diabetes duration, metabolic control level, and diabetes type. Binary regression was used to test relationship of various parameters with CAL.

RESULTS

All periodontal estimates were significantly higher among patients with type 2 diabetes. The periodontal disease was more severe in >45-year-aged participants and with DI-S>1. In patients with type 1 diabetes, the disease duration >12 years was negatively related to most periodontal parameters. No significant correlation between the periodontal estimates and HbA1c was observed in either group. The significant predictors of severe periodontal disease were type 2 diabetes mellitus (OR = 2.356), duration of disease (OR = 1.827), high BOP (OR = 3.343) and DI-S (OR = 2.958).

CONCLUSIONS

Severity of periodontal disease is related to diabetes type, being more pronounced in patients with type 2 diabetes patients than in patients with type 1 diabetes. Dental plaque seems to be the major contributing factor for all patients with progressive periodontitis.

Potential association between prediabetic conditions and gingival and/or periodontal inflammation

AIMS/INTRODUCTION

Prediabetic conditions, which include impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), might be associated with chronic gingival and/or periodontal inflammation. However, the occurrence of this oral inflammation in prediabetic conditions is poorly understood. The present study aimed to assess the association between prediabetes and gingival and/or periodontal inflammation.

MATERIALS AND METHODS

A total of 94 Puerto Rican men and women aged 40-65 years, who were residents of San Juan, Puerto Rico, and free of diabetes, were included in the study. All participants had at least one tooth site with clinical attachment loss ≥3 mm. Fasting and 2-h plasma glucose were collected. Gingival/periodontal inflammation was assessed by bleeding on gentle probing of the sulcus at six sites per tooth.

RESULTS

Participants with the percentage of teeth with bleeding on probing (BOP) equal to or greater than the median were compared with those with the percentage of teeth with BOP less than median. Participants with high BOP tended to present higher IFG (odds ratio [OR] 5.5, 95% confidence interval [CI] 1.2-25.3) and/or prediabetic condition (OR 3.6, 95% CI 1.0-13.2) than those with a low percentage of BOP, adjusting for age, sex, smoking, alcohol consumption, waist circumference and number of missing teeth. Using the continuous form of the outcome, the corresponding adjusted least squares means of percentage of BOP were 26.8 (standard error of the mean [SEM] 2.3) and 43.8 (SEM 6.0) in normal and IFG, respectively (P = 0.01), and 27.0 (SEM 2.4) and 39.0 (SEM 5.3) among healthy and prediabetic individuals, respectively (P = 0.05).

CONCLUSION

IFG and/or prediabetes are strongly associated with BOP, a marker of chronic gingival/periodontal inflammation.

The relationship between gastroesophageal reflux disease and chronic periodontitis

Background/Aims

The most common cause of chronic periodontitis is poor oral hygiene. Gastroesophageal reflux disease (GERD) enhances the proximal migration of gastric contents and may cause poor oral hygiene. We hypothesized that GERD may increase thse risk of chronic periodontitis and investigated this potential relationship.

Methods

A retrospective cross-sectional study was conducted in outpatients between January 1, 2010, and April 30, 2012. GERD was defined as being present based on at least two of the following criteria: etiologic agent(s), identifiable signs and symptoms, and consistent anatomic alterations. A total of 280 patients with chronic periodontitis and 280 controls were analyzed. Information regarding patient demographics and other potential confounding factors for chronic periodontitis were collected through individual medical records.

Results

GERD was revealed to be independently associated with an increased incidence of chronic periodontitis (odds ratio [OR], 2.883; 95% confidence interval [CI], 1.775 to 4.682). The other three variables of dental caries (OR, 1.531; 95% CI, 1.042 to 2.249), tobacco use (OR, 2.335; 95% CI, 1.461 to 3.730), and history of medication (calcium channel blocker, cyclosporine, or phenytoin) (OR, 2.114; 95% CI, 1.160 to 3.854) were also determined to be independent risk factors.

Conclusions

The present study supported our hypothesis that GERD can be a risk factor for chronic periodontitis.

