The aim of this study was to analyse periodontal disease experience in 40- to 70-year-old, sex-matched insulin-dependent diabetics and non-diabetics. The study involved 83 diabetics and 99 non-diabetics. The clinical and radiographic examination comprised recordings of number of teeth, presence of plaque, gingival conditions, probing pocket depth and alveolar bone level (main variable). Diabetics aged 40 to 49 years had more periodontal pockets > or = 6 mm and more extensive alveolar bone loss than non-diabetics in the same age-group. There was also a significantly higher number of subjects belonging to classification groups with severe periodontal disease experience among diabetics in that age-group. In the age-groups 50-59 and 60-69 years, no major differences were found. The disease duration in these 3 age groups was 25.6 years, 20.5 years and 18.6 years, respectively, and the age of onset thus appears to be an important risk factor for future periodontal destruction.

The aim of this study was to compare the prevalence and severity of periodontal disease in age- and sex-matched adult long- and short-duration insulin-dependent diabetics and non-diabetics. The study involved 82 subjects with long- and 72 with short-duration diabetes and 77 non-diabetics, all aged 20-70 years. The clinical and radiographic examination comprised recordings of the number of existing teeth, absence or presence of plaque and supra- and subgingival calculus, gingival conditions, probing pocket depth and alveolar bone level. There were no significant differences in the number of existing teeth or presence of plaque and supra- and subgingival calculus between long- and short-duration diabetics and non-diabetics. Diabetics, irrespective of the duration of the disease, had a higher prevalence of sites with gingivitis than non-diabetics. Overall, there were no significant differences between the groups regarding the prevalence of tooth surfaces with probing pocket depths of 4 and 5 mm. However, on comparison between age subgroups, long-duration diabetics younger than 45 years had significantly more 4 and 5 mm pockets than non-diabetics. Long-duration diabetics altogether had significantly more tooth surfaces with probing depth greater than or equal to 6 mm than non-diabetics. The radiographs of alveolar bone height exhibited significantly more extensive alveolar bone loss in long-duration diabetics aged 40-49 years than in short-duration diabetics and non-diabetics. This, together with the increased number of subjects belonging to classification groups with severe periodontal disease experience among long-duration diabetics, indicates more periodontal disease in these diabetics.

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.

The aim of this study was to compare changes in periodontal status in a Swedish population over a period of 20 years. Cross-sectional studies were carried out in Jönköping County in 1973, 1983, and 1993. Individuals were randomly selected from the following age groups: 20, 30, 40, 50, 60, and 70 years. A total of 600 individuals were examined in 1973, 597 in 1983, and 584 in 1993. The number of dentate individuals was 537 in 1973, 550 in 1983, and 552 in 1993. Based on clinical data and full mouth intra-oral radiographs, all individuals were classified into 5 groups according to the severity of the periodontal disease experience. Individuals were classified as having a healthy periodontium (group 1), gingivitis without signs of alveolar bone loss (group 2), moderate alveolar bone loss not exceeding 1/3 of the normal alveolar bone height (group 3), severe alveolar bone loss ranging between 1/3 and 2/3 of the normal alveolar bone height (group 4), or alveolar bone loss exceeding 2/3 of the normal bone height and angular bony defects and/or furcation defects (group 5). During these 20 years, the number of individuals in groups 1 and 2 increased from 49% in 1973 to 60% in 1993. In addition, there was a decrease in the number of individuals in group 3, the group with moderate periodontal bone loss. Groups 4 and 5 comprised 13% of the population and showed no change in general between 1983 and 1993. The individuals comprising these groups in 1993, however, had more teeth than those who comprised these groups in 1983; on the average, the individuals in disease group 4 had 4 more teeth and those in disease group 5, 2 more teeth per subject. In 1973, these 2 groups were considerably smaller, probably because of wider indications for tooth extractions and fewer possibilities for periodontal care which meant that many of these individuals had become edentulous and were not placed in a group. Individuals in groups 3, 4, and 5 were subdivided according to the number of surfaces (%) with gingivitis and periodontal pockets (> or =4 mm). In 1993, 20%, 42%. and 67% of the individuals in groups 3, 4, and 5 respectively were classified as diseased and in need of periodontal therapy with >20% bleeding sites and >10% sites with periodontal pockets > or =4 mm. In conclusion, an increase in the number of individuals with no marginal bone loss and a decrease in the number of individuals with moderate alveolar bone loss can be seen. The prevalence of individuals in the severe periodontal disease groups (4, 5) was unchanged during the last 10 years; however, the number of teeth per subject increased.

It is important to apply life-span and cohort perspectives to oral health and disease. In our sample of persons born before World War I, caries was the main reason for losing all teeth, with substantially increased prevalence by age. Lifestyle factors were significant for losing and for retaining teeth. Periodontal condition had a significant influence on the likelihood of retaining functional dentition, and also when taking psychosocial variables into account.