Association between periodontitis and diabetes

Background + Aims

• Type 1 Diabetes Mellitus (T1DM) is associated with systemic inflammation, which may worsen oral health. Periodontitis, a chronic inflammatory condition leading to gum and bone loss, has been linked to worse glycaemic control. While studies highlight the relationship between Type 2 Diabetes and periodontal disease, evidence for such links in Type 1 Diabetes is limited. This study focused on non-smoking adults with T1DM to assess whether they had higher prevalence and severity of periodontitis compared to non-diabetic subjects (NDS), controlling for key confounders such as smoking.
• The primary aim was to compare periodontitis levels and associated clinical indicators in these two groups.

Materials + Methods

• This cross-sectional study included 203 adults with T1DM (169 poorly managed [HbA1c >7.5%], 34 well-managed [HbA1c ≤7.5%]) and 112 NDS, all aged 20-55 years, recruited from Glasgow hospitals and local communities.
• Exclusion criteria included smoking in the past 5 years, pregnancy, prescription of antibiotics or anti-inflammatory drugs within the last 6 weeks, medication within the last 6 weeks which affects oral tissues, immunosuppressive conditions, and fewer than 20 teeth.
• Periodontal assessments were blinded to diabetes status and measured clinical attachment loss (CAL), probing depth (PD), and bleeding.
• Key analyses included:
  • Comparison of periodontitis prevalence using CAL and PD thresholds
  • Adjustments for age, gender, body mass index (BMI), and socioeconomic status to identify independent effects of T1DM on periodontal health.

Results

• Severe periodontitis (CAL ≥6 mm on at least one tooth) was more common in T1DM patients (24.1%) than in NDS (20.5%), with an adjusted odds ratio (OR) of 1.19. Poorly controlled T1DM showed a higher prevalence (27.2%) but did not reach statistical significance compared to NDS.
• Mean CAL, PD, and bleeding scores were significantly worse in T1DM groups, especially poorly managed patients (p < 0.001).
• Poor oral hygiene and lower salivary flow rates in T1DM patients were potential contributors.