Diabetes mellitus and periodontal diseases

A bidirectional relationship between diabetes mellitus (DM) and periodontal diseases (PDs) has been established. It is estimated that patients with poorly controlled DM are 3 times more likely to develop chronic PD compared with normoglycemic individuals despite similar composition in subgingival biofilms. Furthermore, these patients present with increased severity and rapid progression of attachment loss around teeth resulting in edentulism. Treatment of PD results in a modest but significant improvement in glycemic control in patients with DM reflected by a 0.4 % reduction in HbA1c-glycated hemoglobin levels. Compelling evidence from in vitro and animal studies supports a plausible biological explanation for the relationship between the 2 conditions centered on systemic low-grade inflammation. However, the limited number of comparable large randomized clinical trials is reflected in the limited specific guidelines offered by the international organizations for DM and PD regarding the management of the 2 diseases in an individual.

Patterns of Dental Diseases in Diabetic Females in Primary Health Centers in Qatar: Cross-sectional, observational study

Periodontal diseases comprise a large group of predominantly infectious and/or inflammatory disorders affecting periodontal tissues. They are diagnosed by assessment of the dento-gingival area, including the the gingival sulcus depth, and the presence of bleeding with radiographic assessment of the alveolar bone. The prevalence of periodontitis (PD) is reported to be 20-50% worldwide;(1) while the aggressive form of PD is found in less than 10% of the population/2,3). Periodontitis is a chronic infectious/inflammatory disease of multi-factorial etiology(4) with a number of risk factors that are shared with other chronic inflammatory conditions; increasing age, low socio-economic conditions, stress, increased body weight, dyslipidemia, hypertension, metabolic syndrome, cigarette smoking and Diabetes mellitus.(5-6) Systemic reviews have shown a clear association between PD and coronary heart diseases (CHD) emphasizing the need to consider PD as a risk factor for CHD.

A clinical study of the relationship between diabetes mellitus and periodontal disease

The relationship between diabetes mellitus and periodontal disease is not clear, even though studied intensively. From the available data, it seemed reasonable to believe that diabetics were more susceptible to periodontal disease than non.diabetics.

AIM

The present study was to clinically evaluate the relationship of diabetes mellitus with periodontal disease along with various parameters.

MATERIALS AND METHODS

Fifteen hundred patients with diabetes mellitus were examined. A thorough oral examination was carried out and relevant history was recorded for all the patients.

RESULTS

Results indicated that the prevalence of periodontal disease in diabetic patients was 86.8%.

CONCLUSION

It can be concluded that poorer the glycemic control, and longer the duration of diabetes, the greater will be the prevalence and severity of periodontal disease.

Evaluation of clinical and metabolic changes after non surgical periodontal treatment of type 2 diabetes mellitus patients: A clinico biochemical study

Aim:

To evaluate the clinical and metabolic changes following nonsurgical periodontal therapy of type-2 diabetic patients and nondiabetic patients.

Materials and Methods:

Fifteen nondiabetics and fifteen type-2 diabetics with moderate to severe periodontitis were selected after meeting inclusion and exclusion criteria. Periodontal pocket probing was performed using a Williams graduated periodontal probe and comparisons of the clinical and biochemical parameters like plaque index, gingival index, probing depth, glycated hemoglobin, and lipid profile (total cholesterol, high density lipoprotein, low density lipoprotein, triglycerides and very low density lipoprotein) were done between and within two groups at baseline and 3 month.

Results:

A correlation was observed between clinical and biochemical parameters between and within two groups at baseline and 3 month. The P value of diabetic group was<0.001 in all clinical parameters (plaque index PI, Gingival index GI, and Probing Pocket Depth PPD) in diabetic and nondiabetic group, showed statistically highly significant difference in GI, PI, PPD, <.01 in Glycated Hemoglobulin (HbAlc1) in test group and<0.05 in control group showed statistically significant difference. The P value of test group was >0.05 in Lipid profile (total cholesterol, low density lipoprotein, high density lipoprotein, serum triglyceride, very low density lipoprotein) that showed no significant difference and in control group<0.05 in total Cholesterol, high density lipoprotein and <0.01 in Low density lipoprotein, Very Low Density Lipoprotein, and Serum Triglyceride, respectively, showed statistically significant in Total cholesterol, Low density lipoprotein, Very Low Density Lipoprotein, and Serum Triglyceride, not significant in high density lipoprotein. The P value >0.05 showed no statistical significance of correlation between the test and control groups.

