Mechanisms linking periodontitis and diabetes

Background + Aims

• Periodontal disease is a common complication in individuals with type 1 diabetes mellitus (T1DM), often exacerbated by inflammatory responses.
• Research suggests an association between periodontal inflammation and altered serum lipid profiles, such as decreased high-density lipoprotein (HDL) levels and increased low-density lipoprotein (LPL), triglycerides, and total cholesterol.
• HDL cholesterol is known for its anti-inflammatory properties, which may play a role in periodontal health.
• This study aimed to investigate the association between serum HDL cholesterol levels and the extent of periodontal inflammation in T1DM patients. By understanding this relationship, the research seeks to identify potential biomarkers for periodontal disease and explore the implications of HDL cholesterol in managing oral health among diabetic individuals.
• The study hypothesised that higher serum HDL levels would correlate with reduced periodontal inflammation, as measured by the number of sites with bleeding and probing pocket depth (PPD) ≥4 mm
• This research is significant as it could provide insights into preventive strategies for periodontal disease in T1DM patients, ultimately improving their overall health outcomes.

Materials + Methods

• 80 caucasian patients with T1DM were examined at the Specialist Dental Health Care Unit in Oulu, Finland.
• Exclusion criteria included the need for prophylactic antibiotics during periodontal probing and recent immunosuppressive or antibiotic treatments.
• Clinical periodontal examinations were conducted by an experienced specialist, assessing plaque presence, bleeding on probing (BOP), and probing pocket depth (PPD) using a standardised protocol.
• Blood samples were collected to measure serum HDL and LDL cholesterol levels, as well as glycosylated hemoglobin (HbA1c) levels.
• Statistical analyses were performed, with a significance level set at p < 0.05.
• Linear regression models were employed to evaluate the associations between serum HDL levels and the number of inflamed sites, adjusting for confounding factors such as age, gender, smoking status, and IL-6 genotype.
• The subjects were categorised into tertiles based on HDL levels to further explore the relationship with periodontal inflammation.

Results

• The study found:
  • Average HbA1c level of 8.5% (±1.4).
  • Mean serum HDL cholesterol level among participants was 1.5 mmol/l (±0.4)
  • 30% of subjects being smokers
• A significant negative association was observed between serum HDL levels and the number of sites with bleeding and PPD ≥ 4 mm, indicating that higher HDL levels were linked to reduced periodontal inflammation (B = -9.72, p = 0.022).
• When subjects were divided into tertiles based on HDL levels, no significant differences in demographic characteristics were noted, except for a higher proportion of females in the highest tertile.
• The analysis revealed that plaque presence, HbA1c levels, age, gender, and smoking status were associated with periodontal inflammation. However, other lipid parameters, including total cholesterol, LDL, and triglycerides, did not show significant associations.

Limitations