Status of association studies linking diabetes mellitus and periodontal disease in India

Abstract

Background:The prevalence of diabetes mellitus (DM) and periodontal disease / periodontitis (PD) is high, and the association of these two as risk factors influencing each other has been recognized and is extensively documented. However, a majority of these association studies have been done in developed countries and / or in developing countries other than India.Objective:To review, quantify and qualify the status of the published indexed scientific literature regarding the bidirectional association of DM and PD in India.Method:An internet search of the literature was conducted to examine relevant association studies of DM and PD in India. As a matter of interest, the related articles were searched manually from one non-indexed national (India) publication of periodontology until October 2008. Specific focus was on indexed literature and only these were considered for the review.Result:Eleven pertinent indexed publications addressing the concern with regard to population in India were identified. Most of them were in agreement with the accepted mechanisms involving these two diseases, but more supported a unidirectional view of interaction, that is, advocating the role of DM in a worsened periodontal condition. One study with an opposite view was recognised.Conclusion:The paucity of such research in India, which will be a hub of diabetics in the near future, reflects the need to make available a strong body of evidence in the indexed literature relating not only to DM and its ‘sixth complication’, PD, but also the strong influence of PD on DM.

Interrelationships of periodontitis and diabetes: A review of the current literature

“…16,17 As such, some have proposed periodontal disease as the sixth complication, due to the almost omnipresence of diabetes along with periodontal disease, 18e21 and some evidence also supports a marked bidirectional correlation between periodontal disease and diabetes. 13,22,11 Epidemiological evidence of an association of diabetes with periodontitis Attachment loss is frequently used as one of the parameters to measure periodontal health, and numerous studies agreed that patients with poorly managed type I or II diabetes have significantly worse periodontal health, including increased attachment loss, compared to patients with better or well-managed diabetes and healthy individuals. 14,18,23 Other factors, such as the bleeding index and pocket depth, were also considered in those studies, which also pointed towards poorer periodontal health in diabetic patients (Table 1).…”

Inflammatory biomarkers in saliva: assessing the strength of association of diabetes mellitus and periodontal status with the oral inflammatory burden

“…Individuals with diabetes experience increased prevalence and severity of periodontal destruction (Graves et al 2000, Gomes et al 2006, Lalla et al 2006, Duarte et al 2007, Lalla et al 2007, Lamster et al 2008, Acharya et al 2010, Venza et al 2010. This increased risk is believed to be due to exacerbation of the inflammatory response in the periodontal tissues of patients with diabetes (Lalla et al 2007).…”

“…Conversely, periodontitis is now recognized as a risk factor for diabetes mellitus (Chen et al 2010). Inflammatory mediators produced in the periodontal tissues may gain access to the circulation, with an antagonist effect on insulin receptors (Graves et al 2000, Gomes et al 2006, Lalla et al 2006, Duarte et al 2007, Lalla et al 2007, Lamster et al 2008, Acharya et al 2010, Venza et al 2010). This bi-directional relationship has important implications for patients with diabetes, considering the significant morbidity and mortality associated with the disease.…”

“…The significance of diabetes mellitus as a risk factor for periodontal disease is believed to relate primarily to the nature and intensity of the inflammatory response in the periodontal tissues (Graves et al 2000, Gomes et al 2006, Lalla et al 2006, Duarte et al 2007, Lalla et al 2007, Lamster et al 2008, Acharya et al 2010, Venza et al 2010. The inflammatory burden presented by periodontitis, however, is difficult to quantify.…”

Building Capacity in the Sikh Asian Indian Community to Lead Participatory Oral Health Projects

“…2 In particular, the bidirectional relationship between diabetes and periodontal disease has been documented in the scientific literature, including for the population of India. 5 Periodontitis is more severe in patients with diabetes 6,7 and pre-diabetes. 8 Further, the presence of periodontitis has been associated with poor metabolic control, increased risk of long-term morbidity, and premature mortality.…”