Abstract
Objectives: To study the prevalence, association and correlation of periodontal disease in patients with type 2 diabetes mellitus (T2DM).
Methods: One hundred consecutive patients with T2DM and an equal number of age- and sex-matched non-diabetic controls were studied. Diabetes was diagnosed as per American Diabetic Association criteria. All subjects were evaluated for presence and severity of periodontal disease activity clinically and radiologically.
Results: Prevalence of periodontitis in cases and controls was not significantly different as per clinical attachment loss (CAL) (97% versus 90%, p=0.085) and radiological assessment (97% versus 89%, p=0.052) but prevalence of severe periodontitis was higher among cases (p=0.001). Gingival index and periodontal pocket depth were significantly higher among cases (p=0.001each). Diabetes had a significant association with severity of CAL (p=0.001) and radiological damage (p=0.001) but not with CAL (p=0.085) and radiological damage (p=0.052). Severity of periodontitis had a significant association with glycosylated haemoglobin (HbA1c) level (p=0.001), fasting blood sugar (FBS) (p=0.001) and post-prandial blood sugar (PPBS) (p=0.011) while radiological severity of periodontitis had a significant association with HbA1c (p=0.001) and FBS (p=0.01). CAL showed a significant correlation with HbA1c (r=0.708, p=0.0001), FBS (r=0.476, p=0.001), PPBS (r=0.425, p=0.001) and random blood sugar (r=0.476, p=0.001) but not with age (r=0.061, p=0.393), and duration of diabetes (r= -0.024, p=0.811). Both CAL and radiological severity were independently associated with HbA1c (p=0.000 each),
Conclusions: Periodontitis is an important complication in T2DM. Severity of periodontitis is associated with diabetes and the related parameters, while HbA1c is independently associated with periodontitis.
Significant findings of the study
• Diabetes increases the severity of periodontitis, assessed by the clinical as well as radiological examination.
• Severity of periodontitis has significant correlation with the blood sugar and glycosylated haemoglobin levels.
What this study adds?
• Glycosylated haemoglobin is independently associated with the severity of periodontitis ascertained by clinical attachment loss and radiological examination.
Keywords: Clinical attachment loss; Diabetic complication; India; Periodontitis; Radiological evaluation; Type 2 diabetes mellitus.
References
1. Kumar A, Pandey MK, Singh A, et al. Prevalence and severity of periodontal diseases in type 2 diabetes mellitus of Bareilly region (India). Int J Med Sci Public Health. 2013; 2: 77-83.
2. Anil S, Remani P, Vijayakumar FT, et al. Total Hemolytic Complement (CH50) and Its Fractions (C3 and C4) in the Sera of Diabetic Patients With Periodontitis. J Periodontol 1990;61:27-29.
3. Cerda J, Torre CV, Malacara JM, et al. Periodontal disease in non-insulin dependent diabetes mellitus (NIDDM). The effect of age and time since diagnosis. J Periodontol. 1994; 65: 991-5.
4. Yan SF, Ramaswamy R, Schimdt AM, et al. Receptors for AGE (RAGE) and its ligands–cast into leading roles in diabetic and the inflammatory response. J Mol Med (Berl). 2009; 87: 235-47.
5. Yan SF, Ramaswamy R, Schimdt AM, et al. Mechanisms of disease: advanced glycation end-product and their receptor in inflammation and diabetes complications. Nat Clin Pract Endocrinol & Metab. 2008; 4: 285-93.
6. Longo DL, Fauci AS, Kasper DL, et al. Editors. Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012; 2: 2970-71.
7. Armitage GC. Periodontal diagnosis and classification of periodontal diseases. Periodontol 2000. 2004; 34:9-21.
8. Sewón L, Parvinen T. The prevalence of periodontal bone loss in Finnish adults measured using simplified radiographic criteria. Proc Finn Dent Soc. 1988; 84:79-83.
9. Nelson RG, Shlossman M, Budding LM, et al. Periodontal disease and NIDDM in Pima Indians. Diabetes care. 1990; 13:836-40.
