Periodontal Treatment and the Risks of Cardiovascular Disease in Patients with Type 2 Diabetes: A Retrospective Cohort Study

Abstract

Objective Periodontal disease may predispose individuals to cardiovascular disease (CVD). Diabetes mellitus, especially in patients with severe periodontitis, increases the risk of CVD mortality. However, the outcomes of periodontal therapy vary among the different treatment modalities. We aim to investigate whether periodontal treatment could influence the occurrence of CVD in patients with type 2 diabetes and periodontal problems. Methods A retrospective cohort study was conducted based on a dataset released by Taiwan National Health Insurance (NHI). The dataset was composed of randomly sampled, newly diagnosed diabetic patients who received insurance benefits from 1999 to 2001; patients who were younger than 18 years of age or who already had CVD before 1999 were excluded. The NHI code was used to identify the treatments, including subgingival curettage and flap operations. The patients' demographic variables were matched using a 1:4 propensity score. All of the subjects were followed up until the onset of CVD, or December 31, 2011. A Cox proportional hazards regression analysis was performed to evaluate the effects of periodontal treatment on the rates of myocardial infarction, heart failure and stroke. Results Three thousand thirty-nine and 12,156 diabetic subjects were classified into the advanced periodontal treatment group and the non-advanced periodontal treatment group, respectively. The Cox proportional hazards analysis revealed that although the overall incidence of CVD was not significantly improved (Hazard ratio, HR 0.95; 95% CI 0.90-1.01), advanced periodontal treatment reduced the rates of myocardial infarction (HR 0.92; 95% CI 0.85-0.99) and heart failure (HR 0.60; 95% CI 0.45-0.80). There was no significance difference in the incidence of stroke (HR 0.95; 95% CI 0.85-1.06). Conclusion Advanced periodontal therapy lowers the rate of CVD, especially myocardial infarction and heart failure. Dental management has a beneficial effect on the health of patients with type 2 diabetes.

Clinical implications of age and sex in the prevalence of periodontitis in Korean adults with diabetes

“…Individuals with periodontitis had an increased rate of microvascular complications ketoacidosis and of hospitalizations associated with hyperglycemia with odds ratio and 95% confidence intervals of [2.43 (1.74–3.40)], [2.72 (1.53–4.80)] and [2.76 (1.72–4.42)], respectively ( 33 ). Treatment of periodontitis reduces the risk of cardiovascular disease in diabetic patients ( 34 ). Therefore, periodontitis may stimulate inflammatory changes in adipose tissue and this may create a self-generating cycle of morbidity that links diabetes and periodontal disease ( 35 ).…”

Cardiovascular risk reduction with periodontal treatment in patients on the waiting list for renal transplantation

“…Our results are in accordance with other prospective works, suggesting a beneficial effect of POD treatment on prognosis, the PAVE and the PAROKRANK studies. A retrospective Taiwanese cohort analysis in patients with diabetes indicated a reduction in the incidence of myocardial infarction and heart failure with treatment, but in that work, the control group also received treatment, although of a different quality.…”

Importance of Mechanical Periodontal Therapy in Patients with Diabetes Type 2 and Periodontitis

“…Periodontal diseases have been associated with a reduced glycemic control in diabetes. Periodontitis increases the risk for the diabetes incidence in nondiabetic patients [ 21 ] as well as increases insulin resistance in patients with DM and disease complications, including mortality [ 44 , 45 ].…”

“…The effect of periodontitis on the control of DM type 2 has been studied, and there is indirect evidence to support biological mechanisms mediating this effect as reduced pancreatic islets β -cell function, elevated oxidative stress, and dyslipidemia. People with DM and periodontitis usually have elevated circulating proinflammatory mediators, like TNF- α , IL-6, CRP, and reactive oxygen species (ROS) that can interfere with diabetes metabolic control [ 44 ] and may act synergistically in worsening cardiovascular complications in diabetes [ 45 ].…”