Periodontal status of Finnish adolescents with insulin-dependent diabetes mellitus

Abstract The periodontal status of 85 12–18 year-old Finnish adolescents with insulin-dependent diabetes mellitus (IDDM) and their paired, age- and sex-matched healthy controls was assessed clinically and radiographically. The clinical examination consisted of plaque index, gingival index (GI), retentive calculus index, WHO community periodontal index of treatment needs, number of pockets ≥4 mm and number of surfaces bleeding after probing. Alveolar bone loss was measured interproximally from the first molars in bite-wing radiographs (all subjects) and from the first incisors in periapical X-rays (patients only). The results show that in spite of similar plaque scores, the patients had higher GI scores and more surfaces bleeding after probing. No differences were found in the number of ≥4 mm pockets or radiographical bone loss in the first molars.     

Periodontal conditions in insulin-dependent diabetics

The aim of this study was to compare the prevalence and severity of periodontal disease in age- and sex-matched adult long- and short-duration insulin-dependent diabetics and non-diabetics. The study involved 82 subjects with long- and 72 with short-duration diabetes and 77 non-diabetics, all aged 20-70 years. The clinical and radiographic examination comprised recordings of the number of existing teeth, absence or presence of plaque and supra- and subgingival calculus, gingival conditions, probing pocket depth and alveolar bone level. There were no significant differences in the number of existing teeth or presence of plaque and supra- and subgingival calculus between long- and short-duration diabetics and non-diabetics. Diabetics, irrespective of the duration of the disease, had a higher prevalence of sites with gingivitis than non-diabetics. Overall, there were no significant differences between the groups regarding the prevalence of tooth surfaces with probing pocket depths of 4 and 5 mm. However, on comparison between age subgroups, long-duration diabetics younger than 45 years had significantly more 4 and 5 mm pockets than non-diabetics. Long-duration diabetics altogether had significantly more tooth surfaces with probing depth greater than or equal to 6 mm than non-diabetics. The radiographs of alveolar bone height exhibited significantly more extensive alveolar bone loss in long-duration diabetics aged 40-49 years than in short-duration diabetics and non-diabetics. This, together with the increased number of subjects belonging to classification groups with severe periodontal disease experience among long-duration diabetics, indicates more periodontal disease in these diabetics.     

A site-by-site follow-up study on the effect of controlled versus poorly controlled insulin-dependent diabetes mellitus

Abstract In the present site-by-site follow-up study, the change in amount of approximal alveolar bone was assessed after 1 year from the baseline examination in 38 and after 2 years in 22 dentate subjects all with insulin-dependent diabetes mellitus. The diabetics, aged 35 lo 56 years at baseline, had a history of a mean duration of 18 years of insulin-dependent diabetes mellitus and were under medical treatment at the outpatient clinic of the III Department of Medicine, University Central Hospital of Helsinki as well as at 2 diabetic clinics of the Helsinki Health Centre. Based upon their Song-term medical records, 26 subjects were after 1 year, and 16 subjects after 2 years from the baseline, identified as having poorly controlled insulin-dependent diabetes (PIDD). At the 1-year examination, 12 subjects were classified as having controlled insulin-dependent diabetes (CIDD) as compared to 6 subjects at the 2-year examination. After 1 and 2 years, from baseline, site-by-site measurements were recorded for plaque index scores, bleeding after probing, loss of attachment, and radiographic loss of alveolar bone. After 1 and 1 years from baseline, the PIDD subjects exhibited higher mean %s of sites with improved bleeding scores (p < 0.01, x³-test) than the CIDD subjects. At the 2-year examination, the mean % of sites with loss of approximal alveolar bone was greater in the PIDD than in the CIDD group (P < 0.05, X³-test). The greatest differences between PIDD and CIDD subjects were found when recordings for only canines were analyzed at the 1 - and 2-year examinations (p<0.05, X²-test). The results of our current 2–year longitudinal site-by-site examinations confirm earlier, results that poorly controlled insulin-dependent diabetes mellitus is strongly related to the amount of alveolar bone loss.     

