Mechanisms linking periodontitis and diabetes

Background + Aims

• Periodontitis, a chronic condition that damages the tissues and bones supporting teeth, linked to systemic inflammation.
• Systemic low-grade inflammation is common in chronic conditions like diabetes and obesity and may contribute to the progression of periodontitis.
• Markers such as fibrinogen and white blood cell (WBC) counts are often used to measure systemic inflammation.
• This study explored the long-term relationship between systemic inflammatory markers and periodontal disease severity over an 11-year follow-up.
• The hypothesis was that low-grade inflammation could serve as a pathway linking conditions like obesity and diabetes to worsening periodontitis.

Materials + Methods

• Prospective cohort study using data from the Study of Health in Pomerania (SHIP), involving 1,784 participants with an 11-year follow-up.
• Systemic inflammation was evaluated using fibrinogen levels and WBC counts.
• Dental assessments were conducted at baseline and follow-up.
• Periodontitis was assessed through:
  • Probing pocket depth (PPD)
  • Clinical attachment loss (CAL)
• Periodontitis was diagnosed using CDC/AAP classification.
• The following factors were accounted for age, gender, smoking, physical activity, alcohol consumption, socioeconomic status, obesity, diabetes, and dyslipidaemia.
• Multilevel regression models evaluated relationships between inflammation markers and periodontitis progression, adjusting for confounders.
• Inflammatory markers were measured through standardised blood tests.

Results

• Higher levels of fibrinogen and WBC were consistently associated with increased periodontitis severity (more sites with PPD/CAL ≥ 3 mm).
  • An increase of 1 g/L in fibrinogen correlated with 3% more affected sites for PPD and 2.7% for CAL.
  • A 1 Gpt/L increase in WBC counts was linked to 1.1% more sites for PPD and 1.3% for CAL.
• Change-on-change analyses confirmed that long-term elevations in inflammatory markers were associated with worsening periodontal conditions.
• No significant relationships were found between inflammatory markers and tooth loss or caries experience.

Limitations