Association among interleukin-6 gene polymorphism, diabetes and periodontitis in a Chinese population

Objectives:  Diabetics significantly increase risk for periodontitis. Interleukin-6 (IL-6) gene polymorphism may play certain roles in the progression of periodontitis with diabetes. The purpose of this study was to assess the association among IL-6 gene polymorphisms, type 2 diabetes mellitus (T2DM) and chronic periodontitis (CP) in a Chinese population.
Material and methods:  DNA was obtained from 159 patients with CP, 88 patients with T2DM, 110 patients with CP&T2DM and 135 control subjects. The -174/-572/-597 polymorphisms of IL-6 gene were investigated by restriction fragment length polymorphism of polymerase chain reaction products. The results were further confirmed by sequencing. Significance was set at P  < 0.008 after Bonferroni correction.
Results:  Among four groups, CP&T2DM group showed the lowest IL-6-572 CC genotype and C-allele frequencies (54.5% and 74.1%). In this regard, there were significant differences between CP&T2DM group and the control group [ P  = 0.006, odds ratio (OR)  =  0.475, 95% CI: 0.279–0.808 and P  = 0.002, OR = 0.502, 95% CI: 0.319–0.788 respectively]. Logistic regression with adjustment for age, gender, body mass index, smoking and stress showed no significant difference in terms of IL-6-572 genotypes ( P  = 0.058, OR= 0.523, 95% CI: 0.268–1.022).
Conclusions:  The IL-6-572 genotype and allele distributions are unique to subjects with CP&T2DM in a Chinese population.     

A population-based study on the association between type 2 diabetes and periodontal disease in 12,123 middle-aged Taiwanese (KCIS No. 21)

Aim: We investigated the association between type 2 diabetes mellitus (T2DM) and periodontal disease (PD) in the context of the current periodontal aetiology model.
Material and Methods: In total, 14,747 community residents aged 35–44 years were invited to a community-based PD survey between 2003 and 2006 using the community periodontal index. Significant factors modifying the association between T2DM and PD were ascertained. We further assessed the association between T2DM and the risk for PD, within strata of significant effect modifiers, after controlling for other putative factors.
Results: The prevalence rate was 10% higher in subjects with T2DM than in those without. After controlling for significant factors, T2DM was positively associated with the risk for PD (adjusted odds ratio=1.34,95% confidence interval: 1.07–1.74). The results of interaction assessment showed that only the waist was identified as a statistically significant effect modifier for such a positive association.
Conclusions: The association between T2DM and the risk for PD among young adult was demonstrated. This finding, together with other aetiological factors, fit with the current hypothesized model of the aetiology of periodontitis. However, the effect of T2DM modified by waist measurement should be verified in future studies.     

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.     

Tooth loss and cognitive impairment

Objectives: Chronic subclinical inflammation may elevate the risk of cognitive impairment. Periodontitis is associated with subclinical inflammation and accounts in part for tooth loss. The hypothesis was tested that periodontitis and tooth loss as a proxy of chronic periodontitis is associated with cognitive impairment in the elderly.
Subjects and Methods: The population-based Study of Health in Pomerania comprises 1336 subjects (60–79 years). Cognitive impairment was assessed with the Mini-Mental Status Examination (MMSE). Tobit regression analyses were adjusted for potential confounders.
Results: A decreased number of teeth was associated with lower MMSE scores in females ( p <0.001) and males ( p =0.007) in age-adjusted models. In the fully adjusted models, tooth loss was associated with cognitive impairment in females ( p =0.002) but not in males ( p =0.825).
Conclusions: A significant association between tooth loss and cognitive impairment was found in females that was not accounted for by potential confounders. Former periodontitis may account for this association as periodontitis was frequently the cause for tooth extractions.     