Conclusion:

Both groups of patients showed an improvement in clinical and metabolic parameters assessed at 3 months after nonsurgical periodontal therapy.

Cross-sectional study of periodontal care and Glycosylated Hemoglobin in an insured population

OBJECTIVE

Compare GHb among people with diabetes who have and have not received periodontal care.

RESEARCH DESIGN AND METHODS

This cross-sectional study linked 5 years of electronic medical record and dental insurance data for dually insured patients with diabetes, ages 40-70 years (n = 5,103). We assessed the association between annual mean GHb (%) and periodontal care (a proxy for periodontitis) defined using claim codes. Among patients who received periodontal care, we assessed the association between GHb and periodontal treatment intensity. We determined associations using linear regression adjusted for potential confounders and tested for effect modification by age, sex, insulin use, diabetes severity, BMI, and smoking.

RESULTS

Mean GHb was 7.66%; 38% of participants received periodontal care during the 5 years. After multivariate adjustment, patients who received periodontal care had a GHb level 0.08 percentage points higher than patients who did not (P = 0.02). In stratified analyses, the association was present for women (0.18 percentage points higher GHb with periodontal care, P < 0.001) but not significant for men (0.008 percentage points lower, P = 0.86). In patients who received periodontal care, those with one, and with two or more, surgical treatments had GHb 0.25 (P = 0.04) and 0.36 (P = 0.002) percentage points lower, respectively, than patients without periodontal surgeries.

CONCLUSIONS

This population-based cross-sectional study showed small associations between periodontal care (a proxy for periodontitis) and higher GHb. Well-controlled longitudinal studies or clinical trials are needed to evaluate causality and temporal trends. Sub-analyses suggest that further investigation of this association among women, and by intensity of periodontal treatment, may be of interest.

Comparative analysis of GCF beta-glucuronidase level in diabetic and nondiabetic patients with chronic periodontitis: A clinicobiochemical study

Recent evidences prove that, release of potent lysosomal enzymes e.g. β-Glucuronidase by degranulation of polymorponuclear leukocytes in host gingiva may contribute significantly to tissue destruction and the pathogenesis of periodontal disease. The purpose of the present study was to compare and correlate GCF β-Glucuronidase with periodontal status among diabetic and non-diabetic patients with chronic periodontitis. A total number of 75 patients were equally divided into Group I (control group), Group II (non diabetic with chronic periodontitis) and Group III (diabetic with chronic periodontitis). Clinical parameters like Plaque index, Gingival index, Probing Pocket Depth and RBS were recorded. The β-Glucuronidase level in GCF of all three groups was determined by spectrophotometric analysis. It was observed that the periodontitis patients irrespective of their diabetic status, showed increased periodontal destruction with elevated level of β-Glucuronidase than the controls. Also, the diabetic patients showed increased severity of periodontal destruction and the elevated level of β-Glucuronidase, thus indicating diabetics at a higher risk for progressive periodontal destruction.

Clinical and laboratory evaluations of non-surgical periodontal treatment in subjects with diabetes mellitus

BACKGROUND

The aim of this study was to evaluate the clinical and laboratory changes 3 months after full-mouth scaling and root planing in subjects with and without diabetes mellitus.

