Accurate diagnosis of periodontal destruction in the furcation region of multi-rooted teeth is a critical component of treatment planning, with different therapeutic approaches chosen based upon clinical determination of the severity of involvement. The current study assessed both vertical and horizontal depths of 274 furcations from 67 patients at three separate time points: by probing prior to anesthesia, by bone sounding after administration of anesthesia, and by direct measurement at the time of surgery. All measurements were made to the nearest millimeter. The mean vertical (1.8 mm) and horizontal (2.16 mm) furcation depths determined prior to anesthesia were significantly less than surgical measurements (2.79 mm and 3.65 mm, respectively). Use of sounding significantly improved the mean accuracy of vertical (2.40 mm) and horizontal (3.11 mm) furcation depth measurements relative to surgical determinations (P = 0.000). Surgical vertical depth was exactly the same as pre-anesthesia probing in 42% of furcations, within +/- 1 mm in 72.3% and within +/- 2 mm in 83.6%. Use of post-anesthesia sounding improved agreement in vertical measurements to 59.5%, 85.7%, and 93.1%, respectively. Surgical horizontal depth was exactly the same as pre-anesthesia probing measurements in 47.1% of furcations, within +/- 1 mm in 68.3% and within +/- 2 mm in 77.4%. Sounding improved agreement of horizontal measurements to 64.2%, 83.6%, and 88.3%, respectively. Underestimation of surgical furcation depths by pre-anesthesia probing was much more common than overestimation. Sounding reduced the percent and degree of underestimation in all furcation types. The data demonstrate the ability of post-anesthesia bone sounding to significantly improve the diagnostic accuracy of furcation invasions.

The prevalence of periodontal disease (POD) among adults aged 30 years and older in the United States is reported to be more than 47%, with higher prevalence seen among patients with diabetes mellitus (DM). POD has been associated with systemic inflammation, a known risk factor for cardiovascular and bone disease, both of which are more common in patients with DM. However, there is mixed evidence that treatment of POD reduces inflammation, improves DM control, and reduces DM complications. Our study objectives are to assess factors associated with POD in patients with DM and determine the impact of POD treatment on inflammation and bone turnover biomarkers associated with complications of DM. In this pilot study, we will first recruit 200 patients with DM to complete a 48-item investigator-administered questionnaire designed to assess socio-economic status, oral health status, adequacy of oral care, glycemic control and presence of DM complications. Responses will be verified by individual chart review. Then, using a crossover design, a subgroup of 24 subjects with responses suggestive of POD will be assigned to undergo POD treatment for three months followed by three months of routine dental care (Group 1) or be followed for three months during routine dental care then receive POD treatment for three months (Group 2). Outcome measures will be collected before and after POD treatment and include glycemic control and inflammatory and bone turnover biomarkers. We hypothesize that the prevalence of POD among DM patients will be associated with inadequate glycemic control and greater DM complications.

Aims There is a high prevalence of dental loss among patients with diabetes. Understanding the factors that impact dental loss in this population will aid with developing new strategies for its prevention. Methods Using a cross-sectional study design, diabetes patients presenting for routine clinic visit were evaluated with an investigator-administered questionnaire. Data was collected on demographics, dental history, duration, control and complications of diabetes. Results Among 202 subjects, 100 were female, mean age: 58.9 ± 13.2 years, duration of diabetes: 15.8 ± 11.0 years, and hemoglobin A1c: 7.7 ± 1.6%. Thirty-one patients (15.3%) had lost all their teeth and only 13 (6.4%) had all 32 of their natural teeth. Using multiple linear regression, older age (β= − 0.146; 95% CI: − 0.062 to − 0.230), not flossing (β= − 3.462; 95% CI: − 1.107 to − 5.817), and presence of diabetic retinopathy (β= − 4.271; 95% CI: − 1.307 to − 7.236) were significant predictors of dental loss. Conclusions Dental loss is common in patients with diabetes and is associated with older age, diabetic retinopathy and not flossing. In order to reduce dental loss among patients with diabetes, regular flossing should be emphasized as an important component of dental care.

There is mixed evidence regarding the impact of poor dental health on cardiovascular disease and other health outcomes. Our objective was to determine the outcomes associated with poor dental health among hospitalized patients with and without diabetes mellitus (DM) at our institution. We enrolled a consecutive sample of adult patients admitted to an academic medical center. We gathered demographic, health and dental information, reviewed their medical records and then examined their teeth. We analyzed data using SPSS V.24. There was a high prevalence of dental loss among all hospitalized patients. Older age (p<0.001), smoking (p=0.034), having DM (p=0.001) and lower frequency of teeth brushing (p<0.001) were predictors of having a lower number of healthy teeth. Among DM and non-DM patients, fewer remaining healthy teeth was associated with presence of heart disease (p=0.025 and 0.003, respectively). Patients with diabetes mellitus (DM) had a higher prevalence of stroke (p=0.006) while patients without DM had a higher number of discharge medications (p=0.001) associated with having fewer number of healthy teeth. There was no correlation between number of healthy teeth and the length or frequency of hospitalization. Patients with DM are more likely to have fewer number of healthy teeth compared with non-DM patients. Fewer number of healthy teeth was associated with higher prevalence of heart disease in both DM and non-DM patients and with more discharge medications in non-DM patients.

Background The underlying mechanisms for increased osteopenia and fracture rates in patients with diabetes are not well understood, but may relate to chronic systemic inflammation. We assessed the effect of treating periodontal disease, a cause of chronic inflammation, on inflammatory and bone turnover markers in patients with diabetes. Methods Using an investigator-administered questionnaire, we screened a cross-section of patients presenting for routine out-patient diabetes care. We recruited 22 subjects with periodontal disease. Inflammatory and bone turnover markers were measured at baseline and 3 months following periodontal disease treatment (scaling, root planing and sub-antimicrobial dose doxycycline). Results There were non-significant reductions in high sensitivity C-reactive protein (6.34 to 5.52 mg/L, p=0.626) and tumor necrosis factor-alpha (10.37 to 10.01 pg/ml, p=0.617). There were non-significant increases in urinary C-terminal telopeptide (85.50 to 90.23 pg/ml, p=0.684) and bone-specific alkaline phosphatase (7.45 to 8.79 pg/ml, p=0.074). Patients with >90% adherence with doxycycline were 6.4 times more likely to experience reduction in tumor necrosis factor-alpha (p=0.021) and 2.8 times more likely to experience reductions in high sensitivity C-reactive protein (p=0.133). Conclusions Treatment of periodontal disease in patients with diabetes resulted in non-significant lowering of inflammatory markers and non-significant increase in bone turnover markers. However, adherence to doxycycline therapy resulted in better treatment effects.