Vitamin D receptor polymorphism (-1056 Taq-I) interacts with smoking for the presence and progression of periodontitis

Aim: The aim of this analysis was to investigate the relationship between a vitamin D receptor (VDR) polymorphism and the diagnosis and progression of periodontitis.
Material and Methods: Data were derived from two different studies, including 231 subjects with healthy periodontium, 224 aggressive periodontitis and 79 chronic periodontitis (CP) patients in a case–control investigation. Sixty-one of these CP patients also took part in an observational study with a 1-year follow-up, in which progression of periodontitis was determined at the subject level. All 534 subjects provided a blood sample from which genomic DNA was extracted to study VDR −1056 TaqI polymorphism.
Results: The interaction between smoking and VDR polymorphism was associated with the diagnosis of periodontitis in Caucasians [ p =0.001, odds ratio (OR)=1.33, 95% confidence intervals (CI)=1.12–1.57] and all subjects ( p =0.033, OR=1.60, 95% CI=1.04–2.48). In the longitudinal study, subjects were divided into two clusters at 1 year according to the median number of progressing sites (Δcumulative attachment loss >2 mm). Logistic regression analysis revealed that the interaction between VDR Taq-I polymorphism and smoking showed limited evidence of association with the "severe progression" cluster ( p =0.033, OR=15.24, 95% CI=1.24–187.42).
Conclusions: Vitamin D receptor Taq-I TT polymorphism was moderately associated with both the presence and the progression of periodontitis in smokers, while no association was detected in non-smoking individuals. VDR genetic factors may interact with smoking in the pathogenesis of periodontitis.     

Effect of antimicrobial periodontal treatment and maintenance on serum adiponectin in type 2 diabetes mellitus

Aims: The aims of this study were to evaluate the effect of mechanical periodontal treatment with local application of minocycline (APT) on serum adiponectin as a marker of insulin resistance improvement in type 2 diabetes mellitus (T2DM) patients and to investigate if effect of APT on serum adiponectin level was sustained by periodontal maintenance (PM).
Material and Methods: Twenty-seven T2DM patients were randomly assigned into test or control groups. Test received scaling with ultrasonic devices at baseline and APT biweekly for 2 months while control received scaling at baseline and mechanical tooth cleaning (MPT) at the same interval. At 6 months, all patients received mechanical tooth cleaning as PM. Periodontal examination and blood measurements were performed at baseline, 4 and 9 months.
Results: Adiponectin concentrations in test had significantly increased by 31.4% after APT ( p =0.024) and by 30.4% after PM ( p =0.002) compared with baseline. The percentage of 4 mm probing depths (PD) had shown 8.3% and 9.3% reduction after APT and PM ( p =0.046, 0.02) in test while 5.0% reduction after MPT in control group ( p =0.031).
Conclusions: Our results suggested that APT and PM not only improve periodontal disease but also increase serum adiponectin in T2DM patients.     

Alveolar bone loss in type 1 diabetic subjects

AIM, BACKGROUND: The aim of this study was to assess the degree of marginal alveolar bone loss in a group of young subjects with type 1 diabetes mellitus (DM) (n=35, age range 24-36 years) and age-matched non-diabetic control subjects (n=10). METHOD: The diabetic group was divided into 3 subgroups (D1, D2, D3) according to the severity of the diabetic state. The level of alveolar bone was measured on panoramic radiographs of maxillary and mandibular molars as the % of the distance between the cemento-enamel junction (CEJ) and the bone crest along the total length of the root. All mesial and distal sites with a distance of > 15% (BL>15%) were picked, and calculations were performed using the individual %s of sites with BL> 15%. RESULTS: Based on the present findings, we conclude that type 1 DM has a modifying effect on marginal loss of alveolar bone. A clear trend towards increased marginal bone loss was seen in the subjects with complicated DM (D3). The subjects with good metabolic control and no complications of DM (D1) are no more susceptible to marginal bone loss than non-diabetic controls of the same age. CONCLUSIONS: The present findings confirm our previous results on increased loss of periodontal support in subjects with complicated DM already at an early age.     

