Periodontal disease in adults with diabetes, prevalence and risk factors. Results of an observational study

Establishment of models to predict factors influencing periodontitis in patients with type 2 diabetes mellitus

BACKGROUND

Type 2 diabetes mellitus (T2DM) is associated with periodontitis. Currently, there are few studies proposing predictive models for periodontitis in patients with T2DM.

AIM

To determine the factors influencing periodontitis in patients with T2DM by constructing logistic regression and random forest models.

METHODS

In this a retrospective study, 300 patients with T2DM who were hospitalized at the First People's Hospital of Wenling from January 2022 to June 2022 were selected for inclusion, and their data were collected from hospital records. We used logistic regression to analyze factors associated with periodontitis in patients with T2DM, and random forest and logistic regression prediction models were established. The prediction efficiency of the models was compared using the area under the receiver operating characteristic curve (AUC).

RESULTS

Of 300 patients with T2DM, 224 had periodontitis, with an incidence of 74.67%. Logistic regression analysis showed that age [odds ratio (OR) = 1.047, 95% confidence interval (CI): 1.017-1.078], teeth brushing frequency (OR = 4.303, 95%CI: 2.154-8.599), education level (OR = 0.528, 95%CI: 0.348-0.800), glycosylated hemoglobin (HbA1c) (OR = 2.545, 95%CI: 1.770-3.661), total cholesterol (TC) (OR = 2.872, 95%CI: 1.725-4.781), and triglyceride (TG) (OR = 3.306, 95%CI: 1.019-10.723) influenced the occurrence of periodontitis (P < 0.05). The random forest model showed that the most influential variable was HbA1c followed by age, TC, TG, education level, brushing frequency, and sex. Comparison of the prediction effects of the two models showed that in the training dataset, the AUC of the random forest model was higher than that of the logistic regression model (AUC = 1.000 vs AUC = 0.851; P < 0.05). In the validation dataset, there was no significant difference in AUC between the random forest and logistic regression models (AUC = 0.946 vs AUC = 0.915; P > 0.05).

CONCLUSION

Both random forest and logistic regression models have good predictive value and can accurately predict the risk of periodontitis in patients with T2DM.

Impact of an Okinawa/Nordic based diet on endocrinological and periodontal conditions in individuals with type 2 diabetes. A randomized case-control study

OBJECTIVES

To assess if the results following intake of a diet using an Okinawan-based Nordic diet (OBND) over one month differs in endocrinological, periodontal clinical outcome, and serum cytokine levels compared to a standard hospital care diet in individuals with diabetes type 2 (T2D) (control group).

BACKGROUND

Scientific evidence suggests that the use of diet for individuals with T2D may be beneficial.

METHODS

Participating individuals with T2D were randomly assigned to a test (OBND) (n = 14), or control group (n = 16). Anthropometric data, blood glucose levels, HbA1c levels, lipids, serum inflammation markers (CRP, and a routine panel of 24 cytokines), blood pressure, gingival bleeding on probing (BOP), probing pocket depths (PPD), and clinical attachment levels (CAL) were studied.

RESULTS

Statistical analyses of baseline study data failed to demonstrate study group differences. The mean weight reduction was greater in the OBND group (4.1 kg) versus the control group (1.3 kg) (p < 0.01). The reduction in BMI was 1.4 kg/m2 in OBND (p < 0.001) and 0.5 kg/m2 in the control group, respectively (p < 0.01). Diastolic and systolic blood pressure reductions were greater in the OBND group than in the control group (p < 0.01). Periodontal study parameters (BOP % scores) and (PPD values) decreased (p < 0.001) overall with no between group differences. The OBND resulted in reduction of serum levels of IFNγ, Eotaxin IL-9, IP10,IL17a, MCP-1,m and PDFBB compared to the control diet.

CONCLUSIONS

A strict T2D- diet provides an association between reduction in serum HbA1c and BOP scores. Serum levels decreases in IFNγ, Eotaxin IL-9, IP-10, IL17a. MCP-1, and PDFBB were only found in the test group.