10. Ficara AI, Levin MP, Grover ME, et al. A comparison of the glucose and protein content of gingival fluid from diabetics and non-diabetics. Periodontal Res. 1975; 10:71-4.
11. Shlossman M, Knowler WC, Pettitt DJ, et al. Type 2 diabetes mellitus and periodontal disease. J Am Dent Assoc. 1990; 121:532-6.
12. Emrich LJ, Shlossman M, Genco RJ, et al. Periodontal disease in non-insulin-dependent diabetes mellitus. J Periodontol. 1991; 52:123-31.
13. Taylor GW, Burt BA, Becker MP, et al. Non-insulin dependent diabetes mellitus and alveolar bone loss progression over 2 years. J Periodontal. 1998; 69: 76-83.
14. Schurch E, Minder CE, Lang NP, et al. Periodontal conditions in a randomly selected population in Switzerland. Comm Dent Oral Epidem. 1988; 16: 181-6.
15. Beck J, Garcia RI, Heiss G, et al. Periodontal disease and cardiovascular disease. J Periodontol. 1996; 16: 170- 8.
16. Papapanou PN, Wennström JL. Periodontal status in relation to age and tooth type. Clin Periodontol. 1988; 1: 23- 6.
17. Zambon JJ, Reynolds H, Fisher JH, et al. Microbiological and immunological studies of adult periodontitis in patients with noninsulin-dependent diabetes mellitus. J Periodontol. 1988; 59; 23- 31.
18. Genco RJ. Current view of risk factors for periodontal disease. J Periodontal. 1996; 67:1041-9.
19. Genco RJ, Grossi SG, Ho A, et al. A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol. 2005; 76:2075–84.
20. Bridges RB, Anderson JW, Saxe SR, et al. Periodontal status of diabetic and non-diabetic men: Effects of smoking, glycemic control, and socioeconomic factors. J Periodontol. 1996; 67; l185-92.
21. Saremi A, Nelson RG, Tulloch-Reid M, et al. Periodontal Disease and Mortality in Type 2 Diabetes. Diabetes Care. 2005; 28:27-32.
22. Zhang JQ, Pan YP, Ma L, et al. A survey on the periodontal status in type 2 diabetic patients. Chinese journal of Stomatology. 2009; 44:668-71.
23. Novak MJ, Potter RM, Blodgett J, et al. Periodontal disease in Hispanic Americans with type 2 diabetes. J Periodontol. 2008; 79:629-36.
24. Tsai C, Hayes C, Taylor GW. Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population. Community Dent Oral Epidemiol. 2002;30:182–92.
25. Demmer RT, Jacobs DR, Desvarieux M. Periodontal disease and incident type 2 diabetes mellitus: Results from the first national health and nutrition examination survey and its epidemiologic follow-up study. Diabetes Care. 2008; 31: 1373-9.
26. Jansson H, Lindholm E, Lindh C, et al. Type 2 diabetes and risk for periodontal disease: A role for dental health awareness. J Clin Periodontol. 2006; 33: 408–14.
27. Bandyopadhyay D, Marlow NM, Fernandes JK, et al. Periodontal disease progression and glycaemic control among Gullah African Americans with type-2 diabetes. J Clin Periodontol. 2010; 37:501–9.
28. Tchobroutsky G. Relation of diabetic control to development of microvascular complications. Diabetologia. 1978; 15: 143- 52.
29. Sznajder N, Carraro JJ, Rugna S, et al. Periodontal findings in diabetic and non-diabetic patients. J Periodontol. 1978; 49:445-8.
30. Apoorva SM, Sridhar N, Suchetha A. Prevalence and severity of periodontal disease in type 2 diabetes mellitus (non–insulin-dependent diabetes mellitus) patients in Bangalore city: An epidemiological study. J Indian Soc Periodontol. 2013; 17: 25–9.
DOI: http://dx.doi.org/10.18535/jmscr/v4i4.31