The relationship of inflammatory periodontal disease to diabetic status in insulin-dependent diabetes mellitus patients

This study was designed to evaluate the relationship of inflammatory periodontal disease to the diabetic status of the insulin-dependent diabetes mellitus (IDDM) patient. 52 IDDM patients, ages 11-22 years, were evaluated. These patients were closely monitored at regular intervals in the University of Kentucky pediatric diabetic clinic. A periodontal examination was carried out for each patient. The patients were then assigned to a periodontitis or non-periodontitis group. Moderate to advanced periodontitis was found in 5.8% of the subjects. The gingival index and sulcular bleeding index were significantly higher in the periodontitis group (P less than 0.05). There was no significant difference between groups for plaque index, age of diabetic onset, duration of diabetes, present age, insulin dosage/weight, or serum glucose (P greater than 0.05). There was a greater % of ketoacidosis, retinopathy and neuropathy in the periodontitis group. IDDM patients with neurological complications or a history of chronic infections had a significantly higher gingival index score than those without the complication (P less than 0.05).     

Periodontal disease experience in adult long-duration insulin-dependent diabetics

Abstract The aim of this study was to analyse periodontal disease experience in 40 to 70 year-old, sex-matched insulin-dependent diabetics and non-diabetics. The study involved 83 diabetics and 99 non-diabetics. The clinical and radiographic examination comprised recordings of number of teeth, presence of plaque, gingival conditions, probing pocket depth and alveolar bone level (main variable). Diabetics aged 40 to 49 years had more periodontal pockets 6 mm and more extensive alveolar bone loss than non-diabetics in the same age-group. There was also a significantly higher number of subjects belonging to classification groups with severe periodontal disease experience among diabetics in that age-group. In the age-groups 50–59 and 60–69 years, no major differences were found. The disease duration in these 3 age groups was 25.6 years, 20.5 years and 18.6 years, respectively, and the age of onset thus appears to be an important risk factor for future periodontal destruction.     

Periodontal status in insulin-dependent diabetic adolescents

Abstract A cross-sectional study was designed to evaluate the periodontal status of 85 12–18 year-old French adolescents with insulin-dependent diabetes (IDDM) and 38 healthy controls in the same age group. The clinical examination consisted of plaque control and gingival inflammation evaluation and probing attachment level. The interproximal marginal bone level was assessed with bitewing radiographs taken on the first molars and on areas presenting an attachment loss over 2 mm. Diabetic children had significantly more gingival inflammation than children without diabetes, in spite of similar plaque scores. No significant relation between gingival condition and age. Tanner's index, HbAlc level or disease duration could be demonstrated. None of the subjects had sites with attachment Toss 3 mm or radiographic signs of periodontitis.     

A longitudinal study on insulin-dependent diabetes mellitus and periodontal disease

Abstract In the present two-year longitudinal investigation, the progression of periodontal disease was assessed after 1 year from the baseline examination in 38 dentate subjects and after 2 years in 22 dentate subjects with a mean duration of 18 years of insulin-dependent diabetes mellitus. The diabetics, aged 35 to 56 years at baseline, were under medical treatment at the outpatient clinic of the III Department of Medicine, University Central Hospital of Helsinki and at 2 diabetic clinics of the Helsinki Health Centre. Based upon their long-term medical records, 26 subjects were at baseline identified as having poorly controlled insulin-dependent diabetes (PIDD) with a mean blood glucose level of 12.5 mmol/1 and a mean glycosylated hemoglobin (HBA₁) level of 10.1%. 12 subjects were classified as having controlled insulin-dependent diabetes (CIDD) with a mean blood glucose level of 6.7 mmol/1 and a mean HBA, level of 9.2% at baseline. For each individual, recordings were made at baseline and after 1 and 2 years from the baseline for the plaque index, gingival index, pocket depth, loss of attachment, bleeding after probing, gingival recession, and radiographic loss of alveolar bone. At baseline and 2 years after the baseline examination, the PIDD subjects had similar plaque conditions as the CIDD subjects. At baseline and after 1 and 2 years from baseline the PIDD subjects had more gingivitis and bleeding after probing (P<0.05, χtest) than the CIDD subjects. Both at baseline and at the 1-year and 2-year examinations, the long-term PIDD subjects had lost more tooth attachment and approximal bone than the corresponding CIDD subjects (P<0.01, χ-test). At all 3 examinations, the PIDD subjects also exhibited more gingival recession than the CIDD subjects (P<0.05, χ-test).     