Analysis of the association of IL1B (C+3954T) and IL1RN (intron 2) polymorphisms with dental implant loss in a Brazilian population

Background: Although dental implants have a high success rate, failures occur, in spite of adequate clinical conditions. Together with the observation that multiple implant losses occur in certain groups of individuals (clusterization phenomenon), this suggests that host response may influence implant failure. Little is known about the influence of genetic susceptibility on implant loss. Interleukin (IL)-1β and IL-1ra are believed to play a key role in the immune-inflammatory response, and polymorphisms IL1B (C+3954T) and IL1RN (intron 2) are shown to alter the coding proteins expression.
Objectives: The aim of this study was to investigate the association between dental implant loss and polymorphisms IL1B (+3954) and IL1RN (intron 2).
Material and methods: The study population ( n =266) was divided into Test group (T) – 90 subjects with implant loss, and Control group (C) – 176 subjects without any implant failure. Genotyping was performed by PCR-RFLP.
Results: The number of present teeth was observed to influence implant loss. No differences in genotype and allele frequencies between C and T were found for IL1B (+3954) and IL1RN (intron 2) polymorphisms. However, the analysis of the whole study population (control and test groups) showed that genotype 2/2 was significantly more frequent in individuals with multiple implant losses ( n =35) than in individuals that lost up to a single implant ( n =231) (OR: 3.07, IC: 1.13–8.34, P =0.027).
Conclusion: It was observed that number of teeth and edentulism were associated with implant loss. Genotype 2/2 of IL1RN polymorphism was significantly more frequent in patients who presented multiple losses, which suggests that the clusterization phenomenon has a genetic basis.     

Diabetes and periodontal disease: a case-control study

BACKGROUND: Periodontitis is often associated with diabetes and might be considered one of the chronic complications of diabetes mellitus, both in Type 1 (T1DM) and Type 2 (T2DM). This case-control study was designed to evaluate the possible association between non-insulin-dependent diabetes (T2DM) and clinical and microbiological periodontal disease among adult Sardinians. METHODS: A total of 212 individuals participated in this study: 71 T2DM patients aged 61.0 +/- 11.0 years and 141 non-diabetic controls in good general health aged 59.1 +/- 9.2 years. All subjects were given a clinical periodontal examination for probing depth, attachment level, presence of calculus, bleeding on probing, and assessment of plaque. Subgingival plaque samples were obtained, and P. gingivalis, P. intermedia, and T. forsythensis were identified using multiplex polymerase chain reaction. RESULTS: T2DM patients showed a significantly lower number of teeth present (P = 0.002); a significant increase in number of probing depths >4 mm, and percent of pocket depths >4 mm (P = 0.04 and P = 0.05, respectively); periodontitis (P = 0.046); bleeding on probing (P = 0.02); and plaque index (P = 0.01). A significant association with diabetes was detected for plaque (X2= 4.46; P <0.05) and bleeding on probing (X2= 3.60; P <0.05). Concerning bacteria prevalence, a positive association was detected for P. gingivalis (X2= 2.80; P <0.05) and T. forsythensis (X2= 3.87; P <0.05). Presence of plaque was positively associated with case status (odds ratio [OR] = 1.3; 95% confidence interval [CI]: 1.2, 3.6) and with prevalence of P. gingivalis and T. forsythensis (OR = 1.2, 95% CI: 1.3, 2.2; and 1.2, 95% CI: 1.2, 1.8, respectively). CONCLUSION: Patients with T2DM undoubtedly have a susceptibility for more severe periodontal disease.     

