A population-based study of periodontal care among those with and without diabetes

Background: Our objectives were to describe the prevalence of periodontal care (a marker of periodontitis) among persons with and without diabetes and to examine the association between periodontal care and diabetes. Methods: We conducted a cross‐sectional analysis, using 5 years of electronic data from a population‐based cohort (N = 46,132), aged 40 to 70 years, with dental and medical insurance, and ≥1 dental and ≥1 medical visit. Periodontal care (yes/no) was defined by dental claims codes for procedures used to manage periodontitis. The association between periodontal care and diabetes was determined using logistic regression adjusted for and stratified by age, sex, insurance type, smoking status, body mass index (BMI) (in kilograms per square meter), and resource utilization band (RUB) (a measure of expected health care utilization attributable to comorbidity). Results: Overall, 11.2% (5,153 of 46,132) met diabetes criteria. The age‐adjusted prevalence of periodontal care among those with and without diabetes was 39.1% and 32.5%, respectively (P <0.0001). The association between diabetes and periodontal care decreased with increasing age (interaction, P <0.0001), adjusting for BMI and RUB. The aged‐stratified, adjusted odds ratio (OR) for periodontal care associated with diabetes was highest among those aged 40 to 44 years [OR, 1.6; confidence interval (CI), 1.30 to 1.97] and lowest among those aged 60 to 64 years (OR, 0.97; CI, 0.81 to 1.15) and was significant only among those aged 40 to 54 years. Conclusion: We found that the prevalence of periodontal care was significantly higher among those with diabetes compared to those without diabetes and that the magnitude of this association decreased with increasing age.     

The effect of smoking on periodontal treatment response: a review of clinical evidence

BACKGROUND: Smoking has been identified as a significant risk factor for periodontal diseases and is regarded as being responsible for incomplete or delayed healing in patients following treatment. AIM AND METHOD: The aim of this conventional review was to review, collate and tabulate the relative effectiveness of treatments of chronic periodontitis in smokers, non-smokers and ex-smokers. OBSERVATIONS: The majority of clinical trials show significantly greater reductions in probing depths and bleeding on probing, and significantly greater gain of clinical attachment following non-surgical and surgical treatments in non-smokers compared with smokers. This benefit is also seen at class I and II furcation sites and in patients prescribed systemic or local antimicrobial treatments. CONCLUSIONS: Data from epidemiological, cross-sectional and case-control studies strongly suggest that quitting smoking is beneficial to patients following periodontal treatments. The periodontal status of ex-smokers following treatment suggests that quitting the habit is beneficial although there are only limited data from long-term longitudinal clinical trials to demonstrate unequivocally the periodontal benefit of quitting smoking.     

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.     

Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective

This review evaluates evidence for a bidirectional relationship between diabetes and periodontal diseases. A comprehensive Medline search of the post-1960 English language literature was employed to identify primary research reports of relationships between diabetes and periodontal diseases. Reports included in the review on the adverse effects of diabetes on periodontal health (DM-->PD) were restricted to those comparing periodontal health in subjects with and without diabetes. Review of adverse affects of periodontal infection on glycemic control included reports of periodontal treatment studies and follow-up observational studies in which changes in glycemic control could be assessed. Observational studies reporting DM-->PD provided consistent evidence of greater prevalence, severity, extent, or progression of at least one manifestation of periodontal diseases in the large majority of reports (supportive evidence in 44/48 total reviewed; 37/41 cross-sectional and 7/7 cohort). Additionally, there were no studies reviewed with superior design features to refute this association. Treatment studies provided direct evidence to support periodontal infection having an adverse, yet modifiable, effect on glycemic control. However, not all investigations reported an improvement in glycemic control after periodontal treatment. Additional evidence to support the effect of severe periodontitis on increased risk for poorer glycemic control comes from 2 follow-up observational studies. The evidence reviewed supports viewing the relationship between diabetes and periodontal diseases as bidirectional. Further rigorous, systematic study is warranted to establish that treating periodontal infections can be influential in contributing to glycemic control management and possibly to the reduction of the burden of complications of diabetes mellitus.     

牙周感染与2型糖尿病患者血清白细胞介素-6水平的关系

目的:探讨牙周感染对2型糖尿病患者血清白细胞介素-6(interleukin-6,IL-6)水平的影响。方法:选择伴重度慢性牙周炎的2型糖尿病患者32例,以年龄(±3)、性别、体重指数(body mass index,BMI)(±1)配比单纯糖尿病对照32例。用酶联免疫测定血清IL-6水平。结果:伴重度慢性牙周炎的2型糖尿病患者血清IL-6测定的阳性百分率明显高于不伴牙周炎的糖尿病患者(P=0.017)。结论:牙周感染可能升高2型糖尿病患者血清IL-6水平。     

2型糖尿病患者牙周指标与糖化血红蛋白关系的研究

目的 :研究 2型糖尿病患者牙周指标与糖化血红蛋白间的相关关系。方法 :随机选择 3 0例 2型糖尿病伴牙周炎患者于牙周基础治疗前检测其体重 ,菌斑指数 ,牙龈指数 ,探诊出血指数 ,探诊深度 ,附着丧失 ,糖化血红蛋白值。结果 :糖化血红蛋白与附着丧失、年龄的密切相关。结论 :糖化血红蛋白是影响牙周破坏的重要指标。     

