Periodontal Infection, Systemic Inflammation, and Insulin Resistance

Abstract

OBJECTIVEAdverse microbial exposures might contribute to diabetogenesis. We hypothesized that clinical periodontal disease (a manifestation of microbial exposures in dysbiotic biofilms) would be related to insulin resistance among diabetes-free participants. The roles of inflammatory mediation and effect modification were also studied.RESEARCH DESIGN AND METHODSThe continuous National Health and Nutrition Examination Survey 1999–2004 enrolled 3,616 participants (51% women) who received a periodontal examination and fasting blood draw. Participants were mean age (± SD) 43 ± 17 years and 28% Hispanic, 52% Caucasian, 17% African American, and 3% other. Log-transformed values of the homeostasis model assessment of insulin resistance (HOMA-IR) or HOMA-IR ≥3.30 (75th percentile) were regressed across full-mouth periodontal probing depth (PD) levels using linear and logistic models. White blood cell (WBC) count and C-reactive protein (CRP) were considered as either mediators or effect modifiers in separate analyses. Risk ratios (RRs) stem from marginal predictions derived from the logistic model. Results were adjusted for multiple periodontal disease and insulin resistance risk factors.RESULTSIn linear regression, geometric mean HOMA-IR levels increased by 1.04 for every 1-mm PD increase (P = 0.007). WBC mediated 6% of the association (P < 0.05). Among participants with WBC ≤6.4 × 109, PD was unrelated to HOMA-IR ≥3.30. Fourth-quartile PD was associated with HOMA-IR ≥3.30 among participants with WBC >7.9 × 109; RR 2.60 (1.36–4.97) (P for interaction = 0.05). Findings were similar among participants with CRP >3.0 mg/L (P for interaction = 0.04).CONCLUSIONSPeriodontal infection was associated with insulin resistance in a nationally representative U.S. sample of diabetes-free adults. These data support the role of inflammation as both mediator and effect modifier of the association.

Elevated insulin resistance in patients with recurrent aphthous stomatitis

“…Periodontal disease has been associated with glycemia. In recent study, the verifying data supported the role of glucose metabolism disorders on the periodontal disease including RAS and the accumulating data hypotheses that periodontal disease might be a potential contributer to the elevation of IR leading to prediabetes [9][10][11]. However, we are unaware of any studies that have assessed IR in patients with RAS in otherwise healthy, diabetes-free individuals.…”

Oral health: a neglected area of routine diabetes care?

“…3 Adverse outcomes in diabetes (including the increased risks of heart disease, stroke and early mortality) are more likely in the presence of periodontitis. 4 For example, severe periodontitis is associated with a threefold increase in the incidence of end-stage renal disease in diabetes compared to patients who lack such disease.…”

How does the social “get under the gums”? The role of socio-economic position in the oral-systemic health link

“…Total white blood cell counts are also a measure of systemic inflammation and were suggested to mediate the relationship between systemic and periodontal inflammations. 11 Derived from the differential white blood cell count, neutrophils are cells of the innate immune system that play a crucial role in systemic inflammation and periodontal disease, and which have recently been employed in understanding the oral-systemic health links. 12,13 Neutrophil:lymphocyte ratio has also been used in several studies as an index of systemic inflammation and as a prognostic factor for a number of diseases.…”