IL-6−174 genotype associated with the extent of periodontal disease in type 1 diabetic subjects

Aim: The aim of this study was to investigate whether genetic polymorphism in certain cytokine and receptor molecule genes and diabetic status associate with the extent of periodontal disease in type 1 diabetes mellitus (DM).
Material and Methods: Eighty patients with type 1 DM participated. Visible plaque, bleeding on probing (BOP), probing pocket depth (PD) and attachment level (AL) were examined clinically and glycosylated haemoglobin (HbA1c) levels were used to assess the glycemic control of DM. CD-14, IL-6, TNF- α , IL-10, IL-1 α , IL-1 β and TLR-4 gene polymorphisms were studied using the polymerase chain reaction (PCR).
Results: The 3-year HbA1c was good (<7.5%) in 16%, acceptable (7.5–8.5%) in 36% and poor (>8.5%) in 48% of the subjects. IL-6⁻¹⁷⁴ genotype and 3-year GHbA1c associated significantly with BOP and PD4 mm, subjects with the GG genotype of the IL-6⁻¹⁷⁴ exhibiting more severe periodontal disease than those with the GC/CC genotype. After stratification by IL-6 genotype, associations between the extent of periodontal disease and 3-year HbA1c levels remained significant in subjects carrying the GC/CC but not the GG genotype.
Conclusions: In addition to the HbA1c level, the IL-6⁻¹⁷⁴ genotype is a significant susceptibility factor for periodontal disease among type 1 diabetics.     

Influence of Periodontal Disease on Changes of Glycated Hemoglobin Levels in Patients With Type 2 Diabetes Mellitus: A Retrospective Cohort Study

Background: Little evidence is available regarding the effects of long‐term periodontal infection on diabetes mellitus (DM) control. The aim of this retrospective cohort study is to evaluate influence of periodontal status on changes of glycated hemoglobin (HbA1c) levels of patients with type 2 DM (DMt2). Methods: Eighty patients (mean age: 56.0 ± 8.9 years) with DMt2 were included. Patients were non‐smokers, aged ≥40 years, and using antidiabetic drugs. Demographics, health history, and HbA1c levels were retrieved from medical charts. Probing depth and clinical attachment loss (AL) were recorded. Results: Patients were examined at two time points within a mean interval of 38.6 ± 6.6 months. Increase in HbA1c over time was statistically significant when severe periodontitis was diagnosed at baseline (2.32%, 95% confidence interval [CI]: 1.50% to 3.15%), in patients showing at least one tooth with ≥2 mm of AL progression (2.24%, 95% CI: 1.56% to 2.91%), in males (2.75%, 95% CI: 1.72% to 3.78%), and in those with HbA1c <6.5% at baseline (3.08%, 95% CI: 2.47% to 3.69%). After adjusting for baseline HbA1c, significant changes were still observed for severe periodontitis and progression of AL with increases of 0.85% and 0.9%, respectively. After adjusting for sex and HbA1c, AL progression was also statistically significant, with increases of 0.84%. Conclusions: Periodontitis progression was associated with increase in HbA1c in patients with DMt2. Identification of these risk factors suggests that periodontal treatment may improve glycemic control of patients with DMt2 by eliminating periodontal infection.     

Lifestyle and psychosocial factors associated with tooth loss in Mexican adolescents and young adults

OBJECTIVE: The aim of the present study was to examine: (1) the prevalence of tooth loss in persons living in community dwellings and (2) the strength of the association identified between tooth loss experience and the psychosocial factors of lifestyle, stress, and anxiety. MATERIAL AND METHODS: A cross-sectional study was carried out in a convenience sample where data were collected by means of self-administered questionnaires of lifestyle and psychosocial factors (stress and anxiety) and a clinical examination. A total of 516 subjects aged 14-30 years of age were included in the study. Subjects had a visual dental examination. Prevalence and mean of tooth loss were calculated excluding third molars, and their related factors were adjusted in a binary logistic regression. RESULTS: Mean age of participants was 17.4+/-3.0 years; 45.5% were men. The prevalence of tooth loss (when at least one tooth was lost) was 20.5%. Among the 516 persons, a total of 201 teeth were lost with a mean tooth loss 0.39+/-0.95 overall. Mean tooth loss in subjects with at least one missing tooth was 1.90+/-1.26 teeth. Results adjusted by anxiety in the multivariate logistic regression model showed tooth loss was associated with lifestyle (OR=1.95, 95% CI=1.17 - 3.24), age (OR=2.65, 95% CI=1.64 - 4.26), and Angle's malocclusion II and III (OR=2.86; 95% CI=1.67 - 4.90). A slight association toward tooth loss was observed (p<0.10) in the sex and stress variables. CONCLUSIONS: Lifestyle and tooth loss have a substantial association. According to age group, these results suggest tooth loss is an oral health problem in the study population.     