Salivary peroxidase activity in whole saliva of patients with insulin-dependent (type-1) diabetes mellitus

Abstract In this study, salivary peroxidase activity was measured in a group of 10 patients with insulin-dependent (type I) diabetes mellitus (IDDM) who had a tendency towards periodontitis. In healthy subjects (N: 10), mean salivary peroxidase activity was 0.0025±0.001 IU/ml, while in this group of type I diabetic patients it was 0.051±0.015 IU/ml, a significantly higher level (p <0.001). Approximal plaque index (API), modified sulcus bleeding index (mod SBI) and pocket depths were assessed clinically. The values for mod SBI and API were 60% and 68% respectively for the diabetic patients while for the control group mod SBI was measured 0.0% and the value for API was 10.67% (p < 0.001). The administration of this simple and practical test may provide an early marker of a tendency towards periodontitis in IDDM patients.     

The onset of diabetes and poor metabolic control increases gingival bleeding in children and adolescents with insulin-dependent diabetes mellitus

Abstract Gingival health (bleeding on probing) and oral hygiene (plaque percent) were assessed in 2 groups of children and adolescents with insulin-dependent diabetes mellitus (IDDM). 1st study group included 12 newly diagnosed diabetic children and adolescents (age range 6.3-14.0 years, 5 boys and 7 girls). They were examined on the 3rd day after initial hospital admission and at 2 weeks and 6 weeks after initiation of insulin treatment. Gingival bleeding decreased after 2 weeks of insulin treatment (37.8% versus 19.0%. p < 0.001. paired t-test). and remained at the same level when examined 1 month later while glucose balance was excellent. Another group (n=80) of insulin-dependent diabetic children and adolescents (age range 11.7 - 18.4 years, 44 boys and 36 girls) with a mean duration of diabetes 6.0 years (range 0.3-15.0 years) were examined 2× at 3-month intervals. Subjects with poor blood glucose control (glycosylated haemoglobin, HbA₁, values over 13%) had more gingival bleeding (46.3% on examination 1, 41.7% on examination 2) than subjects with HbA₁ values less than 10% (mean gingival bleeding 35.2% and 26.9%, respectively) or subjects with HbA₁ values between 10 to 13% (mean gingival bleeding 35.6% and 33.4%, respectively). Differences were significant on both examinations (p < 0.05, Anova). and remained significant after controlling the groups for differences in age, age at the onset of diabetes, duration of diabetes and pubertal stage (Ancova). Results were not related to differences or changes in dental plaque status, supporting the concept that imbalance of glucose metabolism associated with diabetes predisposes to gingival inflammation. An increase in gingival bleeding in association with hyperglycaemia suggests that hyperglycaemia-associated biological alterations, which lower host resistance toward plaque, have apparently taken place. Consequently, although not all gingivitis proceeds into a destructive periodontal disease, prevention of plaque-induced gingival inflammation should be emphasised, particularly in children and adolescents with poorly controlled diabetes.     

Dark field microscopy of the subgingival microflora in insulin-dependent diabetics

