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Steigmann L, Gunaratnam S, Giannobile WV, Van Til M, Daignault-Newton S, Herman WH, Gunaratnam N, Katulanda P, Sarma AV. Poor Glycemic Control Increases Dental Risk in a Sri Lankan Population. Healthcare (Basel) 2024; 12:358. [PMID: 38338243 PMCID: PMC10855197 DOI: 10.3390/healthcare12030358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Introduction: The aim of our study was to investigate the impact of diabetes-related factors on the dental disease outcomes of diabetes patients in Trincomalee, Sri Lanka. Materials and Methods: Dental data were collected from 80 type-2-diabetic individuals. A dental risk score was calculated based on the frequency of dental outcomes observed and categorized as low risk (≤3 dental outcomes) and high risk (>3 dental outcomes). Results: In this cohort of men and women with type 2 diabetes, there was a high frequency of periodontal related outcomes, including missing teeth (70%), gingival recessions (40%), tooth mobility (41%), and bleeding (20%). Thirty-nine (39%) of participants had high dental risk, while forty-nine (61%) had low risk. Conclusions: After controlling for age, participants with higher capillary blood glucose levels had 3-fold greater odds of a high dental risk score (OR = 2.93, 95%CI = 1.13, 7.61). We found that poor glycemic control indicated by elevated capillary blood glucose was associated with increased dental risk.
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Affiliation(s)
- Larissa Steigmann
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Sejal Gunaratnam
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - William V. Giannobile
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Monica Van Til
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | | | - William H. Herman
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | | | - Prasad Katulanda
- Faculty of Medicine, University of Colombo, Colombo 00300, Sri Lanka
| | - Aruna V. Sarma
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
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Glurich I, Berg R, Panny A, Shimpi N, Steinmetz A, Nycz G, Acharya A. Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics. FRONTIERS IN ORAL HEALTH 2022; 2:670355. [PMID: 35048014 PMCID: PMC8757706 DOI: 10.3389/froh.2021.670355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiring integrated care intervention. The present study observed outcomes of POC hemoglobin A1c (HbA1c) screening at community health center (CHC) dental clinics (DC) and compliance with longitudinal integrated care management among at-risk patients attending dental appointments. Materials and Methods: POC HbA1c screening utilizing Food and Drug Administration (FDA)-approved instrumentation in DC settings and periodontal evaluation of at-risk dental patients with no prior diagnosis of diabetes/prediabetes and no glycemic testing in the preceding 6 months were undertaken. Screening of patients attending dental appointments from October 24, 2017, through September 24, 2018, was implemented at four Wisconsin CHC-DCs serving populations with a high representation of disparity. Subjects meeting at-risk profiles underwent POC HbA1c screening. Individuals with measures in the diabetic/prediabetic ranges were advised to seek further medical evaluation and were re-contacted after 3 months to document compliance. Longitudinal capture of glycemic measures in electronic health records for up to 2 years was undertaken for a subset (n = 44) of subjects with available clinical, medical, and dental data. Longitudinal glycemic status and frequency of medical and dental access for follow-up care were monitored. Results: Risk assessment identified 224/915 (24.5%) patients who met inclusion criteria following two levels of risk screening, with 127/224 (57%) qualifying for POC HbA1c screening. Among those tested, 62/127 (49%) exhibited hyperglycemic measures: 55 in the prediabetic range and seven in the diabetic range. Moderate-to-severe periodontitis was more prevalent in patients with prediabetes/diabetes than in individuals with measures in the normal range. Participant follow-up compliance at 3 months was 90%. Longitudinal follow-up documented high rates of consistent access (100 and 89%, respectively), to the integrated medical/DC environment over 24 months for individuals with hyperglycemic screening measures. Conclusion: POC glycemic screening revealed elevated HbA1c measures in nearly half of at-risk CHC-DC patients. Strong compliance with integrated medical/dental management over a 24-month interval was observed, documenting good patient receptivity to POC screening in the dental setting and compliance with integrated care follow-up by at-risk patients.