Psychologically informed oral health interventions in pregnancy and type 2 diabetes: A scoping review

Introduction

Oral health is a critical aspect of gestational diabetes management. Gestational diabetes is high blood glucose levels during pregnancy and is managed like type 2 diabetes with diet and physical activity interventions. This scoping review sets out to discuss why oral health support should also become part of gestational diabetes management.

Objectives

The primary objective was to synthesise the existing psychologically informed oral health interventions for pregnant women and individuals with type 2 diabetes, and the extent to which these interventions map on to the COM-B Model. No literature exists on oral health interventions in gestational diabetes, why studies with type 2 diabetes populations were selected instead. The secondary objective was to identify the precise outcomes targeted in the interventions.

Methodology

The Joanna Briggs Institute's Methodology for Scoping Reviews was used to conduct this review. The populations of interest were pregnant women and individuals with type 2 diabetes, and eligible concepts were psychologically informed oral health interventions. Quasi-experimental and experimental designs were considered. The Ovid Interface including Embase, Medline, Global Health, APA PsychInfo, Health Management Information, Maternity, Infant Care Database, the Cochrane Library, and CINAHL was used as information sources. The study selection followed the PRISMA guidelines. The first search was conducted on the week commencing the 25th of July 2022, with a follow-up search conducted on the 10th of October 2022.

Results

28 records were included for synthesis. The most frequently assessed psychological outcome was oral health knowledge and the most frequently assessed oral clinical outcome was Plaque Index. All studies used an educational intervention approach, while psychological capability in the COM-B Model was targeted in all interventions by increasing oral health knowledge among the participants. The Health Belief Model was the most frequently used theory in the interventions.

Conclusion

The results demonstrate that oral health is a recognised aspect of pregnancy and type 2 diabetes. The findings from this review and a qualitative interview study which is under development will inform the first oral health intervention for women with gestational diabetes in the United Kingdom.

Psychologically informed oral health interventions in pregnancy and type 2 diabetes: a scoping review protocol

INTRODUCTION

Periodontal health is becoming a recognised component in managing gestational diabetes. Gestational diabetes is characterised as raised blood glucose levels first discovered in pregnancy and managed similarly to type 2 diabetes. Currently, the standard intervention for gestational diabetes in the UK entails dietary modifications and physical activity interventions. However, considering the literature discussed in this review, it is argued that oral health advice and support should also become an integrated part of gestational diabetes management.

OBJECTIVE

The objective of this scoping review is to map out psychologically informed oral health interventions in pregnancy and type 2 diabetes. This will inform the development of a new behavioural intervention to promote oral health-related behaviours in women with gestational diabetes. As no literature exists on oral health interventions in gestational diabetes, it was deemed appropriate to synthesise the evidence on oral health interventions designed for pregnant women and individuals with type 2 diabetes.

METHODOLOGY

The scoping review will be conducted using the Joanna Briggs Institute's methodology for scoping reviews. Studies including pregnant women and individuals with type 2 diabetes over 18 years of age will be included. Only studies including a psychologically informed oral health intervention will be considered. The authors will consider experimental and quasi-experimental research designs. The Ovid Interface including EMBASE, Medline, Global Health, APA PsychInfo, Health Management Information, Maternity, Infant Care Database and the Cochrane Library will be used as information sources. The planned searches will commence on the week of the 25 July 2022. Only articles in Danish and English will be considered. The study selection will follow the Preferred Reporting Items for Scoping Reviews process. The data will be presented using narrative synthesis.

ETHICS AND DISSEMINATION

No ethical approval is needed for this review. The results will be published in a relevant scientific journal.