METHODS

This study was performed using 10 subjects with type 2 diabetes mellitus who required insulin therapy (DM) and 10 healthy adult control subjects (NDM) with generalized chronic periodontal disease. Both groups were treated with full-mouth scaling and root planing and given oral hygiene instructions. Clinical parameters, including plaque index (PI), gingival index (GI), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL), were measured at four sites per tooth. Subgingival plaque samples were obtained from sites with the deepest PD (> or =5 mm) and with furcations in each subject. Samples were also tested for the presence of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, and Tannerella forsythia (previously T. forsythensis) by polymerase chain reaction. Glycemic control (glycosylated hemoglobin [HbA1c] and fasting glucose levels) and clinical and microbiologic assessments were recorded at baseline and 3 months after periodontal treatment.

RESULTS

Data revealed statistical changes (P < or =0.05; analysis of variance [ANOVA]) in clinical variables (PI, GI, PD, GR, and CAL) between baseline and 3 months in both groups. Conversely, no improvement in the fasting glucose level or glycosylated hemoglobin (P < or =0.05; ANOVA) was found after treatment. Besides some reduction in the bacterial frequency 3 months after treatment, no statistically significant difference was found between the groups.

CONCLUSION

Clinical and laboratory responses were similar in DM and NDM groups 3 months after full-mouth scaling and root planing.

Periodontal disease in Hispanic Americans with type 2 diabetes

BACKGROUND

Diabetes is a major risk factor for the development of periodontal disease in certain populations. The prevalence of type 2 diabetes is increased in Hispanic Americans, but its impact on the extent and severity of periodontal disease in this population has not been determined.

METHODS

Sixty-three Hispanic Americans, aged 33 to 72 years, from South Texas were grouped based on the presence or absence of type 2 diabetes. Past medical histories, including smoking, were obtained. Periodontal status was evaluated by measuring probing depth (PD), clinical attachment level (CAL), plaque, bleeding on probing, visual gingival inflammation, and calculus.

RESULTS

Type 2 diabetes was associated frequently with major medical complications in this population. Diabetes was associated with significantly more calculus formation and tooth loss and an increased extent and severity of periodontitis. Subjects with diabetes had nearly three times the mean CAL and frequency of PD >6 mm than subjects without diabetes and nearly twice the frequency of moderate to advanced attachment loss (> or =3 mm). Smoking and diabetes had significant independent effects on mean CAL and the frequency of deep pockets. Diabetes and smoking combined were associated with a significantly higher frequency of sites with CAL > or =3 mm compared to healthy non-smokers, healthy smokers, and non-smokers with diabetes.

CONCLUSIONS

Hispanic Americans with type 2 diabetes had more supra- and subgingival calculus, an increased extent and severity of periodontal destruction, and an increased frequency of tooth loss due to periodontitis. An additive/synergistic contribution of type 2 diabetes and smoking for increasing the extent of periodontal disease was observed.

Diabetic complications and dysregulated innate immunity

Diabetes mellitus is a metabolic disorder that leads to the development of a number of complications. The etiology of each diabetic complication is undoubtedly multifactorial. We will focus on one potential component that may be common in many diabetic complications, dysregulation of innate immunity associated with an increased inflammatory response. High glucose levels lead to shunting through the polyol pathway, an increase in diacylglycerol which activates protein kinase C, an increase in the release of electrons that react with oxygen molecules to form superoxides, and the non-enzymatic glycosylation of proteins that result in greater formation of advanced glycation end products. Each of these can lead to aberrant cell signalling that affects innate immunity for example, by activating the MAP kinase pathway or inducing activation of transcription factors such as NF-kappaB. This may be a common feature of several complications including periodontal disease, atherosclerosis, nephropathy, impaired healing and retinopathy. These complications are frequently associated with increased expression of inflammatory cytokines such as TNF-alpha, IL-1beta and IL-6 and enhanced generation of reactive oxygen species. Cause and effect relationship between dysregulation of key components of innate immunity and diabetic complications in many instances have been demonstrated with the use of cytokine blockers and antioxidants.

Relationship between markers of metabolic control and inflammation on severity of periodontal disease in patients with diabetes mellitus

AIM

The aim of this study was to investigate the relationship between markers of metabolic control and inflammation and periodontal disease parameters in patients with diabetes.

