Periodontitis in diabetic patients: prevalence, glycemic associations and renal implications-a cross-sectional study

Shiladitya Sil; Saswati Mukherjee; Rupa Ghosh; Chandreyee Ghosh; Soumyajit Dutta; Chhanda Biswas

doi:10.18203/2320-6012.ijrms20262636

Authors

Shiladitya Sil Department of Oral Medicine and Radiology, North Bengal Dental College and Hospital, Thiknikata, West Bengal, India
Saswati Mukherjee Department of Periodontics, North Bengal Dental College and Hospital, Thiknikata, West Bengal, India
Rupa Ghosh Department of Orthodontics, Dr. R. Ahmed Dental College and Hospital, Sealdah, Kolkata, West Bengal, India
Chandreyee Ghosh North Bengal Medical College and Hospital, Thiknikata, West Bengal, India
Soumyajit Dutta Department of Dentistry, Ranigunj Institute of Medical Sciences, Raniganj, West Bengal, India
Chhanda Biswas Department of Dentistry, North Bengal Medical College and Hospital, Thiknikata, West Bengal, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20262636

Keywords:

Diabetes mellitus, Periodontitis, Glycemic control, Albuminuria, Diabetic nephropathy, Community periodontal index

Abstract

Background: Diabetes mellitus is associated with multiple systemic complications, including periodontal disease. The bidirectional relationship between diabetes and periodontitis is well established, and emerging evidence suggests periodontal disease may contribute to diabetic nephropathy progression through shared inflammatory mechanisms. This study evaluated the prevalence and severity of periodontitis in diabetic patients and assessed its associations with glycemic control and renal function.

Methods: This observational, cross-sectional study enrolled 203 diabetic patients at IPGMER and SSKM Hospital, Kolkata, India (February 2014–August 2015). Periodontal status was assessed using the community periodontal index (CPI) and classified as no, low-grade, or high-grade periodontitis. Clinical parameters including HbA1c, fasting and postprandial plasma glucose, urine albumin-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR) were recorded. Statistical analysis used was statistical package for the social sciences (SPSS) (p<0.05).

Results: Periodontitis prevalence was 85.2%, with high-grade disease in 52.7% and low-grade in 32.5% of participants. Patients with HbA1c ≥8% had significantly greater periodontal severity (p<0.0001). Severe periodontitis was independently associated with higher albuminuria (ACR: 810.94 versus 96.13 mg/g; p=0.0014) and reduced eGFR (73.89 versus 93.13 ml/min/1.73 m²; p=0.0018). Diabetes duration, smoking, and BMI were also significantly associated with periodontal severity.

Conclusions: Periodontitis is highly prevalent in diabetic patients and significantly associated with suboptimal glycemic control and renal dysfunction. These findings support integrating periodontal evaluation into routine diabetes management. Prospective studies are needed to determine whether periodontal treatment can mitigate diabetic complications.

References

Löe H. Periodontal disease: the sixth complication of diabetes mellitus. Diabetes Care. 1993;16(1):329-34.

Pischon N, Heng N, Bernimoulin JP, Kleber BM, Willich SN, Pischon T. Obesity, inflammation, and periodontal disease. J Dent Res. 2007;86(5):400-9.

Chaffee BW, Weston SJ. Association between chronic periodontal disease and obesity: a systematic review and meta-analysis. J Periodontol. 2010;81(12):1708-24.

Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective. Ann Periodontol. 2001;6(1):99-112.

Papapanou PN. Epidemiology of periodontal diseases: an update. Ann Periodontol. 1996;1(11):1-36.

Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, et al. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012;55(1):21-31.

Lalla E, Papapanou PN. Diabetes mellitus and periodontitis: a tale of two common interrelated diseases. Nat Rev Endocrinol. 2011;7(12):738-48.

Chapple IL, Genco R; Working Group 2 of the Joint EFP/AAP Workshop. Diabetes and periodontal diseases: consensus report. J Periodontol. 2013;84(4 Suppl):S106-12.

Saremi A, Nelson RG, Tulloch-Reid M, Hanson RL, Sievers ML, Taylor GW, et al. Periodontal disease and mortality in type 2 diabetes. Diabetes Care. 2005;28(1):27-32.

Shultis WA, Weil EJ, Looker HC, Curtis JM, Shlossman M, Genco RJ, et al. Effect of periodontitis on overt nephropathy and end-stage renal disease in type 2 diabetes. Diabetes Care. 2007;30(2):306-11.

Nelson RG, Shlossman M, Budding LM, Pettitt DJ, Saad MF, Genco RJ, et al. Periodontal disease and NIDDM in Pima Indians. Diabetes Care. 1990;13(8):836-40.

Campus G, Salem A, Uzzau S, Baldoni E, Tonolo G. Diabetes and periodontal disease: a case-control study. J Periodontal Res. 2005;40(3):239-45.

Ainamo J, Barmes D, Beagrie G, Cutress T, Martin J, Sardo-Infirri J. Development of the World Health Organization (WHO) community periodontal index of treatment needs (CPITN). Int Dent J. 1982;32(3):281-91.

Karoli R, Fatima J, Chandra A, Singh G. Periodontal status in patients with diabetes mellitus. Indian J Endocrinol Metab. 2012;16(Suppl 2):S384-6.

Apoorva SM, Sridhar N, Shetty A. Prevalence of periodontal disease among type 2 diabetes mellitus patients. J Indian Soc Periodontol. 2013;17(4):528-31.

Kumar A, Sharma DS, Verma M. Association between periodontal disease and type 2 diabetes mellitus: a cross-sectional study. Int J Med Sci Public Health. 2014;3(6):714-8.

Bhardwaj VK. Periodontal disease and diabetes mellitus: a clinical study. J Craniofac Surg. 2012;23(6):e599-602.

Joshi DV, Deshpande N, Deshpande A. Relationship between periodontal disease and glycemic control in diabetic patients. Natl J Integr Res Med. 2010;11(2):80-4.

Genco RJ, Grossi SG, Ho A, Nishimura F, Murayama Y. A proposed model linking inflammation to obesity, diabetes and periodontal infections. J Periodontol. 2005;76(11 Suppl):2075-84.

Preshaw PM, Heasman PA, Stacey F. The effect of periodontal therapy on glycemic control in patients with type 2 diabetes mellitus. J Clin Periodontol. 2004;31(7):585-92.

Llambés F, Arias-Herrera S, Caffesse R. Relationship between diabetes and periodontal infection. World J Diabetes. 2015;6(7):927-35.