Role of smoking and HbA1c level in periodontitis among insulin-dependent diabetic patients

OBJECTIVES: The aim was to analyse the role of smoking and HbA1c level in attachment loss (AL) and probing depths (PDs) among insulin-dependent diabetic patients. MATERIAL AND-METHODS: The study subjects were selected from a group of 149 insulin-dependent diabetic patients and included 64 patients (39 men and 25 women) aged 30 years or older. Data were obtained from patient records and by clinical examination. The outcome variables were the number of sites with AL and PDs of 5-9 mm. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated using Poisson regression models. RR was adjusted for the number of teeth, dental calculus and age. RESULTS: RR for AL among the smokers was 4.15 (95% CI: 2.30-7.63) and that for PD among the smokers was 7.96 (95% CI: 4.91-13.19). HbA1c was not related to AL or PD. Among smokers with HbA1c > 8.5, RR for AL was 12.34 (95% CI: 4.14-39.35), but RR was not elevated for PD. CONCLUSIONS: It can be concluded that the poor metabolic control together with smoking is extremely detrimental for AL.     

Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population

OBJECTIVE: We investigated the association between glycemic control of type 2 diabetes mellitus (type 2 DM) and severe periodontal disease in the US adult population ages 45 years and older. METHODS: Data on 4343 persons ages 45-90 years from the National Health and Nutrition Examination Study III were analyzed using weighted multivariable logistic regression. Severe periodontal disease was defined as 2 + sites with 6 + mm loss of attachment and at least one site with probing pocket depth of 5 + mm. Individuals with fasting plasma glucose > 126 mg/dL were classified as having diabetes; those with poorly controlled diabetes (PCDM) had glycosylated hemoglobin > 9% and those with better-controlled diabetes (BCDM) had glycosylated hemoglobin 相似文献   

2型糖尿病家系成员牙周状况调查

目的调查2型糖尿病家系成员的牙周状况。方法共收集43个家系[167人，男性71人，女性96人，平均年龄为（49.2±12.2）岁]，分别抽取静脉血，并选取每位受检者的6颗代表牙，记录每颗牙的6个位点的菌斑指数（plaque index，PLI）、牙龈出血指数（bleeding index，BI）、牙周探诊深度（probing depth，PD）、附着丧失（attachment loss，AL）并记录总牙数及失牙数。结果43个家系中共有糖尿病患者101例，其中4例全口牙缺失，经牙周病问卷调查显示，均为牙齿松动自行脱落或拔除。97例糖尿病患者均患牙周炎，其中轻度牙周炎50例，中度牙周炎24例，重度牙周炎23例。48例非糖尿病者中牙龈炎5例，轻度牙周炎30例，中度牙周炎11例，重度牙周炎2例。糖尿病患者和非糖尿病者龈炎和轻、中、重度牙周炎患病率差异有统计学意义（X^2=17.96，P〈0.005），糖尿病患者的PD、AL及缺失牙数均高于非糖尿病者，差异有统计学意义（P〈0.05）。血糖控制不良的糖尿病患者BI、AL均显著高于血糖控制良好的糖尿病患者（P〈0.05）。血糖控制良好的糖尿病患者PLI、BI、PD及AL略高于非糖尿病者，但差异无统计学意义。结论在糖尿病家系成员中糖尿病患者的牙周炎患病率明显高于非糖尿病者，牙周破坏程度亦明显重于非糖尿病者；血糖控制良好患者的牙周状况与非糖尿病者相似。     