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Affiliation(s)
- Ingrid Glurich
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Richard Berg
- Office of Research Computing and Analytics, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Aloksagar Panny
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Neel Shimpi
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Annie Steinmetz
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Greg Nycz
- Family Health Center of Marshfield, Inc., Marshfield Clinic Health System, Marshfield, WI, United States
| | - Amit Acharya
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States.,Family Health Center of Marshfield, Inc., Marshfield Clinic Health System, Marshfield, WI, United States.,Advocate Aurora Research Institute, LLC, Advocate Aurora Health, Inc., Downers Grove, IL, United States
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VALENTIM FB, BARBOSA JSDA, CARNEIRO VC, ARAÚJO AM, ROSETTI EP. Association between periodontitis and type 2 diabetes mellitus: study in a population attended by the Brazilian Health System. REVISTA DE ODONTOLOGIA DA UNESP 2022. [DOI: 10.1590/1807-2577.01022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction Periodontitis control helps to prevent and control diabetes mellitus and understanding of this relationship can lead to changes in health policy. Objective The purpose of this study was to investigate the association between periodontitis, knowledge, and glycemic control. Material and method This is a cross-sectional analytical epidemiological survey with 216 Type 2 diabetic patients, non-smokers, who had current blood screenings with glycated hemoglobin (HbA1c). Result Overall, 93.51% of the patients reported brushing their teeth at least twice a day, 62.5% visited the dentist last year, 81.58% have already undergone treatment for periodontal disease, 43.52% reported having periodontitis and 59.72% had controlled diabetes. No significant (p=0.603) association between HbA1c control and the presence of periodontitis was found. Among the patients with periodontitis, no association between HbA1c control and information on the periodontal disease was found (p=0.996), and know/believe in its relationship with diabetes (p=0.659; p=0.973). Conclusion No relationship between periodontitis and diabetes was found in the sample, as well as in patients with periodontitis, those with knowledge on periodontal disease and knowledge/belief in its relationship with diabetes, which could be justified by the care by a multi-professional health team.
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Dhir S, Bansal S, Wangnoo S, Jana D. Periodontitis and diabetes mellitus—an awareness and perception study among endocrinologists and diabetologists. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Katsiki P, Nazmi K, Loos BG, Laine ML, Schaap K, Hepdenizli E, Bikker FJ, Brand HS, Veerman ECI, Nicu EA. Comparing periodontitis biomarkers in saliva, oral rinse and gingival crevicular fluid: A pilot study. J Clin Periodontol 2021; 48:1250-1259. [PMID: 33998029 PMCID: PMC8453974 DOI: 10.1111/jcpe.13479] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/24/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022]
Abstract
AIM To explore the feasibility of screening for periodontitis by measuring biomarkers, namely total proteolytic activity (TPA), matrix metalloproteinase (MMP)-8, chitinase, lysozyme or their combination, in saliva, oral rinse and gingival crevicular fluid (GCF). MATERIAL AND METHODS Subjects were recruited among healthy/gingivitis individuals and untreated periodontitis patients in Academic Centre for Dentistry Amsterdam (ACTA). All participants donated samples of unstimulated whole saliva, oral rinse and GCF. The protein concentrations and MMP-8 levels were determined by ELISA. Enzymatic activities were measured using appropriate fluorogenic substrates. RESULTS In oral rinse samples, periodontitis patients (n = 19) exhibited significantly higher concentrations of MMP-8 and TPA than controls (n = 20). MMP-8 in combination with chitinase explained 88% of the variance and assigned a subject to control or periodontitis group, with best accuracy (87.2%) in oral rinse. CONCLUSIONS The combination of MMP-8 and chitinase in the current oral rinse procedure has the potential to discriminate periodontitis from periodontal health/gingivitis.
