Diabetes as a prognostic factor in periodontitis

Background + Aims

• The study represents a significant contribution to the understanding of long-term outcomes in periodontal treatment, specifically for patients diagnosed with stages III and IV periodontitis. With the ultimate goal of preserving natural teeth for life, the research addresses the critical need for comprehensive data on tooth loss and treatment efficacy over extended periods.
• Previous studies have indicated that while tooth loss rates are generally low, various factors such as age, smoking, and initial tooth prognosis can influence outcomes. However, many of these studies lacked robust methodologies and long-term follow-up, limiting their applicability to lifetime treatment scenarios.
• By analysing patient data, including smoking status and treatment responses, the researchers aimed to identify patterns of tooth loss and the effectiveness of conventional periodontal therapies. The findings not only provide insights into the stability of periodontal health over time but also highlight the variability in outcomes among patients with similar initial conditions.
• The aim of the study was to investigate the long-term outcomes of periodontal treatment in patients with stages III and IV periodontitis over a 30-year period in a private practice setting.

Materials + Methods

• A 30-year retrospective cohort study was conducted, focusing on patients diagnosed with stages III and IV periodontitis who were referred to a private practice between 1986 and 1990.
• Patients were monitored for tooth loss and treatment outcomes over a period of 30 years, with a focus on those who completed the full duration of treatment.
• Information was collected on various factors, including smoking status, compliance with maintenance therapy, and the presence of systemic conditions such as diabetes.
• Tooth loss was recorded longitudinally, specifying total tooth loss and loss due to periodontal disease, with patients categorised into groups based on the extent of tooth loss.
• The study analysed factors influencing tooth loss, including age, smoking habits, family history of periodontal disease, and initial tooth prognosis.
• Data were analysed to identify trends and correlations between treatment outcomes and prognostic factors, ensuring that all dropouts were accounted for in the analysis.

Results

• A total of 386 patients were included in the study, with an average age of 46.2 years at the start. The cohort consisted of 219 females (56.7%) and 167 males (43.3%). Patients were monitored for an average follow-up time of 16.3 years, with a range of 1 to 34 years.
• The study found that tooth loss was stable for the first 16 years, after which patients were categorised into three groups based on the extent of tooth loss: low (n=65), moderate (n=18), and high (n=20).
• The low tooth loss group lost an average of 1.05 teeth, the moderate group lost 4.83 teeth, and the high tooth loss group lost 11.90 teeth over the follow-up period.
• Significant prognostic factors identified included a family history of periodontitis, prior periodontal treatment before age 35, diabetes, and initial tooth prognosis.
• Out of the original cohort, 283 patients dropped out, leaving 103 patients (67 females and 36 males) who were continuously monitored.
• The results indicated that most patients could maintain their teeth successfully with conventional periodontal treatment over the long term, although a minority experienced significant tooth loss.

Limitations