Oral care practices and A1c among youth with type 1 and type 2 diabetes

Background: Periodontal treatment is associated with lower hemoglobin A1c in individuals with diabetes, but the relationship between oral hygiene practices and A1c among youth with diabetes is understudied. Methods: This study evaluates the cross‐sectional relationships among oral health habits, reported oral conditions, and A1c and control of diabetes among a subset of youth with diabetes enrolled in the SEARCH for Diabetes in Youth study in South Carolina. Oral hygiene practices were determined by questionnaire, and periodontal bone loss was defined as alveolar bone loss ≥3 mm on ≥1 permanent tooth site on preexisting bitewing radiographs. A1c was considered controlled if individuals were aged ≤6 years with A1c <8.5%; aged 7 to 11 years with A1c <8.0%; aged 12 to 18 years with A1c <7.5%; and aged ≥19 years with A1c <7.0%. Results: Among 155 participants, 68% brushed their teeth no less than once daily, 84% flossed, and 70% rinsed, respectively, less than once a week. Diabetes control was associated with toothbrushing (≥1 time daily [odds ratio (OR) = 3.10; 95% confidence interval (CI) = 1.26 to 7.62] and using mouthrinse at least once weekly (OR = 3.33; 95% CI = 1.30 to 8.54) after multivariate adjustment. Periodontal bone loss was three times more common among those with dry mouth (OR = 3.05; 95% CI = 1.07 to 8.70). Conclusions: Clinicians should be aware that children with diabetes tend to have poor oral hygiene practices. Dry mouth may indicate periodontal bone loss in children with diabetes.     

Comparison of periodontal and peri-implant inflammatory parameters among patients with prediabetes,type 2 diabetes mellitus and non-diabetic controls

Objective: The aim was to compare periodontal and periimplant inflammatory parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD] and marginal bone loss [MBL]) among patients with prediabetes, type-2 diabetes mellitus (T2DM) and non-diabetic controls.

Materials and methods: Forty-five patients with prediabetes (Group-1), 43 patients with T2DM (Group-2) and 42 controls (Group-3) were included. Demographic data was recorded using a questionnaire. Full mouth and periimplant clinical (PI, BOP and PD) were assessed and the radiographic MBL were measured on digital radiographs. In all groups, haemoglobin A1c (HbA1c) levels were also measured. p values less than .05 were considered statistically significant.

Results: The mean HbA1c levels of participants in groups 1, 2 and 3 were 6.1%, 8.4% and 4.8%, respectively. The mean duration of prediabetes and T2DM among patients in groups 1 and 2 were 1.9?±?0.3 and 3.1?±?0.5 years, respectively. Periodontal and periimplant PI, BOP, PD and MBL were higher in groups 1 (p?p?Conclusions: Periodontal and periimplant inflammatory parameters were worse among patients with prediabetes and T2DM compared with controls; however, these parameters were comparable among patients with prediabetes and T2DM.     

Distribution of genotypes of Porphyromonas gingivalis in type 2 diabetic patients with periodontitis in Mexico

OBJECTIVE: To determine and compare the distribution of Porphyromonas gingivalis fimA genotypes in type 2 diabetes mellitus (T2DM) patients affected by periodontitis, using non-diabetic subjects with and without periodontitis as control groups. MATERIAL AND METHODS: This study involved 75 subjects divided into three groups of 25 subjects each: Group 1 (non-T2DM without periodontitis), Group 2 (non-T2DM with periodontitis) and Group 3 (T2DM with periodontitis). The outcome variable was periodontitis, and explanatory variables were age, sex, T2DM and specific P. gingivalis fimA genotypes. RESULTS: In non-T2DM subjects with healthy periodontal tissues, type I fimA was the most frequently detected individually (40%) or in combinations (40%). In non-T2DM subjects with periodontitis, the most frequently detected type was Ib individually (20%) or in combinations (36%). In T2DM patients with periodontitis, the most frequently detected types were types I (20%) and III (20%), but there was no statistical difference (p>0.05) with non-T2DM periodontitis subjects. CONCLUSIONS: Type I genotype was more frequently detected in periodontally healthy sites from non-T2DM subjects than in periodontitis sites from either subjects with or without T2DM. However, in sites affected by periodontitis from T2DM subjects the predominating types were I and III, which are less virulent strains of P. gingivalis.     

