Medical Status and complications in relation to periodontal disease experience in insulin‐dependent diabetics

Abstract

The aim of this study was to define a population of diabetics exhibiting an increased risk of developing severe periodontitis by comparing the medical status of 2 groups of diabetics, 1 with no/minor periodontal disease and 1 with severe periodontal disease. The case-control study consisted of 2 parts, a baseline study and a follow-up study. 39 case-control pairs were selected. They were adult, long-duration, insulin-dependent diabetics matched according to sex, age and diabetes duration. One individual in each pair (the CASE) exhibited severe periodontal disease while the other (the CONTROL) exhibited gingivitis or only minor alveolar bone loss. The median age of the cases was 58 years (range 36 to 70 years) and of the controls 59 years (range 37 to 69 years). The median disease duration in cases and controls was 24 years and 25 years, respectively. The median follow-up time was 6 years. The medical variables analysed were weight, insulin dose, systolic and diastolic blood pressure, vibratory threshold, triglycerides, total-cholesterol, HDL-cholesterol, creatinine, HbA1, proteinuria, ECG, retinopathy, stroke, transient ischemic attacks (TIA), angina, myocardial infarct, heart failure, hypertension, intermittent claudication, foot ulcer, death, cause of death, and smoking habit. Biochemical analyses and clinical variables used as a routine in the monitoring of diabetics failed to differentiate between diabetics with severe and minor periodontal disease. In the follow-up study, significantly higher prevalences of proteinuria and cardiovascular complications such as stroke, TIA, angina, myocardial infarct and intermittent claudication were found in the case group. An association between renal disease, cardiovascular complications and severe periodontitis seems to exist. This indicates that a closer cooperation between the diabetologist and the dentist is necessary in monitoring the diabetic patient.

Associations of Periodontal Damage and Tooth Loss with Atherogenic Factors among Patients with Type 2 Diabetes Mellitus

“…Periodontal tissue damage may thus be more expected in diabetics with hypercholesteremia, as found in our study. Some (6,9) but not all (7,10,(14)(15)(16)20) previous studies have associated hypercholesteremia with periodontal disease.…”

“…Whether atherogenic factors other than hyperglycemia are linked with periodontal damage, however, is still being debated, and previous studies have reported inconsistent results (6)(7)(8)(9)(10)(13)(14)(15)(16)(17)(18)(19)(20)(21) …”

“…Some reports associated a high level of HDL cholesterol with a lower risk of periodontal disease (7,10) whereas others found no such association (8,(14)(15)(16)20).…”

Communication and Community

“…There is more attachment loss among adult IDDM subjects with poor metabolic balance and/or multiple complications, and in these patients probed pocket depth ≥ 4 mm re-occurs faster after periodontal therapy (Tervonen & Karjalainen 1997). Further, periodontal disease associates with retinopathy (Rosenthal et al 1988, Karjalainen et al 1994, renal disease and cardiovascular complications (Thorstensson et al 1996) as well as neuropathy (Rosenthal 1988, Moore et al 1999.…”

“…Poor control and/or complications of diabetes are related to the prevalence and severity of inflammatory periodontal disease (Karjalainen et al 1994, Oliver & Tervonen 1994, Yalda et al 1994 and to dental caries among children and adolescents . There is evidence that periodontal disease is related to metabolic control (Miller et al 1992, Grossi & Genco 1998) and complications (Thorstensson et al 1996) in insulin-dependent diabetes mellitus (IDDM). Periodontal disease has actually been regarded as a complication of diabetes (Löe 1993).…”