Factors Associated with Tooth Loss in General Population of Bialystok, Poland

Background: The aim of this study was to assess risk factors for tooth loss in the population of the city of Bialystok, in north-eastern Poland, taking into account the entire population and different age groups. The study included 1138 subjects divided into three subgroups: 20–44 years, 45–64 years, and 65–79 years. Participants were classified according to the number of teeth lost (0–8 vs. 9–28). Socio-economic variables, smoking history, and dental habits were collected through a questionnaire. Medical examinations provided data on the body mass index and the fasting blood glucose level. Data were statistically analysed using Mann-Whitney U, Student’s t, chi² tests, and binary logistic regression, p < 0.05. Results: For the general population, being female (OR 1.38, 1.07–1.79, p = 0.015), having secondary education (OR 4.18, Cl 2.97–5.87, p < 0.000), higher body mass index (OR 1.13, Cl 1.10–1.17, p < 0.000), higher fasting blood glucose level (OR 1.03 1.03–1.04, p < 0.000), being former smoker (OR 1.72, Cl 1.29–2.31, p < 0.000), ever smoker (OR 1.69, Cl 1.29–2.20, p < 0.000), current smoker (OR 1.62, Cl 1.15–2.29, p < 0.006), longer smoking period (OR 1.11, Cl 1.09–1.14, p < 0.000), last visit to the dentist over a year ago (OR 1.92, Cl 0.44–2.58, p < 0.000) and tooth brushing less than two times a day (OR 1.6, Cl 1.14–2.23, p < 0.006) were associated with losing more than 8 teeth. In the subgroup aged 20–44 years, only smoking duration was a risk factor for tooth loss (p = 0.02). For the middle-aged and oldest groups, education level (respectively p < 0.001, and p = 0.001), body mass index (respectively, p < 0.001, and p = 0.037), smoking status ever/former/current (respectively p < 0.001 and p = 0.002), smoking status never/ever (respectively p < 0.001 and p = 0.009), smoking duration (p < 0.001) were related to tooth loss. Additionally, in the elderly group, fasting blood glucose level (p = 0.044) and frequency of dental visits (p = 0.007) were related to tooth loss. We concluded that in the evaluated population, tooth loss was associated with socio-demographic, medical, and behavioural factors.

Anti-Inflammatory and Antioxidant Properties of Carvacrol and Magnolol, in Periodontal Disease and Diabetes Mellitus

Periodontal disease and diabetes mellitus are two pathologies that are extremely widespread worldwide and share the feature of chronic inflammation. Carvacrol is a phenolic monoterpenoid, produced by a variety of herbs, the most well-known of which is Origanum vulgare. Magnolol is a traditional polyphenolic compound isolated from the stem bark of Magnolia officinalis, mainly used in Chinese medicine. The purpose of this paper is to review the therapeutic properties of these bioactive compounds, in the treatment of periodontitis and diabetes. Based on our search strategy we conducted a literature search in the PubMed and Google Scholar databases to identify studies. A total of one hundred eighty-four papers were included in the current review. The results show that carvacrol and magnolol have anti-inflammatory, antioxidant, antimicrobial, anti-osteoclastic, and anti-diabetic properties that benefit both pathologies. Knowledge of the multiple activities of carvacrol and magnolol can assist with the development of new treatment strategies, and the design of clinical animal and human trials will maximize the potential benefits of these extracts in subjects suffering from periodontitis or diabetes.

Association between diabetes and edentulism and their joint effects on health status in 40 low and middle-income countries

INTRODUCTION

Previous studies on the diabetes-edentulism relationship have yielded conflicting results. Therefore, the goal of this study was to investigate the association between diabetes and edentulism, and their joint effects on health status in adults from 40 low and middle-income countries (LMICs).

RESEARCH DESIGN AND METHODS

Data from the World Health Survey were used for this cross-sectional study (2002-2004). Forty countries (18 low-income and 22 middle-income countries) were included. Edentulism and diabetes were assessed using yes-no questions based on self-report. Health status was assessed in seven different domains (self-care, pain/discomfort, cognition, interpersonal activities, sleep/energy, affect, and perceived stress). The association between diabetes (exposure) and edentulism (outcome) was analyzed using multivariable logistic regression models, while their joint effects on health status were assessed using multivariable linear regression models.

RESULTS

There were 175 814 adults aged ≥18 years included in this study (mean (SD) age 38.4 (16.0) years; 49.3% men). Overall, the prevalence of edentulism was 6.0% and diabetes was 2.9%. There was a positive and significant association between diabetes and edentulism in the overall sample (OR=1.40, 95% CI 1.18 to 1.66), in low-income countries (OR=1.78, 95% CI 1.21 to 2.62) and in middle-income countries (OR=1.24, 95% CI 1.04 to 1.47). In addition, people with comorbid diabetes and edentulism had worse health status in the domains of cognition, sleep/energy, and perceived stress, compared with those with diabetes only.

