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Table of Contents   
ORIGINAL RESEARCH  
Year : 2011  |  Volume : 22  |  Issue : 2  |  Page : 291-294
Periodontal treatment needs in diabetic and non-diabetic individuals: A case-control study


1 Department of Periodontics, Kanti Devi Dental College and Hospital, Mathura, Uttar Pradesh, India
2 Department of Periodontics, Regional Dental College and Hospital, Guwahati, Assam, India

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Date of Submission19-Dec-2009
Date of Decision19-May-2010
Date of Acceptance25-Sep-2010
Date of Web Publication27-Aug-2011
 

   Abstract 

Aim: Diabetes mellitus is a chronic metabolic disorder of the carbohydrate, protein and fat metabolism, resulting in increased blood glucose levels. Various complications of diabetes have been described with periodontitis being added as the sixth complication of diabetes mellitus. The aim of this study was to assess periodontal status and treatment needs (TN) in diabetic patients and to compare the findings between diabetic and non-diabetic individuals using community periodontal index (CPI).
Materials and Methods: We evaluated the periodontal status and periodontal TN in diabetic and non-diabetic individuals in Guwahati, Assam. A total of 459 (223 diabetic and 236 non-diabetic) individuals were assessed. A person was considered to be diabetic when his blood glucose levels were above 140 mg/dl under fasting condition and 200 mg/dl 2 hours postprandially. Periodontal status was assessed using CPI.
Results: Periodontal destruction was found to be increased in diabetic individuals, with periodontal destruction increasing with increased blood glucose levels. The necessity of complex periodontal treatment also increased with increasing blood glucose levels.
Conclusions: Individuals with diabetes are more prone to periodontal destruction, and hence, regular periodontal screening and treatment is essential in these individuals.

Keywords: Community periodontal index scores, diabetes mellitus, periodontal disease

How to cite this article:
Das M, Upadhyaya V, Ramachandra SS, Jithendra K D. Periodontal treatment needs in diabetic and non-diabetic individuals: A case-control study. Indian J Dent Res 2011;22:291-4

How to cite this URL:
Das M, Upadhyaya V, Ramachandra SS, Jithendra K D. Periodontal treatment needs in diabetic and non-diabetic individuals: A case-control study. Indian J Dent Res [serial online] 2011 [cited 2019 Oct 22];22:291-4. Available from: http://www.ijdr.in/text.asp?2011/22/2/291/84307
Oral health is an integral part of general health. Many systemic diseases have manifestations in the oral cavity and in turn many oral diseases do have systemic manifestations. It is rightly said by Sir William Osler that "oral health is the mirror of general health." [1] Diabetes mellitus is a disorder characterized by altered glucose tolerance or impaired carbohydrate, protein and lipid metabolism. There are currently over 150 million people with diabetes worldwide and this figure is projected to rise to 300 million by 2025 AD. [2] According to World Health Organization (WHO), one in six diabetics in the world reside in India. [3] Diabetes can involve and affect several organs of the body, resulting in specific complications. Periodontal disease is considered as the sixth complication of diabetes. [4] Several authors have tried to study the relationship of diabetes and periodontal disease, with a majority of the studies done throughout the world suggesting that diabetics are at increased risk for periodontitis. [5],[6],[7] These studies also highlight the need for comprehensive periodontal treatment in patients suffering from diabetes as compared to non-diabetic individuals. [5],[6],[7] The aim of this study was to assess periodontal status and treatment needs (TN) in diabetic patients and to compare the findings between diabetic and non-diabetic individuals using community periodontal index (CPI). In this study, an attempt was made to compare the periodontal health status and TN among diabetic and non-diabetic patients.

Studies have suggested that presence of diabetes might favor the speedy progression of the periodontal disease with extensive destruction. Six major complications of diabetes have been described as retinopathy, nephropathy, neuropathy, macrovascular disease, altered or delayed wound healing and periodontal disease. [4] Increased amount of periodontal destruction has been postulated to be due to increased production of advanced glycation (AGE) end products and polyol pathway mechanism (Glucose is reduced to sorbitol by the enzyme aldose reductase. Sorbitol is considered as a tissue toxin; accumulation of sorbitol leads to increased intracellular osmolarity and influx of water and osmotic cell injury.). [8] This alters the collagen homeostasis of the periodontium, leading to the formation of more mature or old collagen. This old collagen is not destroyed by proteases (collagenases) and other host enzymes, whereas the newer collagen formed is of immature variety which is susceptible to rapid breakdown. [2]


