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Once Again, Periodontitis Tied to Diabetes Complications

Adults with type 2 diabetes and microvascular complications have an increased risk for severe periodontitis compared with those without microvascular complications.

Poor glycemic control is also associated with severity and prevalence of periodontitis in adults with type 2 diabetes, according to the researchers. The larger question is what comes first? Does diabetes cause periodontitis or does periodontitis increase our risk of diabetes?  Over the years, Diabetes In Control has published at least 12-15 articles on the subject. (Do a search at Diabetesincontrol.com)

Shuji Inoue, MD, PhD, in Japan, and colleagues evaluated 620 adults with type 2 diabetes who presented to diabetes clinics at 21 institutions to determine associations between periodontitis, microvascular complications and glycemic control.

Overall, 34.5% of participants had retinopathy, 25.8% had nephropathy and 29.8% had neuropathy. Half of all participants had at least microvascular complication. Glycemic control was poor in 47.2% of participants, fair in 24.5%, good in 21.8% and excellent in 6.5%.

Compared with participants without microvascular complications, participants with all three microvascular complications had a higher prevalence of periodontitis (P < .01), but no significant difference was found for the prevalence of periodontitis between participants without microvascular complications and those with one or two.

Severe periodontitis was more prevalent in participants with three microvascular complications (49.4%) compared with those with one (37.8%) or two (36.9%). Participants with two  or three microvascular complications had greater periodontitis severity compared with participants without complications.

Participants with poor glycemic control had a greater prevalence of periodontitis (71%) compared with participants with excellent glycemic control (50%; P < .01). Severe periodontitis was more prevalent in participants with poor glycemic control (40.6%) compared with those with fair glycemic control (28.3%), good glycemic control (28.1%) and excellent glycemic control (28%). Participants with good (P < .05), fair (P < .01) and poor glycemic control (P < .01) had greater periodontitis severity compared with participants with excellent glycemic control.

Research suggests that control of periodontal disease can play a key role in the control of diabetes. Thus, dentists must be aware of the signs and symptoms of diabetes, and understand the importance of maintaining periodontal health for anyone with diabetes.

Numerous studies have found a positive relationship between poor glycemic control in persons with type 2 and increased periodontitis. One five-year longitudinal study found increased attachment loss in adolescents with diabetes, whereas non-diabetic subjects had stable attachment levels.

A cross-sectional study of over 1,400 subjects found people with diabetes to have 2.3 times increased risk for attachment loss. In 48 studies on children and adolescents with type 1 diabetes, all but one found an increased prevalence of periodontal disease compared to children without diabetes. Of the eight reports limited to people with type 2, all found significantly poorer periodontal health in people with diabetes. In fact, after controlling for other risk factors, the odds of having periodontitis in people with diabetes was increased by two and a half to four times. Similar findings have been reported elsewhere.

In all cases, the level of diabetic control was a significant factor. Subjects with diabetes who were able to maintain consistent glycemic levels had no greater risk than did healthy subjects. For both type 1 and type 2 diabetes, there does not appear to be any correlation between the prevalence or severity of periodontal disease and the duration of diabetes.

The literature provides consistent evidence of greater prevalence and severity of periodontal disease in people with diabetes, both types 1 and 2. As these studies were conducted in distinctly different settings, with heterogeneous subjects and using a number of different measures of periodontal disease, we can state with confidence that people with diabetes have an increased susceptibility to periodontitis related to diabetes control.

Research suggests that control of periodontal disease plays a key role in the control of diabetes. Thus, dentists must be aware of the signs and symptoms of diabetes, and understand the importance of maintaining periodontal health for anyone with diabetes.

Practice Pearls:

  • In patients with type 2 diabetes, the number of microvascular complications was associated with the severity of periodontitis, but not its prevalence.
  • Poor glycemic control was associated with both the prevalence and severity of periodontitis.
  • Prevention and control of periodontal disease must be considered an integral part of diabetes control.

 

Nitta H, et al. J Diabetes Investig. 2017;doi:10.1111/jdi.12633.

Firatli E. The relationship between clinical periodontal status and insulin-dependent diabetes mellitus. Results after 5 years. Journal of Periodontology 1997;68(2):136-40