CONCLUSIONS

Diabetes was positively associated with edentulism in this sample of more than 175 000 individuals living in LMICs. Providing oral care to individuals with diabetes may potentially lead to a reduction in their risk of edentulism.

Oral health and longitudinal changes in fasting glucose levels: A nationwide cohort study

We investigated the association between oral hygiene indicators of periodontitis, tooth loss, and tooth brushing on the longitudinal fasting glucose level in non-diabetic subjects. Using a nationwide health screening database in Korea, we included non-diabetic individuals who received a health screening program with oral health check in 2009-2010. We constructed a linear mixed model for the longitudinal data of fasting glucose from the baseline to 2015. During the 4.84-year of median follow-up, 91,963 individuals (mean age 56.2 at baseline) underwent 392,780 health examinations with fasting glucose level (mmol/L). The presence of periodontitis was 39.3%. In the multivariate linear mixed analysis, periodontitis was related with increased fasting glucose levels (β = 0.0084, standard error = 0.0035, p = 0.018). Similarly, tooth loss was associated with increased level of fasting glucose (β = 0.0246, standard error = 0.0038, p < 0.001). Compared with tooth brushing ≤2 times/day, tooth brushing ≥3 times/day was associated with decreased fasting glucose levels (β = -0.0207, standard error = 0.0033, p < 0.001). Our data showed that periodontitis and tooth loss were associated with increased fasting glucose levels in non-diabetic individuals. The study findings imply that frequent tooth brushing may reduce fasting glucose levels. Further research is needed to determine the effect of periodontal intervention on glycemic control.

The Effect of Gaseous Ozone Therapy in Conjunction with Periodontal Treatment on Glycated Hemoglobin Level in Subjects with Type 2 Diabetes Mellitus: An Unmasked Randomized Controlled Trial

BACKGROUND

It is established that inflammation is involved in the pathogenesis of Type 2 Diabetes Mellitus (T2DM) by promoting insulin resistance and impaired beta cell function in the pancreas. Among the hypothesized independent risk factors implicated in the pathogenetic basis of disease, periodontal infection has been proposed to promote an amplification of the magnitude of the advanced glycation end product (AGE)-mediated upregulation of cytokine synthesis and secretion. These findings suggest an interrelationship between periodontal disease and type 2 diabetes, describing poor metabolic control in subjects with periodontitis as compared to nondiabetic subjects and more severe periodontitis in subjects with T2DM as compared to a healthy population, with a significant positive correlation between periodontal inflammatory parameters and glycated hemoglobin level. Results from clinical trials show that periodontal treatment is able to improve glycemic control in subjects with diabetes. Many therapeutic strategies have been developed to improve periodontal conditions in conjunction with conventional treatment, among which ozone (O₃) is of specific concern. The principal aim of this trial was to compare the clinical effectiveness of an intensive periodontal intervention consisting of conventional periodontal treatment in conjunction with ozone gas therapy in reducing glycated hemoglobin level in type 2 diabetic patients and standard periodontal treatment.

METHODS

This study was a 12-month unmasked randomized trial and included 100 patients aged 40-74 years older, with type 2 diabetes mellitus diagnosed. All the patients received conventional periodontal treatment, or periodontal treatment in conjunction with ozone gas therapy in a randomly assigned order (1:1). The primary outcome was a clinical measure of glycated hemoglobin level at 3, 6, 9 and 12 months from randomization. Secondary outcomes were changes in periodontal inflammatory parameters.

RESULTS

At 12 months, the periodontal treatment in conjunction with ozone gas therapy did not show significant differences than standard therapy in decreasing glycated hemoglobin (HbA1C) level and the lack of significant differences in balance is evident.

CONCLUSIONS

Although the change was not significant, periodontal treatment in conjunction with the gaseous ozone therapy tended to reduce the levels of glycated hemoglobin. The study shows a benefit with ozone therapy as compared to traditional periodontal treatment.

Prevalence of diabetes among patients and the assessment of the awareness of the bidirectional relation between diabetes and periodontal disease

AIM

To assess the extent of self-awareness and knowledge of diabetes and its association with periodontal disease among patients seeking dental care.

