Published online Dec 26, 2021. doi: 10.12998/wjcc.v9.i36.11300
Peer-review started: April 24, 2021
First decision: May 12, 2021
Revised: May 13, 2021
Accepted: August 23, 2021
Article in press: August 23, 2021
Published online: December 26, 2021
The bidirectional link between periodontitis and diabetes mellitus (DM) is well established. Periodontitis causes systemic inflammatory burden through inflammatory mediators. The currently utilized tools [clinical attachment loss (CAL) and probing pocket depth (PPD)] are linear measurements that do not exactly quantify the inflammatory burden of periodontitis. Periodontal inflamed surface area (PISA) quantifies the surface area of bleeding pocket epithelium and estimates the inflammatory burden.
Studies relating to the periodontal status of patients with diabetes with and without microvascular complications are scarce. This study assessed the proportion of periodontitis and correlation of PISA with glycemic status in controlled, uncontrolled type 2 DM (T2DM) with and without microvascular complications.
Firstly, to assess the prevalence and severity of periodontitis in T2DM patients (well-controlled T2DM group: [glycated hemoglobin (HbA1c) levels ≤ 7%], uncontrolled type T2DM group: (HbA1c > 7%) without microvascular complications, uncontrolled T2DM group: (HbA1c > 7%) with microvascular complications. Secondly, to assess the correlation between CAL and HbA1c. Finally, to assess the correlation between PISA and HbA1c.
This cross-sectional study was conducted by the Department of Periodontics, Government Dental College Calicut, in collaboration with the Department of Internal Medicine & Department of Microbiology, Government Medical College, Calicut, Kerala, India. The duration of the study was 12 mo. In this study, 180 T2DM patients were selected from the Diabetic Clinic of the Department of Internal Medicine and divided into three groups based on their HbA1c as follows: (1) Group I: controlled T2DM group: (HbA1c ≤ 7%); (2) Group II: uncontrolled T2DM group: (HbA1c > 7%) without microvascular complications; and (3) Group III: uncontrolled T2DM group: (HbA1c > 7%) with microvascular complications. Patients were evaluated using a detailed questionnaire about their sociodemographic characteristics, medical history, oral hygiene practice, history of diabetes and drug allergy. HbA1c, fasting plasma glucose and postprandial plasma glucose, PPD, CAL, bleeding on probing, oral hygiene index-simplified and PISA were assessed.
The proportion of periodontitis among the controlled T2DM group, uncontrolled T2DM group without microvascular complications, uncontrolled T2DM group with microvascular complications was 75%, 93.4% and 96.6%, respectively. The extent and severity of periodontitis were high in the uncontrolled T2DM group. A significant positive correlation was found between PISA and HbA1c among all patients (r = 0.393, P < 0.001).
The high proportion and severity of periodontitis and increased inflamed surface area in uncontrolled T2DM patients may have contributed to poor glycemic control and microvascular complications.
Since a bidirectional relationship exists between periodontitis and diabetes, the periodontal examination is mandatory for patients with diabetes. Proper periodontal therapy can help improve glycemic control and prevent microvascular complications associated with diabetes to some extent.