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      Association between diabetes-related factors and clinical periodontal parameters in type-2 diabetes mellitus

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          Abstract

          Background

          Evidence consistently shows that diabetes is a risk factor for increased prevalence of gingivitis and periodontitis. But there is a controversy about the relationship between diabetes related factors and periodontal health. The aim of the present study is to explore the relationship between diabetes related factors such as glycosylated hemoglobin, fasting blood glucose, duration of diabetes and compliance to diabetes self management and periodontal health status.

          Methods

          Periodontal health of 125 participants with type-2 diabetes mellitus was measured by the number of missing teeth, community periodontal index (CPI), Russell’s periodontal index and papillary bleeding index. Information on sociodemographic factors, oral hygiene behavior, duration and compliance to self management of diabetes, levels of glycosylated hemoglobin(HbA1c) and fasting blood glucose(FBG) were collected by interview and hospital medical records. Statistically, independent t-test, an analysis of variance (ANOVA), chi-squared test and multiple regression analyses were used to assess the association between diabetes-related factors and periodontal health.

          Results

          Periodontal parameters including the number of missing teeth and papillary bleeding index were significantly influenced by duration of diabetes, FBG and compliance to self management of diabetes. CPI was significantly influenced by duration of diabetes, FBG and HbA1C. And Russell’s periodontal index was significantly influenced by duration of diabetes, FBG, HbA1C and compliance to self management of diabetes. Results of multiple linear regression analysis showed that the duration of diabetes showed significant positive correlation with all of the periodontal health parameters, except for missing teeth. HbA1c was correlated with Russell's periodontal and papillary bleeding index. FBG and compliance to self management of diabetes were correlated with missing teeth and papillary bleeding index respectively.

          Conclusions

          Diabetes-related factors such as duration of diabetes, FBG, HbA1c and compliance to self management of diabetes were significantly correlated with periodontal health among individuals with type-2 diabetes.

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          Most cited references23

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          Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population.

          We investigated the association between glycemic control of type 2 diabetes mellitus (type 2 DM) and severe periodontal disease in the US adult population ages 45 years and older. Data on 4343 persons ages 45-90 years from the National Health and Nutrition Examination Study III were analyzed using weighted multivariable logistic regression. Severe periodontal disease was defined as 2 + sites with 6 + mm loss of attachment and at least one site with probing pocket depth of 5 + mm. Individuals with fasting plasma glucose > 126 mg/dL were classified as having diabetes; those with poorly controlled diabetes (PCDM) had glycosylated hemoglobin > 9% and those with better-controlled diabetes (BCDM) had glycosylated hemoglobin
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            Periodontal disease: associations with diabetes, glycemic control and complications.

            This report reviews the evidence for adverse effects of diabetes on periodontal health and periodontal disease on glycemic control and complications of diabetes. MEDLINE search of the English language literature identified primary research reports published on (a) relationships between diabetes and periodontal diseases since 2000 and (b) effects of periodontal infection on glycemic control and diabetes complications since 1960. Observational studies provided consistent evidence of greater prevalence, severity, extent, or progression of at least one manifestation of periodontal disease in 13/17 reports reviewed. Treatment and longitudinal observational studies provided evidence to support periodontal infection having an adverse effect on glycemic control, although not all investigations reported an improvement in glycemic control after periodontal treatment. Additionally, evidence from three observational studies supported periodontal disease increasing the risk for diabetes complications and no published reports refuted the findings. The evidence reviewed supports diabetes having an adverse effect on periodontal health and periodontal infection having an adverse effect on glycemic control and incidence of diabetes complications. Further rigorous study is necessary to establish unequivocally that treating periodontal infections can contribute to glycemic control management and to the reduction of the burden of diabetes complications.
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              The relationship between diabetes mellitus and destructive periodontal disease: a meta-analysis.

              The aim of this study was to systematically review the studies on the association between diabetes mellitus (DM) and destructive periodontal disease. The methods applied include a literature search strategy, inclusion and exclusion criteria for selecting the studies, characteristics of the studies, quality assessment and meta-analysis. Data sources included PubMed, EMBASE, SciELO and LILACS. Selected papers were articles relating to human studies investigating whether or not diabetes is a risk factor for periodontitis and if it influences the response to periodontal therapy. Those papers that were published between January 1980 and June 2007 were retrieved. Of the 2440 identified studies, 49 cross-sectional and eight longitudinal studies met the inclusion criteria. Twenty-seven of the 49 cross-sectional studies that are included in this review detected more periodontal disease in diabetic subjects compared with non-diabetic subjects. The greater risk of periodontal disease progression was associated with type 2 DM, and one study associated DM with response to periodontal therapy. Methodological flaws of most of the studies included inadequate control for confounders, insufficient statistical analysis and lack of information about sampling design. Random effect model showed a significant association with clinical attachment level (mean difference = 1.00 [CI 95% = 0.15 to 1.84]) and periodontal pocket depth (mean difference = 0.46 [CI 95% = 0.01 to 0.91]) between type 2 diabetics and non-diabetics. Type 2 DM can be considered a risk factor for periodontitis. More studies are needed to confirm the harmful effects of type 1 DM on periodontal disease.
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                Author and article information

                Journal
                BMC Oral Health
                BMC Oral Health
                BMC Oral Health
                BioMed Central
                1472-6831
                2013
                7 November 2013
                : 13
                : 64
                Affiliations
                [1 ]Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
                [2 ]Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
                [3 ]Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
                [4 ]Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
                [5 ]Department of Dentistry, College of Medicine, Yeungnam University Daegu, 317-1, Daemyung-dong, Nam-Gu, 705-717, Daegu, Republic of Korea
                Article
                1472-6831-13-64
                10.1186/1472-6831-13-64
                3829373
                24195646
                358877c3-fd52-4ac3-b33f-effae6055a19
                Copyright © 2013 Kim et al.; licensee BioMed Central Ltd.

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 4 July 2013
                : 5 November 2013
                Categories
                Research Article

                Dentistry
                Dentistry

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