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Todescan SMC, Schroth RJ, Dean H, Wicklow B, Michel-Crosato E, Sellers E. High prevalence of periodontitis in children and adolescents with type 2 diabetes. J Periodontol 2023; 94:174-183. [PMID: 35933589 DOI: 10.1002/jper.21-0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/04/2022] [Accepted: 07/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of the present study was to determine the prevalence of periodontitis in children and adolescents with type 2 diabetes, and if poor glycemic control is associated with increasing prevalence of the disease. METHODS This is a cross-sectional study involving children and adolescents with type 2 diabetes. A questionnaire related to oral health care history and oral health behaviors was administered to each participant and they then underwent a full-mouth oral evaluation. In addition, clinical and metabolic parameters were extracted from the clinical chart. RESULTS One hundred and twenty one children and adolescents (8-17 years, 11 months) participated. Overall, 45.5% presented some degree of periodontitis, with 10 (8.3%) mild, 36 (29.8%) moderate, and nine (7.4%) severe. The periodontitis group (PD-group) had higher mean gingival and plaque indexes, periodontal probing depth, and clinical attachment loss than the group without periodontitis (NoPD-group) (p<0.05). A statistically significant relationship between the prevalence of periodontitis and glycosylated hemoglobin (HbA1c) was verified in the bivariate (odds ratio [OR] 1.31 [95% CI, 1.13-1.53], p = 0.001) and multivariate (OR, 1.29 [95% CI, 1.03-1.61], p = 0.03) analysis. For the adjustment variables, associations were verified for duration of diabetes, age, body mass index z-score, lack of running water, insulin use, and acanthosis nigricans. CONCLUSIONS Children and adolescents with type 2 diabetes presented high rates of periodontitis comparable with that seen in previous studies in youth with diabetes. Uncontrolled HbA1c influences prevalence of periodontal disease. The lack of matched control group and radiographs are limitations of the study. Comprehensive periodontal examination is essential for children and adolescents with type 2 diabetes to prevent, identify, and treat periodontitis early.
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Affiliation(s)
- Sylvia M C Todescan
- Dental Diagnostic and Surgical Sciences, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, Winnipeg, Canada
| | - Robert J Schroth
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, Canada
| | - Heather Dean
- Department of Pediatrics and Child Health, Section of Pediatric Endocrinology and Metabolism, College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Brandy Wicklow
- Department of Pediatrics and Child Health, Section of Pediatric Endocrinology and Metabolism, College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Edgard Michel-Crosato
- Department of Community Dentistry, Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Elizabeth Sellers
- Department of Pediatrics and Child Health, Section of Pediatric Endocrinology and Metabolism, College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Shinjo T, Ishikado A, Hasturk H, Pober DM, Paniagua SM, Shah H, Wu IH, Tinsley LJ, Matsumoto M, Keenan HA, Van Dyke TE, Genco RJ, King GL. Characterization of periodontitis in people with type 1 diabetes of 50 years or longer duration. J Periodontol 2019; 90:565-575. [PMID: 31026349 DOI: 10.1002/jper.18-0735] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/01/2019] [Accepted: 04/15/2019] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Takanori Shinjo
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Atsushi Ishikado
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.,R&D Department, Sunstar, Takatsuki, Japan
| | - Hatice Hasturk
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
| | - David M Pober
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Samantha M Paniagua
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Hetal Shah
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - I-Hsien Wu
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Liane J Tinsley
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Motonobu Matsumoto
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.,R&D Department, Sunstar, Takatsuki, Japan
| | | | - Thomas E Van Dyke
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
| | - Robert J Genco
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - George L King
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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Plessas A, Robertson DP, Hodge PJ. Radiographic bone loss in a Scottish non-smoking type 1 diabetes mellitus population: A bitewing radiographic study. J Periodontol 2018; 89:1043-1051. [PMID: 29766516 DOI: 10.1002/jper.16-0788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/31/2018] [Accepted: 02/06/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The dental complications of uncontrolled diabetes include reduced salivary flow rate, candidiasis and periodontal manifestations. A recent meta-analysis concluded that diabetes patients have a significantly higher severity, but not extent, of destructive periodontal disease than non-diabetics. The authors reported that most type-1 diabetes studies using dental radiographic data have not controlled for confounding factors such as smoking. The aim of this cross-sectional study was to compare radiographic alveolar bone loss between type 1 diabetes (T1DM) and non-diabetes (NDM) participants in a Scottish non-smoking population. METHODS Digital bitewing radiographs for 174 Scottish adults never or ex-smoker (>5 years) participants (108 T1DM, 66 NDS), recruited from outpatient clinics throughout Greater Glasgow and Clyde, were included in the analysis. A single blinded, trained, and calibrated examiner recorded the radiographic bone loss seen on bitewing radiographs using the digital screen caliper (Screen Calliper ICONICO version 4.0 (Copyright (C) 2001-6 Iconico), New York). The bone loss was measured as the distance between the cemento-enamel junction (CEJ) and the deepest radiographic alveolar bone margin interproximally of each tooth. RESULTS T1DM participants had more radiographic alveolar bone loss throughout the all teeth measured (median:1.27 mm versus 1.06 mm, P < 0.001) and more than a two-fold increase in the risk of having sites with ≥2 mm periodontal destruction (OR = 2.297, 95%CI 1.058 to 4.986, P = 0.036) compared with non-diabetes subjects. CONCLUSIONS Patients suffering from type 1 diabetes are at higher risk of periodontitis even when controlling for multiple possible confounding factors and this difference can be detected on routine dental radiographs at an early stage. These data confirm radiographically the previously reported association between T1DM and periodontal bone loss.
