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Diabetes–A Risk Factor for Periodontitis in Adults?

With the increasing number of diabetics in an aging population and controversial research reports on the relationship of diabetes to periodontitis, clarification of diabetes as a risk factor for periodontitis would be helpful. This review notes variations in type, metabolic control, and duration of diabetes and highlights the results of studies that have considered these variations. Diabetics who maintained reasonably good metabolic control had not lost more teeth or experienced more periodontal attachment loss than non-diabetics, although they had more periodontal pockets. Poorly-controlled diabetics with extensive calculus on their teeth had more periodontitis and tooth loss than well-controlled diabetics or non-diabetics. Long-duration diabetics were also at greater risk for periodontitis. Mechanisms by which diabetes may contribute to periodontitis include vascular changes, neutrophil dysfunction, altered collagen synthesis, and genetic predisposition. Minimizing plaque and calculus in the oral cavity through careful self-care and regular professional care is important to reduce the risk of periodontitis in diabetics. J Periodontol 1994; 65:530-538.

Relation of diabetes control to periodontal pocketing and alveolar bone level

The periodontal health status of 50 diabetic and 53 control subjects was examined. The diabetic group was further divided into three subgroups according to the control of diabetes. There were no significant differences between the whole diabetic group and the control group as regards the frequency of pockets and alveolar bone level. A comparison between the controls and the diabetic subgroups revealed that the well-controlled diabetic patients had better periodontal health than the controls. Within the diabetic group, the prevalence of pockets declined as the control of diabetes improved; the decrease in the number of pockets on bleeding surfaces and on surfaces containing subgingival calculus was statistically significant. Better periodontal health seems to be connected with good control of diabetes, indicating better resistance of periodontal connective tissue and alveolar bone.

Serum levels of interleukin-10 and tumour necrosis factor-α in chronic periodontitis

AIMS To investigate, using a cross-sectional study design, whether the extent of periodontal inflammation associates with the serum levels of cytokine interleukin (IL)-10 and tumour necrosis factor (TNF)-α and their ratio. MATERIAL AND METHODS The study group consisted of 61 subjects with chronic periodontitis and 30 control subjects with minimally inflamed periodontal tissues. Probing pocket depth (PD), bleeding on probing (BOP) and periodontal attachment level (AL) were measured. The serum IL-10 (pg/ml) and TNF-α (U/l) levels were analysed using enzyme-linked immunosorbent assays. After categorization of the subjects, associations between serum IL-10 and TNF-α levels and the extent of periodontal inflammation were studied using linear regression models adjusted for age, gender, body mass index and smoking. RESULTS A negative, partly dose-dependent association existed between the extent of BOP, PD ≥ 4 mm and AL ≥ 4 mm and serum IL-10 level. The subjects in the periodontitis group presented significantly higher serum TNF-α levels and their TNF-α/IL-10 ratio was approximately threefold when compared with the ratio in the control group. CONCLUSIONS The significantly higher serum TNF-α/IL-10 ratio in the subjects with chronic periodontitis when compared with the ratio in the controls is indicative of a stronger systemic pro-inflammatory state in chronic periodontitis.

Resolution of periodontal inflammation does not guarantee improved glycemic control in type 1 diabetic subjects

OBJECTIVE The aim of this study was to find out if periodontal therapy has any effect on glycemic control of type 1 diabetes mellitus (DM). SUBJECTS AND METHODS The periodontal health status of 65 type 1 diabetic subjects was assessed at the baseline and 8 weeks after completion of periodontal therapy. Glycemic control was assessed on both visits by measuring the percentage of glycosylated haemoglobin (GHbA1c). The change in HbA1c (DeltaHbA1c) was assessed by using both a positive or negative change >or=0.5% and any change in HbA1c. RESULTS The mean HbA1c level (+/-SD) of the whole study group was 8.6% (+/-1.5) at the baseline and 8.5% (+/-1.5) after treatment. Glycemic control improved during the study period in 23 subjects (35%) and worsened in 18 subjects (28%). Approximately 78% of the bleeding sites and 87% of the sites with probing depth >or=4 mm presented healing. DeltaHbA1c associated significantly with baseline HbA1c but not with baseline periodontal health status or periodontal healing. CONCLUSION Regardless of a significant resolution of periodontal infection, a great majority of the subjects did not present any improvement in their glycemic control.