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Affiliation(s)
- Panagiota Katsiki
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kamran Nazmi
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bruno G Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marja L Laine
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kim Schaap
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Esen Hepdenizli
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Floris J Bikker
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henk S Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Enno C I Veerman
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Elena A Nicu
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Oprisdent, Sibiu, Romania
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Adherence to gynecological screening impacted by experienced orthodontic treatment in childhood. Arch Gynecol Obstet 2018; 299:167-171. [PMID: 30374649 DOI: 10.1007/s00404-018-4950-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Dental and cervical controls are two established screening programs in Germany. Compliance to orthodontic treatment in childhood is essential for dental health and one of the first health interventions that requires adherent behavior; therefore, it may be associated with participation in further screening programs in adulthood. However, it is not yet known whether early orthodontic treatment influences long-term screening adherence. METHODS Using a questionnaire administered during a visit to a special dysplasia outpatient service, this case-control study evaluated women's personal history of orthodontic care, long-term satisfaction, and dental and gynecological screening adherence. Oral health status and dental anxiety were assessed with validated instruments. Cases were categorized as cervical dysplasia only (S2) or cervical dysplasia with conization (S1) and compared to healthy controls with a normal PAP smear. RESULTS A study population of 233 participants included 132 cases and 101 controls. The control group had had orthodontic treatment during childhood more often than our study population with abnormal PAP smears (68.3% controls versus 56.1% subjects; p < 0.005). Orthodontic treatment was not associated with attending dental appointment or gynecological check-ups. However, women with an orthodontic treatment in childhood were significantly more often vaccinated against human papillomavirus than women without orthodontic treatment (p < 0.03). CONCLUSION Data suggest that women with orthodontic treatment in childhood are more conscious about prevention strategies in adulthood; therefore, compliant behavior might be established in childhood.
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Pumerantz AS, Bissett SM, Dong F, Ochoa C, Wassall RR, Davila H, Barbee M, Nguyen J, Vila P, Preshaw PM. Standardized screening for periodontitis as an integral part of multidisciplinary management of adults with type 2 diabetes: an observational cross-sectional study of cohorts in the USA and UK. BMJ Open Diabetes Res Care 2017; 5:e000413. [PMID: 28761663 PMCID: PMC5530235 DOI: 10.1136/bmjdrc-2017-000413] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/08/2017] [Accepted: 06/01/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine prevalence and factors predictive of periodontitis by using a standardized assessment model in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS We performed an observational cross-sectional study to determine the burden of periodontitis in adults with type 2 diabetes attending urban, ambulatory referral centers in the USA and UK. Full-mouth probing was performed and periodontitis was diagnosed based on either a low (≥5 mm at ≥1 site) or high pocket probing-depth threshold (≥6 mm at ≥1 site). Results were stratified into a five-stage schema and integrated with other clinical variables into the novel Diabetes Cross-Disciplinary Index to function as a balanced health scorecard. Corresponding demographic and routinely collected health data were obtained and comparisons were made between patients with and without periodontitis. Multivariable logistic regression was performed to identify factors predictive of the presence or absence of periodontitis. RESULTS Between our two cohorts, 253 patients were screened. Caucasians comprised >90% and Hispanic Americans >75% of the UK and US cohorts, respectively. Males and females were equally distributed; mean age was 53.6±11 years; and 17 (6.7%) were edentulous. Of the 236 dentate patients, 128 (54.2%) had periodontitis by low threshold and 57 (24.2%) by high threshold. Just 17 (7.2%) were periodontally healthy. No significant differences in age, HbA1c, blood pressure, body mass index, low-density lipoprotein cholesterol, or smoking status (all p>0.05) were identified between those with or without periodontitis (regardless of threshold) and none was found to be a significant predictor of disease. CONCLUSIONS Periodontitis is frequent in adults with type 2 diabetes and all should be screened. Periodontal health status can be visualized with other comorbidities and complications using a novel balanced scorecard that could facilitate patient-clinician communication, shared decision-making, and prioritization of individual healthcare needs.
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Affiliation(s)
- Andrew S Pumerantz
- Western Diabetes Institute, Western University of Health Sciences, Pomona, California, USA
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
| | - Susan M Bissett
- School of Dental Sciences, Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Fanglong Dong
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, California, USA
| | - Cesar Ochoa
- Western Diabetes Institute, Western University of Health Sciences, Pomona, California, USA
| | - Rebecca R Wassall
- School of Dental Sciences, Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - Heidi Davila
- Western Diabetes Institute, Western University of Health Sciences, Pomona, California, USA
| | - Melanie Barbee
- Western Diabetes Institute, Western University of Health Sciences, Pomona, California, USA
| | - John Nguyen
- Western Diabetes Institute, Western University of Health Sciences, Pomona, California, USA
| | - Pamela Vila
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
| | - Philip M Preshaw
- School of Dental Sciences, Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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