Gum disease in diabetic children may start as early as age six, according to a case-control study.
When dental researchers matched 182 diabetic children and adolescents, ages six to 18, against 160 nondiabetic controls, they found that periodontal disease in diabetic children starts much earlier than previously thought and worsens in adolescence.
Evanthia Lalla, D.D.S., and colleagues at Columbia’s School of Dental and Oral Surgery reported that, the number of teeth with evidence of attachment loss (the hallmark of periodontal disease) was five times greater in the diabetic children (5.79 ± 5.34 compared with 1.53 ± 3.05 in the controls, unadjusted P < 0.001).
Dental caries were similar in both groups, although diabetic children had significantly more plaque than the controls (plaque index: 1.2 vs. 1.1, unadjusted P < 0.001). Similarly, the percentage of sites that had visible plaque was significantly higher in diabetic children (28.1% versus 18.2%, respectively).
Gingival inflammation was also worse for the diabetics (gingival index 1.2 vs. 1.0; bleeding sites 23.6% versus 10.2%, unadjusted P < 0.001), Dr. Lalla and colleagues wrote.
In this study, the duration of diabetes and especially mean HbAIC levels were not significantly associated with the number of teeth affected, a finding the researchers called "intriguing." Earlier studies had suggested that poor metabolic control increased the risk for more severe periodontitis.
By contrast, obesity showed a modest but significant correlation with the number of teeth affected. Body mass index correlated significantly with destruction of connective-tissue attachment and bone, although the duration of diabetes and mean HbA1C did not.
The obesity connection, they said, though preliminary, reflects the current understanding that obesity is associated with development of a systemic inflammatory state as well as recent reports linking BMI to periodontitis in adults.
When controlling for age, sex, ethnicity, gingival bleeding, and frequency of dental visits, diabetes persisted as "highly significantly related" to periodontitis in the younger children, but especially in the 12- to 18-year-olds. The relationship held even though the nondiabetic controls came from an underserved, mostly Hispanic population in which the oral disease burden is high compared with national standards, the Columbia team said.
Periodontal diseases are largely preventable, the researchers wrote. Therefore screening for periodontal changes along with prevention and treatment programs should be considered as a standard of care for young patients with diabetes.
Lalla, Evanthia, DDS, et al, "Periodontal Changes in Children and Adolescents With Diabetes," Diabetes Care, Feb. 2006: 29, No. 22; 295-299
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