The relationship between glycated hemoglobin level and the stage of periodontitis in individuals without diabetes

Abstract

Glycemic control appears to have a significant impact on the relationship between periodontitis and diabetes. The current study aimed to investigate the association between the stage of periodontitis and hemoglobin A1c (HbA1c) levels in patients considered to be normoglycemic. A total of 135 patients (100 females and 35 males) with no history of diabetes were included in the study. The mean age of the participants was 38.4 years old. All patients underwent a full-mouth periodontal examination. Periodontal diagnosis was determined according to the 2017 World Workshop on the Classification of Periodontal Disease. The glycemic state of the patients was assessed using a chair-side HbA1c analyzer. Ninety patients were diagnosed with periodontitis. Higher average HbA1c levels were associated with the different stages of periodontitis (p<0.01). Most of the non-periodontitis patients were in the non-diabetes group (67%), while most of the periodontitis patients were in the undiagnosed pre-diabetes group (47% of the stages I and II group, and 44% of the stages III and IV groups) (p<0.001). Periodontitis was found to be significantly associated with elevated glycated hemoglobin levels in patients not previously diagnosed with diabetes, and the elevation in HbA1c levels was more evident in patients with stage III and IV periodontitis.

Current scientific evidence for why periodontitis should be included in diabetes management

“…Hyperglycemia leads to inflammatory response disturbances ( 42 ), enhancing pro-inflammatory cytokines and matrix metalloproteinases (MMP) expression ( 35 ), so the periodontal tissue metabolism adversely affects blood vessels and promotes periodontitis, which develops more rapidly and more intensely ( 43 ), with hyperglycemia enhancing its progression ( 44 , 45 ), even at pre-DM levels ( 46 ). Importantly, hyperglycemia severity, not the DM diagnosis, affects the periodontium ( 47 , 48 ).…”

Perceptions of mental health screening and referral to treatment in National Dental‐Practice Based Research Network practices: A qualitative study

“…It is common for dentists to conduct chairside screenings, which are widely accepted and have proven effective for various health conditions such as diabetes, hypertension, sleep apnea, and HIV, among others [13][14][15][16][17]. The importance of these screenings is heightened by research highlighting correlations between dental and medical conditions, exemplified by the link between periodontitis and hypertension [18,19]. Dental professionals commonly exhibit positive attitudes toward chairside medical screenings, even conducting procedures like the collection of saliva or blood samples [20][21][22][23].…”

Studying the Impact of Non-Surgical Periodontal Treatment on Glycosylated Hemoglobin Level in Non-Diabetic People

“…Periodontal disease is the diabetes sixth complication, which is accompanied by neuropathy, nephropathy, retinopathy, macrovascular disease, and changes in wound healing. Periodontitis appears to be a risk factor for diabetes [3,4]. Glycosylated hemoglobin (HbA1c) in blood is used as a diagnostic test in diabetes.…”

“…A few studies suggest that periodontitis may affect glucose metabolism in healthy subjects, albeit to a lesser extent than in diabetic subjects [3]. According to these studies, periodontal infection in non-diabetic people can cause disturbances in their blood sugar regulation [4].…”

“…Large population-based research revealed that the chronic periodontal infection presence at the beginning of the study (baseline) has a positive relationship with alters in HbA1c levels over time [14]. The available evidence shows that the HbA1c test may be used as an objective measure to determine the risk of diabetes in periodontitis people or to determine the progression and severity of periodontitis in patients with diabetes [4].…”