Association of periodontitis and diabetic macular edema in various stages of diabetic retinopathy

Abstract

Objectives Periodontitis and diabetes are known to have a bidirectional relationship. Diabetic macular edema is a complication of diabetes that is strongly influenced by inflammatory pathways. However, it remains to be established whether inflammation at other locations, such as periodontitis, affects diabetic macular edema. Here, we investigated the prevalence of periodontitis in patients treated for diabetic macular edema. Materials and methods Patients with diabetic macular edema were recruited for this cross-sectional study at the Medical University of Graz. Macular edema was documented by optical coherence tomography. Periodontal status was assessed by computerized periodontal probing and panoramic X-ray imaging. Bleeding on probing, clinical attachment level, probing pocket depth, and plaque index were compared between different stages of diabetic retinopathy. Results Eighty-three eyes of 45 patients with diabetic macular edema were enrolled. Forty-four eyes (53.0%) had early stages of diabetic retinopathy (mild and moderate), and 39 eyes (47.0%) had late stages (severe and proliferative). Patients with mild or moderate DR were more likely to have more severe periodontal conditions than patients with severe or proliferative DR. Fourteen patients with mild DR (82.4%), 7 patients with moderate DR (87.5%), 4 patients with severe DR (100.0%), and 15 patients with proliferative DR (93.8%) had some degree of PD. The periodontal inflamed surface areas and the percentages of tooth sites that bled on probing were significantly higher in patients with early stages of diabetic retinopathy than in those with late stages of the disease (p < 0.05). Patients with periodontal inflamed surface areas of more than 500 mm2 required significantly more intravitreal injections in the last year than those with milder forms of periodontitis (n = 6.9 ± 3.1 versus n = 5.0 ± 3.5, p = 0.03). Conclusion In patients with diabetic macular edema, periodontitis is more prevalent in early stages of diabetic retinopathy. We suggest regular dental check-ups for diabetic patients, especially when diabetic macular edema is already present. Clinical relevance Patients with diabetic macular edema should be screened for periodontitis and vice versa, particularly early in the course of diabetes.

Prevalence, extent, and severity of periodontitis among Australian older adults: Comparison of two generations

“…Other possible reason could be the proportion of periodontitis‐associated chronic diseases increased across the two surveys, except heart and COPD. Our findings corroborate evidence that indicates that diabetes is a significant risk factor associated with severe periodontitis among older Australian adults, suggesting a bidirectional relationship between periodontitis and diabetes 16,29 . However, due to the smaller sample size in SADLS II, with no detailed information on diabetes mellitus or glycemic control, 30 the results might not be accurate.…”

“…14,15 Large epidemiological studies have shown a relationship between periodontal disease and some systemic conditions. These include diabetes mellitus, 16 cardiovascular disease, osteoporosis, respiratory disease, obesity, cancer, and renal disease. 17,18 Comparative analysis across generations is useful to better identify groups of greater vulnerability to periodontal disease.…”

A Longitudinal Study of Chronic Periodontitis in Two Cohorts of Community-Dwelling Elderly Australians

“…Higher incidence and progression of periodontitis higher among the most recent generation, which is likely attributed to the greater number of teeth retained and possibly the higher prevalence of periodontitis-associated chronic diseases [ 8 ], such as diabetes [ 6 ] and hypertension [ 15 ]. Given that periodontal disease is influenced by social determinants, the lower proportion of participants in the higher education level (Tertiary) [ 16 ] could also contribute to this greater prevalence of periodontal disease.…”

“…This, in turn, may lead to decreased intake of nutrients which impact the immune system. Periodontitis is associated with systemic diseases, such as diabetes mellitus [ 6 ], cardiovascular disease, respiratory disease, renal disease, obesity, osteoporosis and cancer [ 7 , 8 ].…”

Cost-Effectiveness of Conbercept vs. Ranibizumab for Age-Related Macular Degeneration, Diabetic Macular Edema, and Pathological Myopia: Population-Based Cohort Study and Markov Model

“…DME is a diabetic microvascular complication that occurs in the retina ( 56 ) and diabetic retinopathy (DR) is a common diabetic complication and the main cause of moderate-to-severe visual impairment in diabetic patients ( 57 ). About one-third of diabetic patients develop DR and about one-third of patients with DR develop DME ( 58 ). Until now, diabetes mellitus (DM) remains a major health burden, with ~80% occurring in low- and middle-income countries ( 59 , 60 ).…”