MATERIAL & METHODS

One hundred and eighty one adult patients with diabetes attending treatment at two diabetes centres were invited to participate in the study. Periodontal examination included full-mouth assessment for probing depths and bleeding on probing (BOP). Blood analyses were carried out for glycated haemoglobin, (HbA1c), high-sensitivity C reactive protein, (hsCRP) and lipid profile comprising total cholesterol, low-density lipoprotein cholesterol (LDL chol), high-density lipoprotein cholesterol (HDL chol) and triglycerides.

RESULTS

Upon multivariate analysis, periodontal disease severity in terms of increased percentage of BOP and mean percentage of sites with probing depths > or = 5 mm were found to be associated with inadequate glycaemic control as measured by HbA1c (p<0.01). HsCRP was also found to be a significant predictor for mean percentage of sites with probing depths > or = 5 mm (p<0.05). After controlling for age, gender, smoking habits and number of teeth, positive correlations were found between HbA1c and percentage sites with probing depths > or = 5 mm, percentage sites BOP, total cholesterol, LDL chol and triglycerides (p<0.05). Using the adjusted differences, subjects with acceptable glycaemic control (HbA1c < 8%) showed a lower percentage of sites with BOP and probing depths > or = 5 mm (p<0.05) when compared with those having inadequate glycaemic control. There was also a trend towards lower blood cholesterol in the well-controlled group.

CONCLUSION

The level of glycaemic control as measured by HbA1c emerged as the most consistent risk factor associated with the extent and severity of periodontal disease in this study cohort.

Diabetes mellitus and periodontal diseases

BACKGROUND

The purpose of this review is to provide the reader with practical knowledge concerning the relationship between diabetes mellitus and periodontal diseases. Over 200 articles have been published in the English literature over the past 50 years examining the relationship between these two chronic diseases. Data interpretation is often confounded by varying definitions of diabetes and periodontitis and different clinical criteria applied to prevalence, extent, and severity of periodontal diseases, levels of glycemic control, and complications associated with diabetes.

METHODS

This article provides a broad overview of the predominant findings from research published in English over the past 20 years, with reference to certain "classic" articles published prior to that time.

RESULTS

This article describes current diagnostic and classification criteria for diabetes and answers the following questions: 1) Does diabetes affect the risk of periodontitis, and does the level of metabolic control of diabetes have an impact on this relationship? 2) Do periodontal diseases affect the pathophysiology of diabetes mellitus or the metabolic control of diabetes? 3) What are the mechanisms by which these two diseases interrelate? and 4) How do people with diabetes and periodontal disease respond to periodontal treatment?

CONCLUSIONS

Diabetes increases the risk of periodontal diseases, and biologically plausible mechanisms have been demonstrated in abundance. Less clear is the impact of periodontal diseases on glycemic control of diabetes and the mechanisms through which this occurs. Inflammatory periodontal diseases may increase insulin resistance in a way similar to obesity, thereby aggravating glycemic control. Further research is needed to clarify this aspect of the relationship between periodontal diseases and diabetes.

Salivary Histamine Level as a Predictor of Periodontal Disease in Type 2 Diabetic and Non-Diabetic Subjects

BACKGROUND

Some previous investigations underscored the role of histamine in periodontal disease, especially in diabetic patients, but the behavior of this inflammatory mediator in the early phases of periodontal involvement remains unclear. The aim of the present study was to correlate the presence of histamine in saliva with clinical parameters in healthy, periodontitis-affected, and diabetic subjects to ascertain whether this amine may serve as a predictive index of periodontal risk.

METHODS

For this purpose, subjects were selected as follows: 1) with newly diagnosed type 2 diabetes mellitus; 2) with neither diabetes nor periodontitis; 3) with no diabetes but with chronic, untreated periodontal disease. Histamine salivary levels were measured at the initial time (T0) and after 6, 12, and 24 months using high-performance liquid chromatography. The main periodontal indexes were recorded at the same time intervals.

