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Periodontitis Linked to Diabetes Mellitus

Dental practices should focus on patients with severe periodontitis for screening of prediabetes

Diabetes has been an ongoing global health issue that has been associated with various other health conditions. Multiple studies have demonstrated the connection between diabetes and one such oral condition, periodontitis. Periodontitis is a severe gum infection that damages the soft tissue and destroys the supporting structures of the teeth. Its prevalence is 2X higher in those over 50 years old and 2-3X higher in patients with diabetes than in a normal healthy person. It is mainly associated with uncontrolled diabetes making them susceptible to infections and impaired wound healing.

Diabetes is a preventable disease, thus early diagnosis of prediabetes is essential for the prevention of diabetes and related complications. Studies suggest that periodontitis is an early complication of diabetes and it may be used as a tool to screen patients for diabetes early on. Although most dental practices lack equipment for blood biochemistry, measurements of glycated hemoglobin (HbA1c) may assist to screen for diabetes in patients with diabetes. The study aims to analyze HbA1c levels and affirm the presence of prediabetes in participants with or without periodontitis from a university dental clinic using analysis of dry blood spots. In a study, a consecutive series of patients from the Department of Periodontology of the Academic Centre of Dentistry Amsterdam (ACTA) who were diagnosed with periodontitis were to be enrolled for the treatment. A total of 313 participants were included, among which 126 patients had mild/moderate periodontitis, 78 patients had severe periodontitis and 109 subjects did not have periodontitis. HbA1c values were obtained by the analysis of dry blood spots. Moreover, differences in mean HbA1c values and the prevalence of prediabetes between the groups were analyzed. Patients were classified as suffering from periodontitis using the Centers for Disease Control and Prevention American Academy of Periodontology (CDC-AAP) case definition.

A pilot study determined the sample size, including 49 healthy subjects and 33 patients with periodontitis. Clinical relevance was demonstrated with a mean difference in the HbA1c of 0.7% (7 mmol/mol) between patients with periodontitis and control subjects. Sample size was calculated based on a two-sided student’s t-test of 5% with 80% power and the mean of HbA1c of both controlled and periodontitis groups (5.5% [37 mmol/mol] and 6.2% [44 mmol/mol]) respectively, and an overall study population-based SD of 1.3% (15 mmol/mol). A minimum of 61 subjects per group was required. According to the American Diabetes Association (ADA) guidelines, HbA1c values were classified as normal (<5.7%), prediabetes (5.7– 6.4%), or diabetes mellitus (≥ 6.5%). The parametric and nonparametric tests compared the general and diabetes-related characteristics of the study population, HbA1c levels, and prediabetes prevalence within the study population and were corrected for multiple testing (Bonferroni).

A significantly higher HbA1c value of 6.1% ±1.4% (43 mmol/mol±15 mmol/mol) in mild or moderate periodontitis groups resulted and 6.3% ±1.3% (45 mmol/mol±15 mmol/mol) in severe periodontitis groups compared to the control group of 5.7%±0.7% (39 mmol/mol±8 mmol/mol, p=0.003). Also, a noteworthy overrepresentation of suspected diabetes (23% and 14%) and prediabetes (47% and 46%) in the severe periodontitis group and mild/moderate periodontitis group respectively were shown, in comparison to the control group (10% and 37%, p=0.010). Overall, 18.1% of patients with suspected new diabetes were found among subjects with severe periodontitis compared with 9.9% and 8.5% among subjects with mild/moderate periodontitis and controls respectively (p=0.024).

In conclusion, the dental practices should focus on patients with severe periodontitis for screening for prediabetes because that would considerably decrease the number of suspected new diabetes cases. Since early detection is the key to prevention of diabetes, it adds on to prevent other severe complications along with the treatment of periodontitis. Normally, patients with periodontitis showed higher hbA1c levels compared with individuals without periodontitis. Among the study subjects with severe periodontitis with unknown metabolic status, there were 18% suspected new diabetes cases. Periodontitis as an early sign of diabetes mellitus serves as a valuable risk indicator and thus, dental offices that treat patients with periodontitis are suitable location for screening for diabetes by a simple finger stick and validated HbA1c dry spot analysis.

Practice Pearls:

  • Early diagnosis of prediabetes mellitus is essential for the prevention of diabetes complications.
  • Periodontitis may be a first sign of type 2 diabetes.
  • On average, patients with periodontitis showed higher glycated hemoglobin (HbA1c) plasma levels compared with individuals without periodontitis.
  • Among the subjects with severe periodontitis whose metabolic status was unknown, 18% of suspected new diabetes cases were identified.

References:

  1. Davenport L. Dentists Note Severe Periodontitis ‘May Point to Early Diabetes. Medscape Log In. Medscape Medical News, 2 Mar. 2017. Web. 9 Mar. 2017.
  2.  Lam DW, LeRoith D. The worldwide diabetes epidemic. Curr Opin Endocrinol Diabetes Obes.  2012;19:93–6.
  3.  Mayo Clinic Staff. Periodontitis. Mayo Clinic. MFMER, 4 Feb. 2014. Web. 9 Mar. 2017.
  4.  Teeuw WJ, Kosho MX, Poland DC, Gerdes VEA, and Loos BG. Periodontitis as a possible early sign of diabetes mellitus. BMJ Open Diabetes Research and Care.  2017;5:e000326.