Root surface and coronal caries in adults with type 2 diabetes mellitus

OBJECTIVES: To determine the effect of type 2 diabetes mellitus (DM) on coronal and root surface caries and to investigate some factors suspected of being related to or interacting with DM, that may be associated with coronal and root surface caries. METHODS: A stratified cross-sectional study was conducted in 105 type 2 diabetic patients and 103 non-diabetic subjects of the same age and gender. Coronal and root surface caries, exposed root surfaces, periodontal status, stimulated salivary functions, oral hygiene status, oral health behaviors, and counts of mutans streptococci and lactobacilli were measured. RESULTS: Type 2 diabetic patients compared with non-diabetic subjects had a higher prevalence of root surface caries (40.0% versus 18.5%; P = 0.001), a higher number of decayed/filled root surfaces (1.2 +/- 0.2 versus 0.5 +/- 0.1; P < 0.01) and a higher percentage of generalized periodontitis (98.1% versus 87.4%; P < 0.01); but the prevalence and decayed/filled surface of coronal caries was not significantly different (83.8% versus 72.8% and 8.0 +/- 9.4 versus 6.3 +/- 7.5 respectively). The factors associated with root surface caries included type 2 DM, a low saliva buffer capacity, more missing teeth, and existing coronal caries; whereas wearing removable dentures, more missing teeth, a high number of lactobacilli, and a low saliva buffer capacity were associated with coronal caries. CONCLUSION: Type 2 DM is a significant risk factor for root surface, but not for coronal caries. Periodontal disease should be treated early in type 2 diabetic subjects to reduce the risk of subsequent root surface caries.     

Periodontal Inflammatory Conditions Among Smokers and Never‐Smokers With and Without Type 2 Diabetes Mellitus

Background : There is a dearth of studies regarding the influence of cigarette smoking on periodontal inflammatory conditions among patients with type 2 diabetes mellitus (T2DM). The aim of the present study is to assess periodontal inflammatory conditions among smokers and never‐smokers with and without T2DM. Methods: One hundred individuals (50 patients with T2DM [25 smokers and 25 never‐smokers] and 50 controls [25 smokers and 25 never‐smokers]) were included. Information regarding age, sex, duration and daily frequency of smoking, duration and treatment of diabetes, and oral hygiene was recorded using a questionnaire. Periodontal parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [AL], and marginal bone loss [MBL]) were measured. Hemoglobin A1c (HbA1c) levels were also recorded. Results: Mean age, monthly income status, and education levels were comparable among smokers and never‐smokers with and without T2DM. Mean HbA1c levels were significantly higher among patients with T2DM (8.2% ± 0.1%) compared with controls (4.4% ± 0.3%) (P <0.05). Smokers in the control group were smoking significantly greater numbers of cigarettes (15.5 ± 2.5 cigarettes daily) compared with smokers with T2DM (6.2 ± 2.1 cigarettes daily) (P <0.05). Periodontal parameters were comparable among smokers and never‐smokers with T2DM. Among controls, periodontal parameters (PI [P <0.05], AL [P <0.05], PD ≥4 mm [P <0.05], and MBL [P <0.05]) were significantly higher in smokers than never‐smokers. Never‐smokers with T2DM had worse periodontal status than smokers and never‐smokers in the control group (P <0.05). Conclusions: Periodontal inflammatory conditions are comparable among smokers and never‐smokers with T2DM. Among controls, periodontal inflammation is worse among smokers than never‐smokers.