The purpose of this study was to evaluate the association between long-term control of diabetes mellitus (DM) and periodontitis. A total of 75 diabetics (Type I or II) aged 20-70 years with long-term records of their diabetic control were selected for the study. The following periodontal variables were recorded in a randomized half-mouth examination: plaque, calculus (+/-), probing depth (pd) and attachment loss (al). The mean of glycosylated hemoglobin measurements (HbAlc) over the past 2-5 years was used to indicate the long-term control of DM. The study participants were divided into well-, moderately- and poorly-controlled diabetics. An increase in the prevalence, severity and extent of periodontitis with poorer control of diabetes was observed. The extent of calculus also increased with poorer control. In a multiple regression analysis, calculus and long-term control of diabetes were significant variables when pd > or = 4 mm was used as the dependent variable. Age was a significant predictor for al > or = 3 mm but not for pd > or = 4 mm. Sex, duration and type of DM were not significant variables in the regression models. Less than 2% of sites with no calculus demonstrated pd > or = 4 mm. When calculus was present, the frequency of pd > or = 4 mm increased from 6% in the well-controlled diabetics to 16% in the poorly-controlled ones. We conclude that periodontitis in diabetics is associated with long-term metabolic control and presence of calculus.(ABSTRACT TRUNCATED AT 250 WORDS)

With the increasing number of diabetics in an aging population and controversial research reports on the relationship of diabetes to periodontitis, clarification of diabetes as a risk factor for periodontitis would be helpful. This review notes variations in type, metabolic control, and duration of diabetes and highlights the results of studies that have considered these variations. Diabetics who maintained reasonably good metabolic control had not lost more teeth or experienced more periodontal attachment loss than non‐diabetics, although they had more periodontal pockets. Poorly‐controlled diabetics with extensive calculus on their teeth had more periodontitis and tooth loss than well‐controlled diabetics or non‐diabetics. Long‐duration diabetics were also at greater risk for periodontitis. Mechanisms by which diabetes may contribute to periodontitis include vascular changes, neutrophil dysfunction, altered collagen synthesis, and genetic predisposition. Minimizing plaque and calculus in the oral cavity through careful self‐care and regular professional care is important to reduce the risk of periodontitis in diabetics. J Periodontol 1994; 65:530–538.

Variation in the periodontal health status and the response to oral hygiene education, scaling and root planing were studied in 36 subjects with type-1 diabetes mellitus (DM) and in 10 non-diabetic control subjects. The age range of the subjects was 24-36 years. The diabetic group was divided into 3 subgroups based on the levels of glycosylated hemoglobin (HbAlc) over a 3 year period and the presence of diabetic complications as follows: (D1) subjects with good metabolic control and no complications (n=13), (D2) subjects with varying metabolic control with/without retinopathy (n=15) and (D3) subjects with severe diabetes, i.e., with poor long-term control and/or multiple complications (n= 8). Clinical measurements (plaque, subgingival calculus, probing pocket depth, bleeding after probing and clinical attachment level) were performed at the baseline and 4 weeks and 6 and 12 months after periodontal therapy. The between-group comparisons were made using the Student t-test and ANOVA. Based on the plaque scores, the oral hygiene status was similar in all groups during the whole study. No statistically-significant differences in the periodontal health status could be found between the diabetic group as a whole and the non-diabetic controls at any examination. The level of periodontal health of the diabetics with good control and no complications (D1) and those with moderate control with/without retinopathy (D2) was on the same level with that seen in the non-diabetic controls. Our findings of the significantly higher extent of al > or =2 mm at the baseline and the fast recurrence of pd > or =4 mm during the longitudinal study in diabetic subjects with poor metabolic control and/or multiple complications (D3) indicate increased periodontal breakdown as a complication of DM in these subjects. To be able to assess the periodontal prognosis and the need for periodontal therapy on an individual basis,the clinical practitioner should be well aware of the diabetic status of his/her patients.

According to the present results, an evident association exists between the carriage of the T-containing genotype of CD14(-260) and the GG genotype of IL-6(-174) and the extent periodontal disease.

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