Stewart et al107, USA
AAP = American Academy of Periodontology; CAL = clinical attachment level; CPT = control periodontal treatment; CRP = C-reactive protein; DM = diabetes mellitus; HbA1c = glycated haemoglobin; IPT = intensive periodontal therapy; OHI = oral hygiene instructions; PD = probing depth; ROS = reactive oxygen species; SRP = scaling and root planing; T1DM = type-1 diabetes mellitus; T2DM = type-2 diabetes mellitus. Only studies with SRP, ± surgery and ± antibiotics were included, other therapies, such as lasers, were not listed. All listed studies used HbA1c as a primary outcome.
Table 1-5 Clinical studies assessing the epidemiological association between periodontitis and T1DM
| Type of study | Study, country | Subjects | Findings |
|---|---|---|---|
| Case-cohort | Firatli109, Turkey | 44 subjects with T1DM and 20 healthy controls. Length of the study: 5 y. | CAL was higher in the T1DM subjects. Positive correlation between the duration of diabetes and CAL. Fructosamine was correlated with the Gingival Index in the T1DM group. |
| Case-control | Ajita et al110, India | 28 subjects with T1DM and 20 healthy controls. | T1DM had greater Bleeding Index, PPD and CAL. Patients diagnosed for diabetes for shorter duration of time (4–7 y) showed Bleeding Index-disease severity correlation. |
| Kaur et al111, Germany | 145 subjects with T1DM paired with 2647 healthy controls, and 182 T2DM paired with 1314 healthy controls. | T1 and T2DM had greater CAL. After age stratification, the effect of T2DM was only statistically significant in the 60–69-year-old subjects. T1DM was positively associated with tooth loss. The association between T2DM and tooth loss was statistically significant only for females. | |
| Silvestre et al112, Spain | 90 subjects with T1DM and 90 healthy controls. | T1DM had greater Bleeding Index, PPD and CAL. Deficient metabolic control and presence of diabetic complication were associated with higher BoP and PPD. | |
| Lalla et al113, USA | 350 children with T1DM and 350 healthy (6–18 y old). 7% had T2DM. | DM had increased gingival inflammation and CAL than healthy controls with OR ranging from 1.84 to 3.72. | |
| Al-Shammari et al114, Kuwait | 29 subjects with T1DM of ≤ 5 y duration and 29 subjects with T1DM of > 5 y duration. | T1DM of > 5 y duration had greater number of missing teeth and CAL. Patients with one or more DM complications had greater number of missing teeth and CAL. | |
| Pinson et al115, USA | 26 subjects with T1DM and 24 healthy controls. | No differences in CAL, PPD, recession, Gingival Index, Plaque Index, gingival fluid flow, or BoP. Site-specific comparison measurements showed the Gingival Index to be somewhat higher among the T1DM subjects. Examination of interaction effect plots showed the T1DM subjects to have higher average Gingival Index for most teeth and higher or the same Plaque Index levels on all teeth relative to controls. | |
| Case-control | Seppälä et al116, Finland | 38 dentate subjects with a mean duration of 18 years of T1DM. | After 1 and 2 y from baseline, the poorly controlled T1DM subjects exhibited higher BoP than T1DM subjects. After 2 y from baseline, the poorly controlled T1DM subjects exhibited more sites with loss of approximal alveolar bone than T1DM subjects. |
| Seppälä et al117, Finland | 38 dentate subjects with a mean duration of 18 years of T1DM. | At baseline and after 1 and 2 y from baseline the poorly controlled T1DM subjects had more gingivitis and BoP than the controlled T1DM subjects. | |
| de Pomme- reau et al118, France | 85 subjects with T1DM and 38 healthy controls. | T1DM children had more gingival inflammation than healthy controls. | |
| Cross-sectional | Patiño Marín et al119, Mexico | 35 subjects with T1DM with HbA1c between 6.5% and 7%; 35 subjects with T1DM with HbA1c > 7%; 35 subjects without T1DM; 35 subjects with T2DM; and 35 subjects without T2DM. | No differences among in frequency of caries, filled teeth, missing teeth, prosthetic restoration, bacterial dental plaque, Calculus Index, PPD and CAL between T1DM and healthy controls. T2DM subjects had more missing teeth, calculus, PPD and CAL. |
| Patiño Marín et al120 Mexico | 20 subjects with uncontrolled T1DM, 20 subjects with controlled T1DM, and 40 healthy controls. | The imbalance of glucose of subjects with T1DM was associated with more frequency of periodontal disease. |
BoP = bleeding on probing; CAL = clinical attachment level; HbA1c = glycated haemoglobin; OR = odds ratio; PPD = pocket probing depth; T1DM = type 1 diabetes; T2DM = type-2 diabetes.
SUMMARY
● The prevalence of diabetes is 13.1% among subjects with periodontitis and 9.6% among subjects without periodontitis according to a 2018 meta-analysis.
● There is strong evidence for an association between periodontitis and glycaemic status, expressed as HbA1c, fasting blood glucose levels and/or glucose