Matrix metalloproteinase‐8 concentration in shallow crevices associated with the extent of periodontal disease

OBJECTIVE The aim of this study was to analyse the association between matrix metalloproteinase-8 (MMP-8) concentration in shallow, mostly non-bleeding gingival crevices, and the extent of periodontal disease. MATERIAL AND METHODS Plaque, bleeding on probing (BOP), probing pocket depth (PPD) and attachment level (AL) were assessed clinically in 48 patients with chronic periodontitis. MMP-8 concentrations in gingival crevicular fluid (GCF) from four shallow (PPD<or=3 mm), and four diseased sites and in serum, were measured by enzyme-linked immunosorbent assay. RESULTS The mean concentration of MMP-8 in GCF from shallow crevices was 11.8 +/- 12.8 ng/ml and from diseased sites was 150.1 +/- 91.8 ng/ml. In subjects with moderate to high plaque scores, a statistically significant association was found between MMP-8 concentration from shallow crevices and the extent of AL>or=4 mm (p=0.028) and AL>or=6 mm (p<0.001). CONCLUSION The above association between MMP-8 concentration in shallow crevices and attachment loss provides a new aspect to future studies of MMP-8 as a prognostic marker for periodontal disease.

Adult diabetic and nondiabetic subjects as users of dental services: A longitudinal study

Utilization of dental services by 30 diabetic and 30 nondiabetic subjects was assessed by longitudinal monitoring over a period of 3 years. All subjects were examined clinically three times, and their treatment consisted mainly of cariologic and periodontal treatment. The treatment was delivered by a dentist and an expanded-duty dental hygienist. The study groups were similar with regard to the total number of dental visits needed. However, the treatment of diabetic subjects was more demanding in that more dentists workload was needed for the diabetic group. They also missed more appointments without cancellation and therefore more office time had to be reserved for them.

IL-6(-174) genotype associated with the extent of periodontal disease in type 1 diabetic subjects.

AIM The aim of this study was to investigate whether genetic polymorphism in certain cytokine and receptor molecule genes and diabetic status associate with the extent of periodontal disease in type 1 diabetes mellitus (DM). MATERIAL AND METHODS Eighty patients with type 1 DM participated. Visible plaque, bleeding on probing (BOP), probing pocket depth (PD) and attachment level (AL) were examined clinically and glycosylated haemoglobin (HbA1c) levels were used to assess the glycemic control of DM. CD-14, IL-6, TNF-alpha, IL-10, IL-1alpha, IL-1beta and TLR-4 gene polymorphisms were studied using the polymerase chain reaction (PCR). RESULTS The 3-year HbA1c was good (<7.5%) in 16%, acceptable (7.5-8.5%) in 36% and poor (>8.5%) in 48% of the subjects. IL-6(-174) genotype and 3-year GHbA1c associated significantly with BOP and PD>or=4 mm, subjects with the GG genotype of the IL-6(-174) exhibiting more severe periodontal disease than those with the GC/CC genotype. After stratification by IL-6 genotype, associations between the extent of periodontal disease and 3-year HbA1c levels remained significant in subjects carrying the GC/CC but not the GG genotype. CONCLUSIONS In addition to the HbA1c level, the IL-6(-174) genotype is a significant susceptibility factor for periodontal disease among type 1 diabetics.

Serum sCD14, polymorphism of CD14-260 and periodontal infection.

