Association between periodontitis and diabetes

Background + Aims

• Periodontal disease, a chronic inflammatory condition affecting the supporting structures of teeth, is prevalent among individuals with diabetes, who are often at a heightened risk due to compromised immune responses and metabolic dysregulation. Conversely, poor glycaemic control has been implicated in the progression of periodontal disease, suggesting a bidirectional relationship that warrants further investigation.
• Despite the growing body of evidence linking these two conditions, much of the existing research has focused on unidirectional associations, leaving a gap in understanding the reciprocal nature of periodontal health and glycaemic status.
• This study aims to address this by employing a longitudinal design to explore the bidirectional temporal relationship between periodontal condition and glycaemic status, specifically assessing how each condition may influence the other over time.

Materials + Methods

• A longitudinal study was conducted to examine the bidirectional association between periodontal condition and glycaemic status over a five-year period.
• Baseline and follow-up examinations included medical and dental assessments, focusing on periodontal health and glycaemic status. Probing pocket depth (PPD) and clinical attachment level (CAL) were measured at two sites per tooth, excluding third molars. The percentage of teeth with bleeding on probing was also recorded. Fasting glucose and glycated haemoglobin (HbA1c) levels were assessed to evaluate participants’ glycaemic control.
• Cross-lagged panel analysis was performed using the Mplus statistical package to assess the relationships between baseline and follow-up measurements.
• The analysis adjusted for potential confounding factors, including age, sex, smoking status, toothbrushing frequency, regular dental visits, occupation, drinking habits, exercise, and obesity.
• The primary outcomes were mean PPD and mean CAL at follow-up, with the aim of determining the predictive relationships between glycaemic status and periodontal condition.

Results

• The study initially included 6572 participants, with 2198 included after excluding those with missing data. Participants excluded from the analysis had worse periodontal conditions, poorer glycaemic status, and more smokers compared to those included.
• Significant correlations were observed between periodontal condition (mean PPD and CAL) and glycaemic status (fasting glucose and HbA1c) at both baseline and follow-up.
• A significant prospective association was found where a 1% increase in HbA1c at baseline resulted in a 0.027 mm increase in mean probing pocket depth at follow-up (p = .032).
• The analysis showed that baseline HbA1c was associated with mean probing pocket depth at follow-up (β = 0.044, p = .039), while no significant effect of baseline periodontal condition on glycaemic status was identified.
• A marginal effect of fasting glucose on mean probing pocket depth was noted (β = 0.037, p = .059).

Limitations