Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2021; 9(36): 11300-11310
Published online Dec 26, 2021. doi: 10.12998/wjcc.v9.i36.11300
Correlation of periodontal inflamed surface area with glycemic status in controlled and uncontrolled type 2 diabetes mellitus
Krishna Anil, Rosamma Joseph Vadakkekuttical, Chandni Radhakrishnan, Fairoz Cheriyalingal Parambath
Krishna Anil, Rosamma Joseph Vadakkekuttical, Department of Periodontics, Government Dental College (Affiliated to Kerala University of Health Sciences), Calicut 673008, Kerala, India
Chandni Radhakrishnan, Department of Medicine, Government Medical College (Affiliated to Kerala University of Health Sciences), Calicut 673008, Kerala, India
Fairoz Cheriyalingal Parambath, Department of Microbiology, Government Medical College (Affiliated to Kerala University of Health Sciences), Calicut 673008, Kerala, India
Author contributions: Vadakkekuttical RJ has proposed the article’s conception; Vadakkekuttical RJ and Anil K has contributed to data analysis; Vadakkekuttical RJ, Radhakrishnan C and Parambath FC has contributed to intellectual content; all authors did the study design, data interpretation and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Institutional ethics committee government dental college Kozhikode on 29-11-2016, IEC No. 83/2016 DCC dated 29-11-16.
Informed consent statement: All the study participants were explained about the study and informed written consent was obtained prior to study enrollment.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest in this study.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rosamma Joseph Vadakkekuttical, MDS, Professor, Department of Periodontics, Government Dental College (Affiliated to Kerala University of Health Sciences), Govt. Medical College Campus, Calicut 673008, Kerala, India. drrosammajoseph@gmail.com
Received: April 24, 2021
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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).

Research conclusions

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.

Research perspectives

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.