BACKGROUND AND AIMS CD14 is a co-receptor involved in the recognition of Gram-negative and positive bacteria. Infections are known to influence serum sCD14 levels, and CD14 gene promoter polymorphism (CD14 C-260T) has been reported to be associated with many infectious diseases. Our aim was to investigate whether serum sCD14 concentration is associated with periodontal infection and the CD14(-260) genotype. SUBJECTS AND METHODS The periodontal status of 56 subjects with chronic periodontitis and 28 controls was clinically examined. Serum sCD14 concentration was analyzed using ELISA and CD14(-260) genotype using polymerase chain reaction (PCR). RESULTS The mean concentration of sCD14 in serum was significantly higher in subjects with periodontitis than in control subjects (4.9 microg ml(-1)vs 3.8 microg ml(-1), P < 0.001). Serum sCD14 concentration associated significantly with the extent of advanced periodontal disease. In a regression analysis including both subject groups, the CD14(-260) genotype was a significant determinant for serum sCD14 concentration. After stratification by periodontal health status (periodontitis vs controls), the influence of the CD14(-260) genotype on serum sCD14 concentration was seen only in the control group. CONCLUSIONS Periodontal infection is associated with the serum concentration of sCD14. Moderate to severe periodontal infection overshadows the influence of the genotype on serum sCD14 concentration.

Serum interleukin‐6 may modulate periodontal inflammation in type 1 diabetic subjects

AIMS To evaluate the associations between serum inflammatory biomarkers and periodontal inflammation in subjects with type 1 diabetes mellitus (T1DM). Our hypothesis was that local host responses may be modulated by the serum inflammatory mediators. MATERIAL AND METHODS Plaque, bleeding on probing and probing pocket depth (PD) were examined in 80 T1DM subjects at the baseline and in 58 subjects 8 weeks after periodontal therapy. The levels of glycosylated haemoglobin, serum interleukin (IL)-6, ultrasensitive C-reactive protein and the lipid profile were measured at the baseline and after therapy. Stratification of the sample separately by smoking and body mass index (BMI) was performed. Adjusted associations between the levels of systemic biomarkers and periodontal parameters were studied using multiple regression models. RESULTS The level of serum IL-6 was associated with the extent of bleeding and PD≥4 mm at the baseline in non-smokers and in subjects with BMI≤26 kg/m(2). These associations were also evident after periodontal therapy. Subjects with a high after-therapy IL-6 level presented poorer periodontal healing than those with a low level. CONCLUSIONS The observed associations may be considered to be suggestive of a modulatory effect of IL-6 on host responses in T1DM subjects.

Serum 1,25(OH)D level increases after elimination of periodontal inflammation in T1DM subjects.

OBJECTIVES The aim of the present study was to investigate associations between serum concentrations of vitamin D metabolites, 25-hydroxyvitamin D [25(OH)D], and its active form, 1,25-dihydroxyvitamin D [1,25(OH)D], and the severity of chronic periodontitis. SUBJECTS AND DESIGN Presence of dental plaque, probing pocket depth (PD), and attachment level in 80 type 1 diabetes mellitus subjects were recorded. The serum levels of 25(OH)D, 1,25(OH)D, ultrasensitive C-reactive protein, IL-6, TNF-α, high-density lipoprotein cholesterol, and glycosylated hemoglobin (percentage) were determined. Multivariate regression models were used to explore the associations between serum 25(OH)D (nanomoles per liter) and 1,25(OH)D (picomoles per liter) levels and periodontal health status. INTERVENTION Antiinfective periodontal therapies were delivered and the clinical examination and laboratory analyses were repeated 8 weeks after the therapies. RESULTS A statistically significant association was found between the serum level of 1,25(OH)D (odds ratio 1.06, 95% confidence interval 1.02-1.11) and periodontal health at the baseline; subjects with a high level were more likely to belong to the group of no or mild periodontitis. The serum level of 1,25(OH)D showed a statistically significant increase after antiinfective periodontal therapy in both no or mild (P = .001) and moderate or severe periodontitis (P < .001) subjects. The association between serum 25(OH)D level and periodontal health was negligible. CONCLUSION This study has shown a significant positive association between the serum 1,25(OH)D level and periodontal health status. To what extent this association is causal in nature remains to be confirmed.