MATERIALS AND METHODS

Data were collected in the form of a questionnaire from 150 consecutive adult patients from the outpatient department of Saveetha Dental College in Chennai, India. Complying patients were tested for diabetes mellitus by checking their random blood sugar and the results were correlated with the questionnaire and their periodontal findings. The findings were interpreted to examine the relationship between self-awareness and clinically diagnosed periodontitis.

RESULTS

One hundred fifty patients participated in the questionnaire and 70% were unaware of diabetes causing periodontal disease. A total of 47.3% of patients were also unwilling to get themselves tested for diabetes by their dentists as nearly 73.3% believed that they did not have diabetes. As a result, out of 150 patients, 41 consented to random blood sugar but only 23 patients followed up. Among these 23, 14 believed they were diabetic but only 12 of those 14 were proven to be so. Additionally, 20 patients were diagnosed with either localized or generalized chronic periodontitis while the remaining 3 patients had gingivitis. All 12 patients diagnosed with diabetes were affected by periodontitis as well.

CONCLUSIONS

Patients are generally apprehensive and misinformed regarding the influence of periodontitis and diabetes between both diseases and must be educated by both the medical and dental practitioners regarding the implications of these chronic inflammatory diseases.

Improved oral hygiene is associated with decreased risk of new-onset diabetes: a nationwide population-based cohort study

AIMS/HYPOTHESIS

Inflammation plays an important role in the development of diabetes, a major global health problem. Periodontal disease is also common in the general population. Because periodontal disease and poor oral hygiene can provoke transient bacteraemia and systemic inflammation, we hypothesised that periodontal disease and oral hygiene indicators would be associated with the occurrence of new-onset diabetes.

METHODS

In this study we analysed data collected between 2003 and 2006 on 188,013 subjects from the National Health Insurance System-Health Screening Cohort (NHIS-HEALS) in Korea who had no missing data for demographics, past medical history, oral hygiene indicators or laboratory findings. The presence of periodontal disease was defined on the basis of a modified version of ICD-10 codes (Korean Classification of Disease, sixth edition), if claims for treatment for acute periodontitis (K052), chronic periodontitis (K053) and periodontosis (K054) were made more than two times by a dentist, or if, according to medical records, subjects received treatment by a dentist for periodontal disease with ICD-10 codes K052, K053 or K054. Oral hygiene behaviours (number of tooth brushings, a dental visit for any reason and professional dental cleaning) were collected as self-reported data of dental health check-ups. Number of missing teeth was ascertained by dentists during oral health examination. The incidence of new-onset diabetes was defined according to ICD-10 codes E10-E14. The criterial included at least one claim per year for both visiting an outpatient clinic and admission accompanying prescription records for any glucose-lowering agent, or was based on a fasting plasma glucose ≥7 mmol/l from NHIS-HEALS.

RESULTS

Of the included subjects, 17.5% had periodontal disease. After a median follow-up of 10.0 years, diabetes developed in 31,545 (event rate: 16.1%, 95% CI 15.9%, 16.3%) subjects. In multivariable models, after adjusting for demographics, regular exercise, alcohol consumption, smoking status, vascular risk factors, history of malignancy and laboratory findings, the presence of periodontal disease (HR 1.09, 95% CI 1.07, 1.12, p < 0.001) and number of missing teeth (≥15 teeth) remained positively associated with occurrence of new-onset diabetes (HR 1.21, 95% CI 1.09, 1.33, p < 0.001, p for trend <0.001). Frequent tooth brushing (≥3 times/day) was negatively associated with occurrence of new-onset diabetes (HR 0.92, 95% CI 0.89, 0.95, p < 0.001, p for trend <0.001).

CONCLUSIONS/INTERPRETATION

Frequent tooth brushing may be an attenuating factor and the presence of periodontal disease and an increased number of missing teeth may be augmenting factors for the occurrence of new-onset diabetes. Improving oral hygiene may be associated with a decreased risk of occurrence of new-onset diabetes.

Epigenetic and inflammatory events in experimental periodontitis following systemic microbial challenge

AIM

The purpose of this study was to determine inflammatory and epigenetic features following induction of oral and gut dysbiosis in experimental periodontitis in order to examine the interplay between oral and systemic infection.

