Impact of periodontal disease on outcomes in diabetes

Abstract

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.

Quantification of TNF-α in Patients with Periodontitis and Type 2 Diabetes

“…Studies have shown that diabetic patients with periodontal infection have a higher risk of losing control of their glycemic condition; and this deteriorates over the long term compared to diabetic patients who do not suffer POD [30–32]. In the course of periodontal disease, various proinflammatory mediators occur, such as interleukin- (IL-) 1, IL-6, and IL-8, IFN- γ , CCL5, TNF- α , prostaglandins, and metalloproteinases.…”

Dental loss among ambulatory patients with diabetes

“…The details of our study methods have been published previously [8] . In summary, this was a cross-sectional study of all patients with diabetes presenting for their routine care at a university outpatient clinic.…”

“…Using a 48-item investigator-administered questionnaire [8] , all subjects were interviewed to obtain information about their age, gender, body mass index (BMI), diabetes history (onset, use of insulin), diabetes control and complications (A1c, retinopathy, neuropathy, nephropathy, heart attack, stroke), dental care history (last visit to dentist, frequency of brushing, flossing and use of mouthwash), dental problems (loose teeth, bleeding while brushing, teeth sensitivity and number of teeth) and presence of osteoporosis (treatment for or history of osteoporotic fracture). We manually counted their teeth, and all questionnaire responses regarding the above clinical variables were verified from the patient's clinic chart.…”

Changes in Inflammatory and Bone Turnover Markers After Periodontal Disease Treatment in Patients With Diabetes

“…Prospective participants were screened with an investigator-administered questionnaire 19 to determine their eligibility. Patients with responses suggestive of POD who met inclusion criteria and agreed to participate in the study were referred for a full dental examination to confirm presence of POD.…”