RESULTS

At T0, a very typical shape of the histamine chromatogram was found for all patients of the three groups; at this time, the salivary histamine levels of diabetic patients were increased and comparable to those of healthy patients with periodontal disease, whereas healthy subjects with no periodontitis showed reduced histamine levels. Further controls at 6, 12, and 24 months showed a statistically significant correlation between the increase of salivary histamine and the worsening of the periodontal indexes in diabetic and non-diabetic subjects.

CONCLUSION

These results suggest that salivary histamine may serve as a predictive index in the prevention of periodontal disease.

Diabetes as a Risk Factor for Periodontal Disease: Current Status and Future Considerations

Introduction: Over the past decade, there has been an emerging interest in the interrelationship between systemic conditions and oral health. Diabetes is perhaps one of the best documented conditions that have been closely linked with periodontal disease. This paper reviews the role of diabetes as a risk factor in periodontal disease. The treatment implications in the management of periodontal disease as an integral component of diabetes care is also discussed in light of the current understanding of the pathogenesis of these 2 chronic conditions. Materials and Methods: Epidemiological, clinical and laboratory studies examining the relationship between diabetes and periodontal diseases were selected from both medical and dental journals. Results: The severity of periodontal destruction has been shown to be related to the direct and indirect effects of glycaemic control, with other factors also being implicated. Although some studies have pointed towards a bi-directional relationship between glycaemic control and periodontal health, it is still not clear if improvement in periodontal health could lead to improved metabolic control. Conclusion: Diabetes and periodontal disease are closely related in many ways, though the effect of periodontal disease on diabetes control remain to be determined, with larger intervention studies. In light of the increasing evidence of the relationship between diabetes and periodontal disease, management of oral health should form an integral part of diabetes management. Key words: Diabetes mellitus, Infection, Periodontitis

Type 2 diabetes and risk for periodontal disease: a role for dental health awareness

BACKGROUND

Several studies have found correlations between diabetes and an increased prevalence of periodontitis.

OBJECTIVE

To analyse, in a group of subjects with type 2 diabetes (T2D), (i) the association between medical characteristics and severe periodontal disease and (ii) dental care habits and knowledge of oral health.

METHODS

One hundred and ninety-one subjects with T2D were examined. Based on assessment of marginal bone height in panoramic radiographs, two periodontal subgroups were identified: one periodontally diseased (PD+) and one periodontally healthy (PD-) group. All subjects completed a questionnaire about their medical and oral health.

RESULTS

Twenty per cent of the subjects were classified as PD+. This was verified by clinical parameters. PD+ individuals had higher haemoglobin A1c (HbA1c) levels (p=0.033) and higher prevalences of cardiovascular complications (p=0.012). They were also less likely to be of Scandinavian origin (p=0.028) and more likely to smoke (p<0.001) than the PD- group. The PD+ group rated their oral health as poor (p<0.0001) and believed that T2D had an influence on their oral status (p<0.0001).

CONCLUSION

The best predictor for severe periodontal disease in subjects with T2D is smoking followed by HbA1c levels. T2D subjects should be informed about the increased risk for periodontal disease when suffering from T2D.

Type 2 diabetes and periodontal indicators: epidemiology in France 2002-2003

BACKGROUND AND OBJECTIVE

Diabetes and periodontal disease have been associated in the literature. In the present study, the periodontal heath of noninsulin-dependent diabetic adults was compared with that of a general population of nondiabetic patients.

MATERIAL AND METHODS

In France, 2144 adults (age: 35-65 years) were examined for life habits (tobacco, alcohol), biological diagnosis (type II diabetes, arterial hypertension), biometry (weight, size) and biochemistry. Dental and periodontal data included plaque index, gingival index, probing depth, and clinical attachment loss.

RESULTS

Descriptive and multifactorial analysis evidenced a more severe periodontal disease in diabetic patients. Moreover, when the plaque index was held constant, the gingival index was more elevated in diabetics. In nondiabetics, age, gender, glycemia, alcohol, and tobacco smoking were identified as significant risk factors for periodontal disease. In contrast, in diabetic subjects, only tobacco smoking was a significant risk factor.

