Periodontal disease related to diabetic status

Abstract

Variation in the periodontal health status and the response to oral hygiene education, scaling and root planing were studied in 36 subjects with type-1 diabetes mellitus (DM) and in 10 non-diabetic control subjects. The age range of the subjects was 24-36 years. The diabetic group was divided into 3 subgroups based on the levels of glycosylated hemoglobin (HbAlc) over a 3 year period and the presence of diabetic complications as follows: (D1) subjects with good metabolic control and no complications (n=13), (D2) subjects with varying metabolic control with/without retinopathy (n=15) and (D3) subjects with severe diabetes, i.e., with poor long-term control and/or multiple complications (n= 8). Clinical measurements (plaque, subgingival calculus, probing pocket depth, bleeding after probing and clinical attachment level) were performed at the baseline and 4 weeks and 6 and 12 months after periodontal therapy. The between-group comparisons were made using the Student t-test and ANOVA. Based on the plaque scores, the oral hygiene status was similar in all groups during the whole study. No statistically-significant differences in the periodontal health status could be found between the diabetic group as a whole and the non-diabetic controls at any examination. The level of periodontal health of the diabetics with good control and no complications (D1) and those with moderate control with/without retinopathy (D2) was on the same level with that seen in the non-diabetic controls. Our findings of the significantly higher extent of al > or =2 mm at the baseline and the fast recurrence of pd > or =4 mm during the longitudinal study in diabetic subjects with poor metabolic control and/or multiple complications (D3) indicate increased periodontal breakdown as a complication of DM in these subjects. To be able to assess the periodontal prognosis and the need for periodontal therapy on an individual basis,the clinical practitioner should be well aware of the diabetic status of his/her patients.

Clinical Case Report of Long-term Follow-up in Type-2 Diabetes Patient with Severe Chronic Periodontitis and Nifedipine-induced Gingival Overgrowth

“…to that of non-diabetics 23) . On the other hand, it was reported that poorly controlled diabetics respond less successfully to periodontal therapy relative to well-controlled and non-diabetics 19) . Tervonen and Karjalainen 19) reported that although poorly controlled diabetics responded to nonsurgical therapy similarly to controls in the short term (4 weeks), in the absence of maintenance therapy, more rapid recurrence of periodontal pockets and subgingival calculus was found.…”

“…On the other hand, it was reported that poorly controlled diabetics respond less successfully to periodontal therapy relative to well-controlled and non-diabetics 19) . Tervonen and Karjalainen 19) reported that although poorly controlled diabetics responded to nonsurgical therapy similarly to controls in the short term (4 weeks), in the absence of maintenance therapy, more rapid recurrence of periodontal pockets and subgingival calculus was found. The data from the present study, however, seem to indicate that careful control of disease in patients with diabetes will result in a similar low frequency of recurrent periodontitis to that seen in non-diabetic patients if they receive treatment for periodontal disease and follow a careful plaque control program.…”

Deliberations on Non-Surgical Periodontal Therapy

“…The short and long term response to periodontal therapy in well controlled diabetics with regular maintenance therapy is as good as non-diabetic patients [23]. However, long-term response to nonsurgical periodontal therapy in a poorly controlled diabetic patient would result in rapid recurrence of the original deep pockets [24]. Hence, by maintaining good oral hygiene and keeping blood sugar level in check, failure of nonsurgical periodontal therapy can be prevented.…”

Chronic Periodontitis as a Risk Marker for Systemic Diseases with Reference to Cardiometabolic Disorders: Common Pathways in their Progression

“…87 Other longitudinal studies demonstrate these concepts; poorly controlled diabetics do not respond to periodontal therapy as well as controlled diabetics or non-diabetics. 88,89 Genetic factors play an important role in susceptibility to periodontal disease [90][91][92] as well as to systemic diseases. The impact of a poorly regulated immune response in fuelling the progression of periodontal destruction secondary to bacterial plaque is well documented.…”