Periodontal status of diabetics compared with nondiabetics: A meta-analysis

Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, P.O. BOX 121, Jordan.
Journal of Diabetes and its Complications (Impact Factor: 3.01). 02/2006; 20(1):59-68. DOI: 10.1016/j.jdiacomp.2005.05.006
Source: PubMed


This meta-analysis was conducted to assess the association between diabetes mellitus and periodontal diseases by comparing the extent and severity of periodontal diseases between diabetics and nondiabetics.
A literature search was performed using MEDLINE database for published studies from January 1970 through October 2003 with manual search for references in relevant studies. This meta-analysis was based on 18 comparative cross-sectional studies, three prospective cohort studies and baseline data of two clinical trials that compared oral hygiene, gingival and periodontal status between diabetics and nondiabetics. Heterogeneity was obvious among included studies; therefore, the analysis using random-effects model was conducted.
This study demonstrated that diabetics had significantly worse oral hygiene as measured by the average of plaque index (P1I), higher severity of gingival disease as measured by the average of gingival index (GI) and higher severity of periodontal disease as measured by the average of probing pocket depth (PPD) and clinical attachment loss (CAL). However, diabetics had similar extent of oral hygiene, gingival and periodontal disease as measured by percentages of surfaces or sites with specific scores of P1I, GI, bleeding on probing (BOP), PPD and CAL.
Diabetics had a significantly higher severity but the same extent of periodontal disease than nondiabetics.

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    • "So, what evidence should be incorporated into everyday patient care? Significant evidence has been established to support the following: & Both types 1 and 2 diabetes increase the risk for periodontal disease pathogenesis2223242526. & Poorly controlled diabetes increases the risk for deterioration of the periodontium, including clinical attachment loss, progression of periodontal pocket depth, and alveolar bone loss272829. "
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    ABSTRACT: Several decades of research of the interrelationships between diabetes and periodontitis have evolved into a significant body of knowledge that should be incorporated into dental practice. However, there may be a delay in implementing this important information into everyday patient care. Oral healthcare providers (i.e., dentists and dental hygienists) should be progressively engaged in changing the trajectory of the epidemics of diabetes and periodontitis. This article synthesizes the cumulative evidence on the diabetes-periodontitis link, proposes ideas for risk stratification of dental patients with diabetes and periodontitis, and builds a case for the development of a risk-prediction model that provides for the earliest identification of dental patients who have dysglycemia.
    Preview · Article · Jan 2016
    • "There is strong evidence that periodontitis is associated with diabetes mellitus (Khader 2006; Chavarry et al. 2009, Demmer et al. 2010, Lalla & Papapanou 2011, Preshaw et al. 2012, Borgnakke et al. 2013). Two meta-analyses showed that mean periodontal probing depth (PPD) and mean clinical attachment loss (CAL) are higher in subjects with than in subjects without diabetes (Khader et al. 2006, Chavarry et al. 2009). Because the association between diabetes and periodontitis is bidirectional, periodontitis also has a negative impact on glucose regulation . "
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    ABSTRACT: AimTo examine associations of prediabetes and well controlled diabetes with periodontitis.Materials and methodsThe Study of Health in Pomerania (SHIP)-Trend is a cross-sectional survey in North-Eastern Germany including 3,086 participants (49.4% men; age 20–82 years). Clinical attachment loss (CAL) and periodontal probing depth (PPD) were assessed applying a random half-mouth protocol. The number of teeth was determined. Prediabetes comprised impaired fasting glucose and impaired glucose tolerance. Previously known diabetes was defined as well controlled if glycated hemoglobin (HbA1c) was <7.0%. Participants were categorized as follows: normal glucose tolerance (NGT), prediabetes, newly detected type 2 diabetes (T2DM), known T2DM with HbA1c<7.0%, known T2DM with HbA1c≥7.0%.ResultsPrediabetes was neither associated with mean CAL and PPD in multivariable adjusted linear regression models nor with edentulism (OR=1.09 (95%-CI: 0.69-1.71)) and number of teeth (OR=0.96 (95%-CI: 0.75-1.22), lowest quartile versus higher quartiles) in logistic regression models. Associations with mean CAL and edentulism were stronger in poorly controlled previously known diabetes than in well controlled previously known diabetes (for edentulism: OR=2.19 (95%-CI: 1.18-4.05), and OR=1.40 (95%-CI: 0.82-2.38), respectively, for comparison with NGT).Conclusions Periodontitis and edentulism were associated with poorly controlled T2DM, but not with prediabetes and well controlled diabetes.This article is protected by copyright. All rights reserved.
    No preview · Article · Mar 2015 · Journal Of Clinical Periodontology
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    • "Obesity is considered a major risk factor for type 2 diabetes and has also risen substantially throughout the globe over the past decades [2, 3]. A number of meta-analyses have demonstrated that diabetes mellitus and obesity are linked to periodontitis, a chronic disease characterized by the irreversible destruction of the tooth-supporting tissues, that is, periodontium [4–7]. The periodontium consists of the gingiva, periodontal ligament (PDL), root cementum, and alveolar bone. "
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    ABSTRACT: Type 2 diabetes and obesity are increasing worldwide and linked to periodontitis, a chronic disease which is characterized by the irreversible destruction of the tooth-supporting tissues, that is, periodontium. The mechanisms underlying the association of diabetes mellitus and obesity with periodontal destruction and compromised periodontal healing are not well understood, but decreased plasma levels of adiponectin, as found in diabetic and obese individuals, might be a critical mechanistic link. The aim of this in vitro study was to examine the effects of adiponectin on periodontal ligament (PDL) cells under normal and regenerative conditions, and to study the regulation of adiponectin and its receptors in these cells. Adiponectin stimulated significantly the expression of growth factors and extracellular matrix, proliferation, and in vitro wound healing, reduced significantly the constitutive tumor necrosis factor- α expression, and caused a significant upregulation of its own expression. The beneficial actions of enamel matrix derivative on a number of PDL cell functions critical for periodontal regeneration were partially enhanced by adiponectin. The periodontopathogen Porphyromonas gingivalis inhibited the adiponectin expression and stimulated the expression of its receptors. In conclusion, reduced levels of adiponectin, as found in type 2 diabetes and obesity, may compromise periodontal health and healing.
    Full-text · Article · Jul 2014 · Journal of Diabetes Research
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