CONCLUSION

In type II diabetics, the diabetes factor is probably more significant than periodontal risk factors, age, and gender.

Periodontal status of diabetics compared with nondiabetics: a meta-analysis

BACKGROUND

This meta-analysis was conducted to assess the association between diabetes mellitus and periodontal diseases by comparing the extent and severity of periodontal diseases between diabetics and nondiabetics.

METHODS

A literature search was performed using MEDLINE database for published studies from January 1970 through October 2003 with manual search for references in relevant studies. This meta-analysis was based on 18 comparative cross-sectional studies, three prospective cohort studies and baseline data of two clinical trials that compared oral hygiene, gingival and periodontal status between diabetics and nondiabetics. Heterogeneity was obvious among included studies; therefore, the analysis using random-effects model was conducted.

RESULTS

This study demonstrated that diabetics had significantly worse oral hygiene as measured by the average of plaque index (P1I), higher severity of gingival disease as measured by the average of gingival index (GI) and higher severity of periodontal disease as measured by the average of probing pocket depth (PPD) and clinical attachment loss (CAL). However, diabetics had similar extent of oral hygiene, gingival and periodontal disease as measured by percentages of surfaces or sites with specific scores of P1I, GI, bleeding on probing (BOP), PPD and CAL.

CONCLUSIONS

Diabetics had a significantly higher severity but the same extent of periodontal disease than nondiabetics.

A socio-economic perspective on periodontal diseases: a systematic review

OBJECTIVE

The aim of this systematic review was to ascertain whether socio-economic conditions increase the risk of periodontal diseases.

METHODS

A MEDLINE search was conducted for the period 1965-April 2004. Only original articles were included; 47 studies remained for the final assessment. The studies were analysed regarding the outcome of the association between socio-economic variables and periodontal disease, depending on the study design (cross-sectional survey or longitudinal case-control) and whether smoking was included or not.

RESULTS

Twenty-nine out of 36 studies with a cross-sectional design were in favour of the association between socio-economic factors and periodontal diseases. In the studies with a longitudinal or case-control design, there were five in favour of the association, and also six against. When smoking was included in the analysis of cross-sectional studies, a significant association between socio-economic variables and periodontal disease was found in 11 studies and no significance in another five studies. The corresponding figures for case-control studies showed four studies being significant, but also four studies showing no significance.

CONCLUSION

Based on relevant study designs and including smoking in the analysis, the socio-economic variables associated with periodontal diseases appear to be of less importance than smoking.

Potential impact of subject-based risk factor control on periodontitis

AIMS

To assess the potential impact of the control of subject-based modifiable risk factors on periodontitis.

BACKGROUND

Cross-sectional and longitudinal data from epidemiological research indicate that risk factors can be identified and, if modified, may improve both periodontal conditions and the outcome of treatment.

MATERIAL AND METHODS

A search was conducted to identify factors involved in the etiology and pathogenesis of periodontal diseases. The factors identified were separated into modifiable and non-modifiable, and control of the subject-based modifiable risk factors were further analyzed.

RESULTS

The analysis was limited to the influence of the control of the remaining modifiable subject-based risk factors. It was observed that most of the subject related risk factors were hitherto not validated in controlled intervention studies. Therefore, the evidence for the efficacy of risk factor control had to be based on results from cohort studies. While the control of most of the modifiable risk factors for periodontitis was not tested, some evidence suggested that smoking cessation may retard the progression of periodontitis.

CONCLUSIONS

Although only limited evidence was available, it appeared reasonable to suggest that second to the removal of the bacterial biofilm, smoking cessation was the most important measure in the management of periodontitis.

Analytical epidemiology of periodontitis

AIMS

To review the literature related to the analytical epidemiology of periodontitis generated over the past decade. This review does not deal with descriptive epidemiologic studies of the prevalence, extent and severity of periodontitis with respect to global geography, but focuses exclusively on analytical epidemiology issues, including the challenges posed by the use of different case definitions across studies, current theories and models of disease progression, and risk factors associated with the onset and progression of periodontitis.

