Epidemiologic relationship between periodontitis and type 2 diabetes mellitus

Abstract

ObjectivesTo systematically reviewing the epidemiologic relationship between periodontitis (PD) and type 2 diabetes mellitus (T2DM). Materials and MethodsFour electronic databases were searched up to December, 2018. Manual search including the reference lists of included studies and relevant journals. Observational studies evaluating the relationship between T2DM and PD were included. Meta-analyses were applied using STATA. ResultsA total of 53 observational studies were included. Pooled results of cross-sectional studies found the strength of association between these two diseases was very strong (OR=3.27, p=0.000). Adjusted T2DM prevalence was significantly higher in PD patients (OR=4.04, p=0.000) and vice versa (OR=1.58, p=0.000). T2DM patients had significantly worse periodontal status, reflected in a 0.61mm deeper periodontal pocket, a 0.89mm higher attachment loss and about 2 more lost teeth (all p=0.000). Results of cohort studies found T2DM could elevate 27% risk of developing PD (p=0.000).Glycemic control state of T2DM might result in different PD outcomes. Severe PD increased 53% of incident T2DM (p=0.000) and this result was stable. In contrast, the impact of mild PD on T2DM incidence (RR=1.28, p=0.007) was less robust. ConclusionsThere is an evident bidirectional relationship between T2DM and periodontitis. Further well-designed cohort studies are needed to confirm this. Clinical RelevanceBoth dentists and physicians need to be aware of this strong connection between PD and T2DM.Control these two diseases might benefit the prevention of the incidence of each other.

Periodontal disease and incident prediabetes and diabetes: The Hispanic Community Health Study/Study of Latinos

“…In contrast to our findings, those of the most recent systematic review, which summarized observational studies exploring the bidirectional relationship between periodontal disease and diabetes, found that severe periodontitis increased the risk of type 2 diabetes by 53% (RR: 1.53; 95% CI: 1.27–1.83) (Wu et al, 2020). An earlier systematic review and meta‐analysis, which included six studies from 2013 to 2017 (most of which were conducted in Japan and Taiwan) also concluded that individuals with periodontal disease had a higher risk (adjusted hazard ratios ranged from 1.19 to 1.33) of developing diabetes compared to individuals with no periodontal disease (Graziani et al, 2018).…”

“…(RR: 1.53; 95% CI: 1.27-1.83) (Wu et al, 2020). An earlier systematic review and meta-analysis, which included six studies from 2013 to 2017 (most of which were conducted in Japan and Taiwan) also concluded that individuals with periodontal disease had a higher risk (adjusted hazard ratios ranged from 1.19 to 1.33) of developing diabetes compared to individuals with no periodontal disease (Graziani et al, 2018).…”

“…The prevalence of periodontal disease is estimated to be 38.5% but also varies by the Hispanic background (Sanders et al, 2014). Both diabetes and periodontitis are chronic diseases sharing a bidirectional association marked by systemic increases in inflammatory mediators such as IL‐6 and C‐reactive protein (CRP) (Taylor, 2001; Preshaw et al, 2012; Kocher et al, 2019; Wu et al, 2020). Individuals with diabetes are likely at greater risk of developing periodontal disease; similarly, individuals with chronic periodontal disease are at greater risk of altered glycaemic control (Lalla & Papapanou, 2011; Borgnakke et al, 2013; Sanz et al, 2018; Genco & Borgnakke, 2020).…”

Recovery from chronic periodontal disease is associated with lower risk for incident diabetes

“…Diabetes was defined using ICD‐10 codes E10–E14, at least one claim per year with a prescription of anti‐diabetics for more than 30 days, or fasting glucose level ≥126 mg/dl from health screening. Follow‐up initiation was 1 year after the second screening, which was a wash‐out period to secure sufficient time from exposure to onset of diabetes and to minimize the prevalence of undiagnosed baseline diabetes (Wu et al, 2020). The follow‐up period lasted until the subject died or December 2013.…”

The dilemma of different dental degrees: DDS and DMD

“…45 While the dental profession debates the impact of closer alignment with the larger healthcare environment, and whether the DMD better reflects that intent, there is ever-increasing evidence-based research on the oralsystemic connection and its significance for physical and mental health. For example, ongoing research in "periodontal medicine" indicates that oral infection and inflammation have been identified as risk factors for cardiovascular disease, 46 diabetes mellitus, 47 and other chronic diseases, much of which is being reported by esteemed journals of medicine, dentistry, and public health; for example, that conservative treatment of oral disease significantly reduces the cost of overall healthcare, particularly for inpatient/hospital utilization. 48 In general, the addition of selected primary healthcare activities in the dental office including possible monitoring and managing some chronic diseases such as diabetes will require greater use of mid-level providers.…”