Impact of diabetes management on periodontitis

Background + Aims

• Periodontal disease and type 2 diabetes mellitus (T2DM) are interrelated, with evidence suggesting that periodontal disease worsens diabetic control and, conversely, that managing periodontal disease can improve glycaemic control. The host inflammatory response plays a key role in increasing susceptibility to periodontal disease, particularly in individuals with systemic conditions like T2DM. Studies show that individuals with severe periodontitis experience more diabetes-related complications and have poorer HbA1c levels over time.
• The Gullah population of coastal South Carolina and Georgia, descendants of enslaved Africans, is particularly affected by T2DM due to their genetic predisposition and social isolation. The Gullah have a higher prevalence of chronic diseases, including obesity and hypertension, compared to other populations.
• Notably, periodontal disease is more prevalent among Gullah individuals with T2DM (70.6%) compared to national estimates for African Americans with diabetes (31.3%).
• This study aimed to explore the relationship between glycaemic control and periodontal disease progression in Gullah individuals with T2DM.

Materials + Methods

• The study involved 88 Gullah African American adults with type 2 diabetes mellitus (T2DM) who participated in a longitudinal cohort from a previous cross-sectional study (2007–2009) to evaluate periodontal disease progression.
• Participants were followed for an average of 3 years, from baseline (pre-treatment) to follow-up, before undergoing periodontal interventions.
• Inclusion criteria required participants to have ≥3 natural teeth (excluding third molars) and no periodontal treatment within the prior six months.
• Participants were excluded if they:
  • Had abnormal blood glucose levels, hepatic or renal dysfunction, and haemoglobinopathy
  • Had advanced periodontal disease
  • Were pregnant
  • Required antibiotic prophylaxis before dental procedures
• Clinical assessments included:
  • Medical history
  • Anthropometrics (weight, height, blood pressure)
  • Laboratory tests for glaciated haemoglobin (HbA1c), glucose, C-peptide, creatinine clearance, and lipid profiles.
    • HbA1c levels were measured at baseline and follow-up using high-performance liquid chromatography.
• Oral health assessments involved radiographic and soft tissue examinations, probing pocket depths (PPD), clinical attachment levels (CAL), and bleeding on probing (BOP) at six sites per tooth. Oral hygiene habits were assessed via questionnaire.
• Data analysis included 10,148 tooth sites at baseline and 9,880 at follow-up, with a small reduction due to tooth loss or missing data.
• The study used multivariable logistic regression with generalised estimating equations (GEE) to account for the clustering of tooth sites within patients.
• The progression of periodontal disease (PPD, CAL, BOP) was analysed in relation to glycaemic control (HbA1c) and covariates like age, gender, BMI, and smoking status. Models were adjusted for baseline periodontal status, and results were presented as odds ratios with 95% confidence intervals.

Results

• The study followed 88 Gullah African Americans with type 2 diabetes mellitus (T2DM) for an average of 3 years.
• At baseline:
  • Mean age was 55.57 years
  • Average diabetes duration was 10.65 years.
  • Most participants were obese (71.59%)
  • The majority were non-smokers (76.14%).
  • Average  PPD was 1.85 mm (with similar values across participants with well-controlled and poorly controlled diabetes)
  • Average CAL  was 1.86 mm (with similar values across participants with well-controlled and poorly controlled diabetes)
• HbA1c levels ranged from 4.70% to 15.10%, with 68.18% of subjects classified as having poorly controlled diabetes at follow-up.
• The study found significant associations between poor glycaemic control and periodontal disease progression.
• Subjects with poorly controlled diabetes had increased odds of experiencing PPD and AL progression compared to those with well-controlled diabetes.
• OR for PPD progression were:
  • Baseline PPD = 3mm – OR: 1.98
  • Baseline PPD = 5mm – OR: 2.76
  • Baseline PPD = 7mm – OR 3.85
• OR for CAL progression were:
  • Baseline PPD = 3mm – OR: 1.93
  • Baseline PPD = 5mm – OR: 2.64
  • Baseline PPD = 7mm – OR: 3.62
• Molar teeth and sites from obese individuals showed higher odds of periodontal progression.
• Obese individuals had an OR of 2.64 compared to those with normal BMI. However, smoking status, age, and upper-jaw tooth sites were not consistently significant predictors.
• BOP progression was not significantly associated with glycaemic control, though past smoking status and upper-jaw sites showed increased odds of BOP progression.
• Overall, the results indicate that poor glycaemic control and obesity are key risk factors for periodontal disease progression in this population.

Limitations