METHODS

Relevant publications in the English language were identified after Medline and PubMed database searches.

FINDINGS AND CONCLUSIONS

There is a conspicuous lack of uniformity in the definition of periodontitis used in epidemiologic studies, and findings from different research groups are not readily interpretable. There is a lack of studies that specifically address the distinction between factors responsible for the onset of periodontitis versus those affecting its progression. Colonization by specific bacteria at high levels, smoking, and poorly controlled diabetes have been established as risk factors for periodontitis, while a number of putative factors, including specific gene polymorphisms, have been identified in association studies. There is a clear need for longitudinal prospective studies that address hypotheses emerging from the cross-sectional data and include established risk factors as covariates along with new exposures of interest. Intervention studies, fulfilling the "targeting" step of the risk assessment process, are particularly warranted. Obvious candidates in this context are studies of the efficacy of elimination of specific bacterial species and of smoking cessation interventions as an alternative to the traditional broad anti-plaque approach in the prevention and control of periodontitis. Ideally, such studies should have a randomized-controlled trial design.

The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus

OBJECTIVES

The aim of the present study was to investigate the effect of improved periodontal health on metabolic control in type 2 diabetes mellitus (DM) patients.

MATERIAL AND METHODS

Fourty-four patients with type 2 DM were selected. Subjects were randomly assigned into two groups.

DATA COLLECTION

Plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment levels (CALs), gingival recession (GR) and bleeding on probing (BOP) were recorded at baseline at 1st and 3rd months. Fasting plasma glucose (FPG), 2-h post-prandial glucose (PPG), glycated haemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), HDL-cholesterol, LDL-cholesterol and microalbuminure were analysed at baseline, 3 months following the periodontal therapy. The treatment group received full-mouth scaling and root planing whereas the control group received no periodontal treatment.

RESULTS

A statistically significant effect could be demonstrated for PI, GI, PPD, CAL and BOP for the treatment group. HbA1c levels in the treatment group decreased significantly whereas the control group showed a slight but insignificant increase for this parameter.

CONCLUSIONS

The results of our study showed that non-surgical periodontal treatment is associated with improved glycaemic control in type 2 patients and could be undertaken along with the standard measures for the diabetic patient care.

Characterisation of advanced glycation endproducts in saliva from patients with diabetes mellitus

Patients with diabetes mellitus are prone to develop increased advanced glycation endproducts causing local complications and increased overall morbidity and mortality. Nuclear magnetic resonance spectra were determined in saliva of 52 consecutive patients with diabetes mellitus and 47 age-matched healthy control subjects. Resonance spectra showed specific peaks at 2.3, 7.3, and 8.4 ppm in saliva from patients with diabetes mellitus. These peaks could be generated by incubation of saliva from healthy control subjects with hypochloric acid in vitro, indicating the presence of advanced glycation endproducts. The presence of advanced glycation endproducts in patients with diabetes mellitus was associated with approximal plaque index, indicating increased periodontal damage. The study indicates that increased advanced glycation endproducts are involved in the pathogenesis of diabetic complications.

Relation of different measures of psychological characteristics to oral health habits, diabetes adherence and related clinical variables among diabetic patients

Among diabetic patients, oral health status and oral health behavior have been found to relate to metabolic control. The aim was to analyse which psychological characteristics, i.e. intention, self-efficacy, locus of control or self-esteem related to health behavior most comprehensively explain oral health habits, diabetes adherence, dental caries, deepened periodontal pockets, and the metabolic parameter HbA1c (glycosylated hemoglobin). The study subjects consisted of a group of 149 insulin-dependent diabetic patients. Data were obtained from self-completed questionnaires. The proportions of variance explained by the linear regression model were used as measures in the comparisons. It was found that oral health habits and diabetes adherence correlated. Both dental and diabetes self-efficacy scores were related to oral health habits and diabetes adherence. This indicates that self-efficacy is the best overall determinant of various health behavior practices. The ability of psychological characteristics to explain oral health was limited. Improvement of self-efficacy therefore may have a positive effect on various aspects of health behaviors.