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Affiliation(s)
- Anastasios Plessas
- Peninsula School of Dentistry, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Douglas P Robertson
- Oral Science Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary a Life Sciences, University of Glasgow, Glasgow, UK
| | - Penny J Hodge
- Oral Science Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary a Life Sciences, University of Glasgow, Glasgow, UK
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Zarkesh M, Asghari G, Amiri P, Hosseinzadeh N, Hedayati M, Ghanbarian A, Azizi F. Familial Aggregation of Metabolic Syndrome With Different Socio-Behavioral Characteristics: The Fourth Phase of Tehran Lipid and Glucose Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e30104. [PMID: 27781113 PMCID: PMC5065923 DOI: 10.5812/ircmj.30104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/09/2015] [Accepted: 08/15/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Since genetic and most environmental factors shape the context of families, some studies have been initiated to investigate the role of familial relationships in metabolic syndrome (MetS). OBJECTIVES To estimate the familial aggregation of MetS and its components by identifying both case and control probands among Tehranian adults with different socio-behavioral and reproductive characteristics. PATIENTS AND METHODS This case-controlled/family-based study was conducted on 1,777 families (635 case probands) who participated in the Tehran Lipid and Glucose Study (TLGS). Socio-demographic and reproductive information including levels of education, marital status, occupation status, age at menarche, number of abortions, number of children, and lifestyle habits such as smoking, physical activity and regular diet were obtained from the TLGS data bank. Metabolic syndrome was defined according to the joint interim statement (JIS) criteria. To estimate the regression co-efficient for familial aggregation and environmental factors, the generalized estimation equation method was used. RESULTS The risk of having MetS among family members for case versus control probands was 2.19 (95% CI: 1.68 - 2.84), which, after adjusting for potential confounders including age, sex, educational level, marital status, occupation, age at menarche and energy, soft drink and starchy vegetable intake, increased to 2.31 (95% CI: 1.81 - 2.94; P < 0.05). Compared to control probands, the risk of having MetS components increased significantly from OR = 1.28 for both high waist circumference (WC) and blood pressure (BP) to OR = 1.72 for high triglycerides in cases. Familial aggregation inherited from the father was significantly observed in all MetS components, from adjusted OR = 1.63 for hyperglycemia to adjusted OR = 2.69 for high WC, except for low HDL, after controlling for potential confounders. CONCLUSIONS Considering spouses and siblings, there was a higher risk for MetS components among families whose fathers and offspring had MetS components, implying the pivotal role of genetic inheritance in the incidence of the syndrome and its components.
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Affiliation(s)
- Maryam Zarkesh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Endocrine Health and Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Parisa Amiri, Research Center for Social Determinants of Endocrine Health and Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P. O. Box: 19395-4763, Tehran, IR Iran. Tel: +98-212409309, Fax: +98-212402463, E-mail:
| | - Nima Hosseinzadeh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Arash Ghanbarian
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Mohamed HG, Idris SB, Mustafa M, Ahmed MF, Åstrøm AN, Mustafa K, Ibrahim SO. Impact of Chronic Periodontitis on Levels of Glucoregulatory Biomarkers in Gingival Crevicular Fluid of Adults with and without Type 2 Diabetes. PLoS One 2015; 10:e0127660. [PMID: 25993052 PMCID: PMC4438982 DOI: 10.1371/journal.pone.0127660] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/17/2015] [Indexed: 12/23/2022] Open
Abstract
The relationship between diabetes and periodontal disease is bidirectional, but information about the effect of chronic periodontitis on the levels of the glucoregulatory biomarkers locally in gingival crevicular fluid (GCF) is limited. The aim of this study was to compare the levels of 10 glucoregulatory biomarkers in GCF, firstly in subjects with type 2 diabetes (T2DM) presenting with and without chronic periodontitis and secondly, in subjects without diabetes, with and without chronic periodontitis. The material comprised a total of 152 subjects, stratified as: 54 with T2DM and chronic periodontitis (G1), 24 with T2DM (G2), 30 with chronic periodontitis (G3) and 44 without T2DM or periodontitis (G4). The levels of the biomarkers were measured using multiplex biometric immunoassays. Periodontal pocket depths were recorded in mm. Subsets G1 and G2 and subsets G3 and G4 were compared independently. Among T2DM subjects, GIP, GLP-1 and glucagon were significantly up-regulated in G1 compared to G2. Moreover, there were no statistical differences between the two groups regarding C-peptide, insulin, ghrelin, leptin and PAI-1. Comparisons among individuals without T2DM revealed significantly lower amounts of C-peptide and ghrelin in G3 than in G4. The number of sites with pocket depth ≥ 4mm correlated negatively with C-peptide (Spearman’s correlation co-efficient: -0.240, P < 0.01) and positively with GIP and visfatin (Spearman’s correlation co-efficient: 0.255 and 0.241, respectively, P < 0.01). The results demonstrate that chronic periodontitis adversely influences the GCF levels of glucoregulatory biomarkers, as it is associated with disturbed levels of biomarkers related to the onset of T2DM and its medical complications.
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Affiliation(s)
- Hasaan G. Mohamed
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
- * E-mail:
| | - Shaza B. Idris
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Manal Mustafa
- Oral Health Competence Center in Western Norway, Hordaland, Bergen, Norway
| | | | - Anne N. Åstrøm
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Kamal Mustafa
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Salah O. Ibrahim
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Diaz R. Diabetes: Diabetes mellitus and periodontal disease in youth. Nat Rev Endocrinol 2011; 7:313. [PMID: 21544052 DOI: 10.1038/nrendo.2011.64] [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: 11/08/2022]
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