MATERIALS AND METHODS

Periodontitis was induced in 6- to 8-week-old C57BL/6 mice by (a) Ligature placement (Lig group) (oral challenge); (b) P. gingivalis gavage (Pg group) (systemic challenge); and (c) the combination of the two models oral and systemic challenge (Pg + Lig). The duration of the experiment was 60 days, and the animals were then sacrificed for analyses. Alveolar bone loss was assessed, and a multiplex immunoassay was performed. Maxillae and gut tissues were immunostained for DNMT3b (de novo methylation marker), B and T lymphocyte attenuator (BTLA) and IL-18R1 (inflammation markers).

RESULTS

Pg and Pg + Lig groups exhibited higher bone loss when compared to Sham. BAFF, VEGF, RANKL, RANTES and IP-10 were significantly higher with Pg gavage. Likewise, DNMT3b was overexpressed in both gut and maxilla after the Pg administration. The same pattern was observed for BTLA and IL-18R1 in gut tissues.

CONCLUSIONS

The systemic microbial challenge either alone or in combination with local challenge leads to distinct patterns of inflammatory and epigenetic features when compared to simply locally induced experimental periodontitis.

Characterization of periodontitis in people with type 1 diabetes of 50 years or longer duration

BACKGROUND

Periodontitis is more common and severe in people with diabetes than the general population. We have reported in the Joslin Medalist Study that people with type 1 diabetes of ≥50 years (Medalists) may have endogenous protective factors against diabetic nephropathy and retinopathy.

METHODS

In this cross-sectional study, the prevalence of periodontitis according to the Centers for Disease Control/American Academy of Periodontology classification in a subset (n = 170, mean age = 64.6 ± 6.9 years) of the Medalist cohort, and its associations to various criteria of periodontitis and diabetic complications were assessed.

RESULTS

The prevalence of severe periodontitis in Medalists was only 13.5% which was lower than reported levels in diabetic patients of similar ages. Periodontal parameters, including bleeding on probing, plaque index, gingival index, and demographic traits, including male sex, chronological age, and age at diagnosis were significantly associated with severity of periodontitis, which did not associate with diabetes duration, hemoglobin A1c (HbA1c), body mass index, and lipid profiles. Random serum C-peptide levels inversely associated with severity of periodontitis (P = 0.03), lower probing depth (P = 0.0002), and clinical attachment loss (P = 0.03). Prevalence of cardiovascular diseases (CVD) and systemic inflammatory markers, plasma interleukin-6 (IL-6), and serum immunoglobulin G titer against Porphyromonas gingivalis positively associated with severity of periodontitis (P = 0.002 and 0.02, respectively). Antibody titer to P. gingivalis correlated positively and significantly with CVD, serum IL-6, and high-sensitivity C-reactive protein.

CONCLUSIONS

Some Medalists could be protected from severe periodontitis even with hyperglycemia. Endogenous protective factors for periodontitis could possibly be related to residual insulin production and lower levels of chronic inflammation.

Periodontal Disease: A Risk Factor for Diabetes and Cardiovascular Disease

Periodontitis is a chronic inflammatory disease, initiated by the presence of a bacterial biofilm, called dental plaque, which affects both the periodontal ligaments and bone surrounding teeth. In the last decades, several lines of evidence have supported the existence of a relationship between periodontitis and systemic health. For instance, as periodontitis acts within the same chronic inflammatory model seen in cardiovascular disease (CVD), or other disorders, such as diabetes, several studies have suggested the existence of a bi-directional link between periodontal health and these pathologies. For instance, people with diabetes are more susceptible to infections and are more likely to suffer from periodontitis than people without this syndrome. Analogously, it is now evident that cardiac disorders are worsened by periodontitis, both experimentally and in humans. For all these reasons, it is very plausible that preventing periodontitis has an impact on the onset or progression of CVD and diabetes. On these grounds, in this review, we have provided an updated account on the current knowledge concerning periodontal disease and the adverse effects exerted on the cardiovascular system health and diabetes, informing readers on the most recent preclinical studies and epidemiological evidence.