Abstract The subgingival microflora was assessed by means of dark field microscopy in 106 pockets of 47 subjects with long-term insulin-dependent diabetes mellitus (IDD). The microbiota of 55 healthy sulci (probing depth<4 mm) and 51 periodontally diseased (probing depth ≥4 and 6 mm) pockets were analyzed. The mean duration of the IDD of the diabetic subjects was 23.7 years (range from 10 to 41 years). The diabetic patients, aged 30–65 years, were under medical treatment at the III Department of Medicine. University of Helsinki Central Hospital, and at 2 clinics of the Helsinki Health Centre. Based upon their long-term medical records. 26 subjects were assessed to have poorly controlled insulin-dependent diabetes meilitus (P1DD) and 21 had controlled insulin-dependent diabetes (CIDD). The P1DD subjects exhibited higher mean blood glucose levels (12.9±4.6 mmol/l, x?± S.D.) than the CIDD subjects (7.9±3.6 mmol/1) (p<0.001), The mean glycosylated hemoglobin HBA_l (HBA_lc) levels were 11.2±4.6% (10.3±1.2%) and 8,8±1.8% (7.7±1.4%) for PIDD and CIDD subjects, respectively. These differences were statistically significant (p<0.01 and p<0.001, t-test). For each individual, site-specific recordings were made for plaque index and bleeding index scores, probing depth, loss of attachment and radiographic loss of alveolar bone. Dark field microscopy analysis of the presence of spirochetes, motile rods, cocci, non-motile rods, filaments and fusiforms was performed in the total of 106 pockets. According to the results of the dark field microscopy, the % of spirochetes and motile rods in the periodontally diseased pockets was significantly higher in the PIDD than in the CIDD subjects (9.2±13.4% and 10.8±14.3% versus 4.0±5.2% and 3.1 ±3.2%, p<0.01 and p<0.001, x²-test, respectively). Moreover, the PIDD subjects had lower mean %s of coccoid cells in periodontally diseased sites than the CIDD subjects (52.1 ±20.8% versus 60.7±9.0%, p<0.001, x²-test).     

Minor manifestations of periodontal diseases in young adults with type 1 diabetes mellitus. Periodontal and microbiological findings

Abstract

Objective. The aim of this study was to evaluate periodontal status and microbiological conditions in young adults with insulin-dependent diabetes (IDDM) in comparison with age- and sex-matched non-diabetic controls. Materials and methods. Forty-one patients, 18–24 years of age with IDDM since childhood, were examined and the results were compared to those of a group of 41 sex- and age-matched non-diabetic controls. According to the HbA_1c %, the group of diabetic patients was divided into two groups, with good or poor metabolic control. Results. Periodontal health, expressed in probing pocket depths and marginal bone loss, was fairly good in all patients. Fifty per cent of the patients in the study and control groups displayed probing pocket depths ≥4 mm, mostly pocket depths 4 mm. These findings were also equally distributed among the patients with good and poor metabolic control. No significant differences were found between the groups regarding bleeding on probing, but in the number of sites with excessive bleeding the study group exhibited higher scores than the healthy controls. Different microbiological species were equally distributed between the groups. Conclusion. Neither periodontal nor microbiological status in young adults with IDDM differs from that of healthy controls.     

Ⅱ型糖尿病病人牙周附着水平的调查

目的:了解Ⅱ型糖尿病病人的牙周附着水平。方法:调查1 503名Ⅱ型糖尿病病人和819名健康志愿者的牙周附着水平,按年龄分组,用SPSS 16.0软件包对结果进行分析。结果:同一年龄组内,Ⅱ型糖尿病病人和健康对照组年龄构成相似,差异无统计学意义(P>0.05),除≥75岁组外,同一年龄组内Ⅱ型糖尿病病人牙周附着丧失程度明显较正常对照组严重,差异具有统计学意义(P<0.01)。结论:Ⅱ型糖尿病病人牙周附着丧失程度较正常人群明显严重,倡导早期对糖尿病病人进行口腔卫生保健指导,预防牙周炎的发生。     