   Materials and Methods Top


The present study was conducted in diabetic patients visiting Guwahati Medical College and Hospital, Guwahati, Assam, and non-diabetic patients attending Regional Dental College, Guwahati, Assam, to assess the periodontal status by using a CPI probe aided by a mouth mirror and to compare the findings of diabetics with those of non-diabetic individuals. A person was considered to be diabetic when his blood sugar levels were above 140 mg/dl under fasting condition and 200 mg/dl 2 hours postprandially. [9] All required and relevant information regarding the diabetes status were obtained from hospital records. The study sample consisted of 223 diabetic patients and a control group of 236 non-diabetic individuals. Patients with any other systemic diseases like hypertension, epilepsy, etc., were not included in the study. Those who were on antimicrobial medication and had undergone any periodontal therapy during past 6 months were excluded from the study. The control group consisted of non-diabetic patients attending Regional Dental College, Guwahati, Assam, who were age-matched pairs from the same geographic location (Guwahati, Assam) and from government hospitals.

CPI was used for the assessment of periodontal health status and TN. This is the standard index to assess the periodontal health status and TN as recommended by WHO. [10] The periodontal probing was done on the index teeth by gently inserting the tip of the probe into sulcus or periodontal pocket to the full depth. A probing force of not more than 25 gms was used. The direction of the CPI probe during insertion was kept as parallel as possible with long axis of the tooth.

Blood glucose analysis was done and according to blood glucose level, the subjects were grouped arbitrarily as shown in [Table 1].
Table 1: Subjects grouped based on their blood glucose levels

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Statistical analysis

Data were stastistically analyzed using SPSS for Windows (version 11.5, SPSS Inc., Chicago, IL, USA). Descriptive analysis was done to assess the mean number of sextants with CPI scores of 0, 1, 2, 3 and 4 with postprandial blood glucose levels and TN in both the groups. Z test was used to assess the distribution of mean number of sextants in both the groups. P value ≤0.05 was considered as statistically significant.


   Results Top


The present study using the CPI was carried out on a total of 459 subjects [223 diabetic (161 males and 62 females) and 236 non-diabetic (133 males and 103 females)]. The collected data were statistically analyzed and the observation and results were tabulated. The number of sextants in various categories of the CPI scores is given in [Table 2]. The distribution of mean score of sextants in diabetic cases and non-diabetic cases is given in [Table 3].

The distribution of sextant of cases based on postprandial blood glucose levels and CPI scores is given in [Table 4]. The distribution of TN of diabetic and non-diabetic individuals is given in [Table 5].
Table 2: Distribution of sextant in diabetic cases and non-diabetic cases by CPI score

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Table 3: Distribution of mean score of sextants in diabetic cases and non-diabetic cases

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Table 4: Distribution of sextant of cases by postprandial sugar levels and CPI score

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Table 5: Distribution of diabetic and non-diabetic cases according to different TN

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   Discussion Top


Diabetes mellitus is a chronic metabolic disorder, the incidence of which is increasing due to population growth, aging, urbanization, and increasing prevalence of obesity and physical inactivity. [3] India with its increasing population serves as one of the major centers for diabetic patients. In the last few decades, many epidemiological studies have been done to understand the relationship between diabetes and oral diseases and the results have been found conflicting and contradictory in nature, which guarantees that future research is yet to be done in this regard.

Periodontal health status

On individual evaluation of CPI scores, the number of sextants with healthy periodontium among diabetics (6.54%) was less when compared with non-diabetics (27.4%). The percentage of sites with the scores as bleeding and calculus among non-diabetics was 28.5 and 31.6%, respectively, when compared to diabetics with values of 13.0 and 43.7%, respectively. Campus et al. conducted a similar study in Sardinian adults and found that diabetic individuals were at more risk of periodontal destruction as compared to non-diabetic individuals. [5]

Periodontal pockets (both shallow and deep) were more prevalent among the diabetics when compared to non-diabetics. This was similar to the findings of previous studies. The above findings confirm that more sextants of diabetic subjects are affected by the severe degree of periodontal disease manifested as deep pockets but among non-diabetics more number of sextants are affected by the relatively lower degree of disease manifested as bleeding. In [Table 3], it is seen that mean score of sextant in diabetic was 2.21±0.68 and in non-diabetics it was 1.32±0.92. Diabetics were found to have more mean score when compared to non-diabetics. This difference is statistically significant (P <0.001). Bacic et al. had applied CPI index in their study. Since it is almost similar, this comparison is valid.

