Diabetes as a prognostic factor in periodontitis

Background + Aims

• Periodontal maintenance (PM) is crucial for preventing the progression of periodontitis and minimising tooth loss after active periodontal treatment (APT). It includes tailored care such as oral hygiene education, scaling, root planing, and tooth polishing.
• Despite advances in periodontal therapy, factors like age, smoking, diabetes, and compliance with PM visits impact treatment outcomes.
• This updated review revisits predictors of tooth loss during PM, focusing on systemic and local factors like tooth type and location.
• The study builds on previous findings and addresses gaps in research, aiming to clarify the risks of tooth loss over long-term PM.
• The research question explores the relationship between systemic conditions (e.g. diabetes) and tooth loss in patients who underwent APT and adhered to PM protocols.

Materials + Methods

• The systematic review adhered to PRISMA guidelines and Cochrane methodology.
• Inclusion criteria:
  • Studies with patients undergoing APT and at least 5 years of PM.
  • Data on tooth loss (number, percentage, or statistical analysis).
  • Absence of patients with refractory periodontitis or AIDS
  • Absence of patients who missed PM visits.
• Databases searched included PubMed, EMBASE, and Cochrane up to September 2020, supplemented by manual searches.
• Outcome measures:
  • Primary: Tooth loss per patient per year.
  • Secondary: Tooth loss by location (maxilla vs. mandible) and type (molar vs. non-molar).
• Meta-analyses and regressions were used to determine relationships between tooth loss and factors like smoking, diabetes, and furcation lesions.
• Risk of bias was assessed using the Newcastle-Ottawa Scale, categorising studies as low, moderate, or high risk.

Results

• The systematic review included 36 papers (33 studies). These comprised 3 prospective and 30 retrospective cohort studies from 16 countries across Europe, Asia, and America.
• Risk of bias (RoB) was assessed, with 12 studies classified as low RoB, 20 as moderate RoB, and 1 as high RoB. 
• Overall, periodontal interventions during PM generally included oral hygiene instructions, scaling, and root planing.
• Most studies reported reliable tooth loss data and used valid statistical analyses. However, only 9 studies clarified tooth loss due to periodontal reasons.
• A total of 4,381 patients were followed regularly during PM, with tooth loss rates averaging 0.1–0.2 teeth per patient per year. 
• Meta-analysis showed no significant difference in tooth loss rates between prospective and retrospective studies or between studies with varying sample sizes. 
• During PM, 75,776 teeth were present after active periodontal therapy (APT), and 8.8% (6,640 teeth) were lost. 
  • Studies from private practices reported lower tooth loss rates compared to university-based studies. 
  • Tooth loss due to periodontal reasons accounted for 66.88% of total losses in 16 studies. 
  • The comparison between different periodontitis types showed no significant differences in tooth loss rates. 
  • Tooth loss was higher in maxillary and molar teeth compared to mandibular and non-molar teeth.
  • Smoking and diabetes did not significantly influence outcomes.

Limitations

• High heterogeneity in study designs and methodologies, complicating direct comparisons.
• Most studies were retrospective, limiting causal inferences.
• Only a few studies included participants with diabetes, restricting insights on this group.
• Inconsistent reporting of PM protocols and outcomes reduced data comparability.
• Many studies did not differentiate tooth loss due to periodontal reasons from other causes.
• Limited data on patient-related factors, such as compliance and oral hygiene practices.

Conclusion

• Regular periodontal maintenance significantly reduces the risk of tooth loss, with most patients retaining nearly all their teeth over a decade.
• Tooth-specific factors, such as molars and maxillary teeth, remain the primary predictors of loss, while systemic conditions like diabetes show limited influence in this context.
• Emphasising consistent follow-ups and personalised care can help maintain oral health and minimise complications, even in high-risk individuals