The relationship between periodontal diseases and diabetes: an overview

Diabetes mellitus, caused by the malfunction of insulin-dependent glucose and lipid metabolism, presents with the classical triad of symptoms: polydypsia, polyuria, and polyphagia which are often accompanied by chronic fatigue and loss of weight. Complications of diabetes mellitus include retinopathy, nephropathy, neuropathy, and cardiovascular disease. Periodontal diseases are infections affecting the periodontium and resulting in the loss of tooth support. The association between diabetes mellitus and periodontitis has long been discussed with conflicting conclusions. Both of these diseases have a relatively high incidence in the general population (diabetes 1% to 6% and periodontitis 14%) as well as a number of common pathways in their pathogenesis (both diseases are polygenic disorders with some degree of immunoregulatory dysfunction). On the one hand, numerous reports indicate a higher incidence of periodontitis in diabetics compared to healthy controls, while other reports fail to show such a relationship. Clarification of this dilemma is occurring as the diagnostic criteria for periodontitis and diabetes mellitus improve, controlled studies with increased sample sizes are carried out, and the studies take into account major confounding variables that impact on the pathogenesis of both diseases. Current studies tend to support a higher incidence and severity of periodontitis in patients with diabetes mellitus. The overview looks at the bidirectional relationship between periodontitis and diabetes. An analysis of the National Health and Nutrition Examination Survey (NHANES) III data set confirms the previously reported significantly higher prevalence of periodontitis in diabetics than in non-diabetics (17.3% versus 9%). The analysis of the data also shows that the prevalence of diabetes in patients with periodontitis is double that seen in the non-periodontitis patients (12.5% versus 6.3%) and that this difference is also statistically significant. The pathogenesis of the 2 diseases is reviewed with an emphasis on common genetic and immune mechanisms. On the basis of the overview, 2 hypotheses for testing the relationship between periodontitis and diabetes are discussed. The first proposes a direct causal or modifying relationship in which the hyperglycemia and hyperlipidemia of diabetes result in metabolic alterations that may then exacerbate bacteria-induced inflammatory periodontitis. The second hypothesis proposes that a fortuitous combination of genes (gene sets) could result in a host who, under the influence of a variety of environmental stressors, could develop either periodontitis or diabetes or both.     

Periodontal disease and diabetes mellitus

Periodontal disease (PD) is one of the most commonly known human chronic disorders. The relationship between PD and several systemic diseases such as diabetes mellitus (DM) has been increasingly recognized over the past decades.

Objective:

The purpose of this review is to provide the reader with knowledge concerning the relationship between PD and DM. Many articles have been published in the english and Portuguese literature over the last 50 years examining the relationship between these two chronic diseases. Data interpretation is often confounded by varying definitions of DM, PD and different clinical criteria were applied to determine the prevalence, extent and severity of PD, levels of glycemic control and diabetes-related complications.

Methods:

This paper provides a broad overview of the predominant findings from research conducted using the BBO (Bibliografia Brasileira de Odontologia), MEDLINE, LILACS and PubMed for Controlled Trials databases, in english and Portuguese languages published from 1960 to October 2012. Primary research reports on investigations of relationships between DM/DM control, PD/periodontal treatment and PD/DM/diabetes-related complications identified relevant papers and meta-analyses published in this period.

Results:

This paper describes the relationship between PD and DM and answers the following questions: 1- The effect of DM on PD, 2- The effects of glycemic control on PD and 3- The effects of PD on glycemic control and on diabetes-related complications.

Conclusions:

The scientific evidence reviewed supports diabetes having an adverse effect on periodontal health and PD having an adverse effect on glycemic control and on diabetes-related complications. Further research is needed to clarify these relationships and larger, prospective, controlled trials with ethnically diverse populations are warranted to establish that treating PD can positively influence glycemic control and possibly reduce the burden of diabetes-related complications.     

Long-term control of diabetes mellitus and periodontitis

Abstract The purpose of this study was to evaluate the association between long-term control of diabetes mellitus (DM) and periodontitis, A total of 75 diabetics (Type I or II) aged 20–70 years with long-term records of their diabetic control were selected for the study. The following periodontal variables were recorded in a randomized half-mouth examination: plaque, calculus (+/?), probing depth (pd) and attachment loss (al). The mean of glycosylated hemoglobin measurements (IIbAlc) over the past 2–5 years was used to indicate the long-term control of DM. The study participants were divided into well-, moderately- and poorly-controlled diabetics. An increase in the prevalence, severity and extent of periodontitis with poorer control of diabetes was observed. The extent of calculus also increased with poorer control. In a multiple regression analysis, calculus and long-term control of diabetes were significant variables when pd≥4 mm was used as the dependent variable. Age was a significant predictor for al > 3 mm but not for pd ≥4 mm. Sex, duration and type of DM were not significant variables in the regression models. Less than 2% of sites with no calculus demonstrated pd≥4mm. When calculus was present, the frequency of pd ≥4 mm increased from 6% in the well-controlled diabetics to 16% in the poorly-controlled ones. We conclude that periodontitis in diabetics is associated with long-term metabolic control and presence of calculus. Therefore, regular maintenance care, including patient motivation and instruction as well as professional calculus removal, is important for diabetic patients.     