Java project on periodontal diseases. The natural development of periodontitis: risk factors, risk predictors and risk determinants

OBJECTIVE: To identify risk factors, risk predictors and risk determinants for onset and progression of periodontitis. MATERIAL AND METHODS: For this longitudinal, prospective study all subjects in the age range 15-25 years living in a village of approximately 2000 inhabitants at a tea estate on Western Java, Indonesia, were selected. Baseline examination was carried out in 1987 and follow-up examinations in 1994 and 2002. In 2002, 128 subjects could be retrieved from the original group of 255. Baseline examination included evaluation of plaque, bleeding on probing, calculus, pocket depth, attachment loss and presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, spirochetes and motile microorganisms. RESULTS: The mean attachment loss increased from 0.33 mm in 1987 to 0.72 mm in 1994 and 1.97 mm in 2002. Analysis identified the amount of subgingival calculus and subgingival presence of A. actinomycetemcomitans as risk factors, and age as a risk determinant, for the onset of disease. Regarding disease progression, the number of sites with a probing depth > or = 5 mm and the number of sites with recession were identified as risk predictors and male gender as a risk determinant. CONCLUSION: Screening of these parameters early in life could be helpful in the prevention of onset and progression of periodontal diseases.     

糖尿病与牙周病相关性的流行病学调查

目的：探讨天津地区糖尿病病人牙周疾病的发生情况，以及糖尿病与牙周炎之间的关系。方法：对天津市945名参加年度体检的享有卫生保健的干部和知识分子进行牙周健康状况和全身健康状况检查，其中牙周检查以社区牙周指数（CPI）和附着丧失（AL）作为诊断标准。结果：945名受检人群中共检出糖尿病177例，此糖尿病人群中牙周炎的发生率高达51．41％，与非糖尿病人群（40．23％）比较差异有显著性（χ^2=7．363，P=0．007）。CPI值与空腹血糖呈正相关性（r=0．076，P=0．031），且是糖尿病患病的一个独立的危险因素。结论：糖尿病可以增加牙周炎的发病风险，但长期的牙周炎是否可引起糖尿病的发生，有待于进一步研究。     

Smoking, periodontal disease and the role of the dental profession

Abstract:  Epidemiological investigations support a firm relationship between smoking and periodontal disease. The likely benefits of smoking cessation programmes are considerable for periodontal disease, cancers and nearly all chronic systemic diseases. The mechanisms by which smoking may influence the development and progression of periodontal disease are as yet unclear, but may include changes in the vasculature, the immune and inflammatory systems, tissue oxygenation and the healing processes. Unfortunately, although dental professionals have more opportunities to encourage smokers to quit (most people visit their dentist more frequently than their doctor), dentists claim that they are not well informed on this subject. The purpose of this review is to describe the evidence for a link between smoking and periodontal disease, the possible pathology induced by smoking on the periodontal tissues and its impact on therapy, and to outline the smoking cessation techniques that are currently available.     

糖尿病对大鼠牙周组织及诱导型一氧化氮合酶分布的影响

目的：观察糖尿病对大鼠牙周炎牙周组织形态结构的影响及诱导型一氧化氮合酶（iNOS）在牙龈组织中的分布。方法：建立大鼠糖尿病牙周炎模型,制作组织切片,进行HE及免疫组织化学染色,观察牙周组织形态结构的破坏情况及iNOS在牙龈组织中的分布。结果：糖尿病牙周炎组的结缔组织附着丧失量及牙槽骨高度丧失量均明显高于牙周炎组、糖尿病组及正常组。差异有显著性（P〈0．05）。糖尿病牙周炎组和糖尿病组的免疫组化染色均为阳性或强阳性。结论：糖尿病加重了牙周炎牙周组织的破坏程度。     

Influence of obesity and bariatric surgery on the periodontal condition

Background: Recent studies have shown that being overweight or obese is associated with a higher risk of periodontitis. However, the literature offers an insufficient number of published reports regarding the effect of bariatric surgery on oral health. As such, the present study aims to determine the association between periodontal status and being overweight/obese in prebariatric and postbariatric surgery populations of Brazil. Methods: Three hundred forty‐five participants between 18 and 60 years of age, from both sexes, were grouped according to prebariatric or postbariatric surgery and underwent a complete periodontal examination. Biologic, demographic, and behavioral variables were analyzed in a Poisson regression model. Results: Considering the timing of bariatric surgery, the sample was divided into three groups: PRE‐OP (preoperative, n = 133), POS‐OP1 (postoperative ≤6 months, n = 72), and POS‐OP2 (post‐surgery >6 months, n = 140). Regardless of the type of surgery (PRE‐OP, POS‐OP1, POS‐OP2), the prevalence of periodontitis proved to be high (81.45%). There was a statistically significant difference in the prevalence of periodontitis among the PRE‐OP, POS‐OP1, and POS‐OP2 groups (P = 0.040). In the Poisson regression model, after adjusting for biologic, demographic, and behavioral risk variables, only bleeding on probing remained significantly associated with the prevalence of periodontitis (P <0.001). Conclusion: Differences in periodontal condition were observed in individuals at different times of the bariatric surgery, showing a high prevalence of periodontitis in both preoperative and postoperative follow‐up.