|LETTER TO THE EDITOR
|Year : 2012 | Volume
| Issue : 7 | Page : 127-129
Status of periodontal health in patients with type 2 diabetes mellitus at a teaching hospital of North India
Ritu Karoli1, Jalees Fatima1, Roshan Jafri2, Zeba Siddiqi1, Vaibhav Shukla1
1 Department of Medicine, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
2 Department of Dentistry, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
|Date of Web Publication||24-Mar-2012|
255/100, Kundari Rakabganj, Lucknow - 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Karoli R, Fatima J, Jafri R, Siddiqi Z, Shukla V. Status of periodontal health in patients with type 2 diabetes mellitus at a teaching hospital of North India. Indian J Endocr Metab 2012;16, Suppl S1:127-9
|How to cite this URL:|
Karoli R, Fatima J, Jafri R, Siddiqi Z, Shukla V. Status of periodontal health in patients with type 2 diabetes mellitus at a teaching hospital of North India. Indian J Endocr Metab [serial online] 2012 [cited 2020 Sep 26];16, Suppl S1:127-9. Available from: http://www.ijem.in/text.asp?2012/16/7/127/94247
Both type 2 diabetes mellitus and periodontal disease are common diseases in India. Asian Indians have a racial predisposition that makes diabetes epidemic in our country. 
Periodontitis is a chronic inflammatory disease characterized by periodontal pocket formation, loss of connective tissue attachment and alveolar bone resorption which eventually results in tooth loss. In recent years, a biological link has been established between the two diseases and periodontal disease has been cited as the sixth complication of diabetes mellitus after microangiopathy (including neuropathy, nephropathy and retinopathy), macrovascular disease and delayed wound healing.  It has been a well-recognized fact that periodontal disease is commoner and severe in patients with diabetes mellitus and becomes worse with progression of diabetes.  Hyperglycemia impairs gingival fibroblast synthesis, resulting in the loss of periodontal fibers, pocket formation, loss of connective tissue attachment and alveolar bone resorption.  In addition, advanced glycation end product accumulation in the periodontium affects phagocytic migration and activity of polymorphonuclear and mononuclear phagocytic cells, leading to establishment of more pathogenic subgingival flora and consequent periodontal damage. 
Many investigators have suggested the possibility of bidirectional relationship between the two diseases, proposing that not only diabetes mellitus increases periodontal disease but also the presence of periodontal disease raises the risk of development of diabetes by inducing insulin resistance and worsens glycemic control and is therefore responsible for other complications of diabetes. ,,
Diabetes mellitus and its complications are major burden on health care resources. Therfore, it is important to know about the association of the two diseases of public health importance. There is paucity of Indian literature on this issue and not many properly designed population surveys or cross-sectional studies are available in our population. There is suboptimal awareness among the physicians and patients about this complication of diabetes. We undertook this study to observe the prevalence of periodontal disease in our patients with type 2 diabetes, its relation with duration, glycemic control and other chronic complications of diabetes.
In a cross-sectional study conducted between January and December 2010, we included 200 patients with type 2 diabetes mellitus. Periodontal assessment was done by measurement of probing depth and clinical attachment loss (CAL). Patients were classified as no periodontitis when there was no CAL or bleeding on probing,mild periodontitis when CAL was≥1mm in ≥2 teeth, moderate periodontitis  and severe periodontitis  when more advanced destruction was present.
We excluded those patients who had history of smoking, pan masala/tobacco chewing, antimicrobial therapy within 1 month, patients on antiepileptic/immunosuppressive agents, pregnant women or patients who never used to brush at least once daily.
The characteristics of the patients are shown in [Table 1]. Prevalence of periodontitis was observed in 82% patients. [Table 2] shows periodontal disease according to glycosylated hemoglobin, and presence of co-morbidities has been shown in [Table 3]. Mild periodontitis was present in 46%, moderate in 27% and severe in 9% patients. Age, duration of diabetes, macrovascular and microvascular complications (neuropathy, nephropathy and retinopathy) showed positive correlation in univariate analysis, while gender, body mass index (BMI), glycemic control, hypertension and dyslipidemia had no correlation with the periodontal disease status. In multivariate analysis, only duration of diabetes was significantly associated with the presence of severe periodontal disease. Although no correlation could be demonstrated between periodontal disease and glycosylated hemoglobin, the presence and severity of periodontal disease had definite positive correlation with chronic complications of diabetes. Since these complications are related to long-term poor glycemic control, it can be extrapolated that it will also have an impact on periodontal health.
|Table 1: Characteristics of study patients with type 2 diabetes mellitus (N=200)|
Click here to view
|Table 3: Prevalence of co-morbidities and diabetes-related complications in patients with type 2 diabetes mellitus (N=200)|
Click here to view
Type 2 diabetes mellitus is a growing health concern in our country. There is definite evidence that presence of type 2 diabetes leads to poor periodontal health and risk increases with duration of diabetes and presence of other chronic complications of diabetes. There is a need to make physicians, dentists and patients more aware of this complication of diabetes mellitus. Oral health care should be an integral part of comprehensive diabetes management from the outset.
| References|| |
|1.||Pradeepa R, Deepa R, Mohan V. Epidemiology of diabetes in India-current perspective and future projections. J Indian Med Assoc 2002;100:144-8. |
|2.||Loe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 1993;16:329-34. |
|3.||Taylor GW. Bidirectional interrelationship between diabetes and periodontal disease: An epidemiological perspective. Ann Periodontol 2001;6:99-112. |
|4.||Kiran M, Arpak N, Unsal E, Erdogan MF. The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus. J Clin Periodontol 2005;32:266-72. |
|5.||Janket SJ, Jones JA, Meurman JH, Baired AE, Van Dyke TE. Oral infection, hyperglycemia and endothelial dysfunction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:173-9. |
|6.||Mealey BL, Oates TW. Diabetes mellitus and periodontal diseases. J Periodontol 2006;77:1289-303. |
|7.||Shimura F, Murayama Y. Periodontal inflammation and insulin resistance-lessons from obesity. J Dent Res 2001;80:1690-4. |
|8.||Lamster IB, Lalla E, Borgnakke WS, Taylor GW. The relationship between oral health and diabetes mellitus. J Am Dent Assoc 2008;139:19S-24. |
|9.||Borrell LN, Burt BA, Taylor GW. Prevalence and trends in periodontitis in the USA: The [corrected] NHANES, 1988 to 2000. J Dent Res 2005;84:924-30. |
|10.||Machtei EE, Christersson LA, Grossi SG, Dunford R, Zambon JJ, Genco RJ. Clinical criteria for the definition of "established periodontitis". J Periodontol 1992;63:206-14. |
[Table 1], [Table 2], [Table 3]