Periodontal disease and type diabetes mellitus in children and adolescents

Abstract This study compared the periodontal status of a juvenile diabetic study group with that of a non-diabetic control group similar in age and sex. The study group consisted of 26 type I diabetic patients with an average age of 13.42 years and 24 control subjects of similar age. The diabetic subjects were evaluated with glycosylated hemoglobin (GHb) to obtain a measure of diabetic control. Clinical periodontal evaluations were performed for all teeth in each subject, and consisted of the plaque index, gingival fluid flow, gingival index, probing depths, clinical attachment levels, recession, and bleeding on probing. Analysis of the data demonstrated no statistically significant differences in the overall means for the 2 groups for average attachment loss, probing depths, recession, gingival index, plaque index, gingival fluid flow, or bleeding on probing. There was no significant association between the level of control of diabetes (GHb) and clinical variables. However, comparisons based on site-specific measurements showed the gingival index to be somewhat higher among the diabetics (p=0.0002), and examination of interaction effect plots showed the diabetic group to have higher average gingival index for most teeth and higher or the same plaque index levels on all teeth relative to controls. Thus, a young study population with type 1 diabetes mellitus was found to have significantly increased severity of inflammatory gingival disease compared to controls of similar age.     

Oral health of patients with insulin-dependent diabetes mellitus

Abstract — Oral health, the amount of salivary Streptococcus mutans and lactobacilli, and the flow rate, pH and buffer capacity of paraffin-stimulated whole saliva were analyzed in 35 adult diabetic patients and their age- and sex-matched non-diabetic, clinically healthy controls. All patients had insulin-dependent diabetes (IDDM) with a mean (± SD) duration of 14.0 ± 9.1 yr. The prevalence of dental caries was as high in the diabetic group as in the controls but the past caries experience was remarkably lower in those individuals whose diabetes had started at a very early age (= 7 yr). In agreement with the clinical data, the salivary levels of cariogenic microorganisms were of the same order of magnitude in both study groups. However, the relative proportion of S. mutans from the total cultivable aerobic microflora was significantly higher ( P <0.01) in diabetics compared to the controls. The other studied salivary parameters did not differ between the groups. Remarkable individual differences were observed in the correlation between glucose levels of blood and whole saliva among diabetics. In spite of the noncariogenic dietary habits, the adult diabetic patients seem to be at least as susceptible to dental caries as non-diabetics, probably due to the leakage of glucose from blood into the oral cavity.     

Inverse association between periodontitis and respiratory allergies in patients with type 1 diabetes mellitus

Aim: In a general adult population, we have demonstrated an inverse association between periodontitis and respiratory allergies that is in line with the hygiene hypothesis suggesting a protective effect of infections against the development of allergies. The objective of the present study was to investigate the association between periodontitis and respiratory allergies in a type 1 diabetes mellitus population. Material and Methods: The study population comprised 170 patients with type 1 diabetes mellitus aged 17–80 years. Respiratory allergies were present in 22 subjects. The attachment loss (AL) was measured. Periodontitis was defined according to the percentage of surfaces that exceeded 3 mm AL (healthy, mild, moderate, severe periodontal conditions). Results: Our adjusted analyses revealed an inverse association between periodontitis and respiratory allergies. For increasing AL, a trend towards a decreasing risk was present for respiratory allergies (p_trend<0.05). Compared with subjects with healthy periodontal conditions, individuals with severe periodontal conditions had the lowest risk of respiratory allergies [odds ratios (OR) 0.06 (95% confidence interval (CI) 0.01–0.39)], followed by subjects with moderate AL [OR 0.14 (95% CI 0.03–0.63)] and mild AL [OR 0.32 (95% CI 0.09–1.08)]. Conclusion: There is a strong inverse association between periodontitis and respiratory allergies in patients with type 1 diabetes mellitus. These findings further support the hygiene hypothesis.