As given in [Table 4], the percentage of healthy condition or mild destruction (i.e., score 1) decreases as postprandial sugar level increases. On the other hand, the percentage of higher level of destruction (i.e., CPI scores 3 and 4) increases with increasing sugar level. Studies have reported that diabetics with poor metabolic control have a higher prevalence and more extensive periodontitis than diabetics who maintain good control. [11],[12],[13] Previous studies have shown that well-controlled diabetic patients had better periodontal health than the poorly controlled, and that within the diabetic group the prevalence of periodontal pocket declined as the control of diabetes improved. [11],[12],[13]

Treatment needs

Oral hygiene instructions and scaling were required for all subjects, i.e., needed by 69.9% of the diabetic group and 45.3% of non-diabetic group. In [Table 5] it is seen that a vast majority of diabetic cases, i.e., about 70% need TN 3 (complex treatment), followed by TN 2 (20.1%; scaling and removing of plaque retentive factors), but in non-diabetic cases 45.3% need TN 3, followed by TN 2 (28.3%).


   Conclusions Top


More diabetic subjects were affected by severe degree of periodontal disease manifested as deep pockets while in non-diabetics more number of subjects was affected by relatively lower degree of disease manifested as bleeding and calculus. Majority of diabetic subjects required complex periodontal treatment. Diabetes can have an adverse effect on oral health and periodontal health. [14] Good oral health improves glycemic control and may contribute to the prevention of long-term complications of the disease. The dental team can play an important role of recognizing the signs of undiagnosed diabetes and refer these patients for further medical investigation and treatment. [14]

 
   References Top

1.Osler W. "Occupational Disease of Teeth". In: Carrol Chouinard MA, editor. The American People′s Encyclopedia. Chicago: Spencer Press Inc; 1971: 191.  Back to cited text no. 1
    
2.Ryan ME. Diagnostic and therapeutic strategies for the management of the diabetic patient. Compend Contin Educ Dent 2008;29:32-8, 40-4.  Back to cited text no. 2
    
3.Available from: http://www.who.int/entity/diabetes/actionnow/en/mapdiabprev.[Last accessed on 2009 Dec 14.]  Back to cited text no. 3
    
4.Löe H. Periodontal disease: The 6th complication of diabetes mellitus. Diabetes Care 1993;16:329-34.  Back to cited text no. 4
    
5.Campus G, Salem A, Uzzau S, Baldoni E, Tonolo G. Diabetes and periodontal disease: A case-control study. J Periodontol 2005;76:418-25.  Back to cited text no. 5
    
6.Bakhshandeh S, Murtomaa H, Mofid R, Vehkalahti MM, Suomalainen K. Periodontal treatment needs of diabetic adults. J Clin Periodontol 2007;34:53-7.  Back to cited text no. 6
    
7.Almas K, Al-Qahtani M, Al-Yami M, Khan N. The relationship between periodontal disease and blood glucose level among type II diabetic patients. J Contemp Dent Pract 2001;2:18-25.  Back to cited text no. 7
    
8.Gustke CJ. Treatment of periodontitis in the diabetic patient. A critical review. J Clin Periodontol 1999;26:133-7.  Back to cited text no. 8
    
9.Diagnosis of diabetes accessed on National Diabetes information Clearing house Available from: http://www.diabetes.niddk.nih.gov/dm/pubs/diagnosis/ [Last accessed on 2009 Dec 18].  Back to cited text no. 9
    
10.Bacic M, Plancak D, Granic M. CPITN assessment of periodontal disease in diabetic patients. J Periodontol 1988;59:816-22.  Back to cited text no. 10
    
11.Firatli E. The relationship between clinical periodontal status and insulin-dependent diabetes mellitus. result after 5 yrs. J Periodontal 1997;68:136-40.  Back to cited text no. 11
    
12.Kinane DF, Chestnutt IG. Relationship of diabetes to periodontitis. Curr Opin Periodontol 1997;4:29-34.  Back to cited text no. 12
    
13.Karjalainen KM, Knuuttila ML, Von Dickhoff KJ. Association of the severity of periodontal disease with organ complications in type 1 diabetic patients. J Periodontol 1994;65:1067-72.  Back to cited text no. 13
    
14.Fiske J. Diabetes mellitus and oral care. Dent Update 2004;31:190-6.  Back to cited text no. 14
    

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Correspondence Address:
Manas Das
Department of Periodontics, Kanti Devi Dental College and Hospital, Mathura, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.84307

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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