Periodontal disease in adult insulin-dependent diabetics

Abstract

The overall objective with the present investigations was to study the influence of insulin-dependent diabetes mellitus (IDDM) on periodontal conditions and to identify factors that may be predictors for severe periodontal disease in individuals with IDDM. Periodontal conditions were studied in two cross-sectional studies of adult, insulin-dependent diabetics and age-and sex-matched controls. In one study 72 diabetics with short-(SD) and 82 with long-duration (LD) diabetes and 77 controls participated. In the other study 83 LD diabetics and 99 controls took part. The portion of individuals exhibiting severe periodontal disease was larger in the diabetic group than in the control group. Advanced periodontal disease appeared in earlier ages (40-49 years) in the LD diabetics compared to the SD diabetics and controls. In fact, the 40-49-year-old LD diabetics had alveolar bone loss equal to the older controls (60-69 years). LD diabetics exhibited more severe periodontitis than SD diabetics. Some salivary factors were studied in 72 SD and 82 LD diabetics and 77 controls. LD and SD diabetics had a lower stimulated salivary secretion rate and an increased glucose content compared to the controls. The reduction in flow rate, however, was moderate, and all mean values were within the normal limits. The moderately increased glucose content did not result in higher mean numbers of Candida albicans, lactobacilli, and mutans streptococci. The subgingival bacterial species currently considered to be associated with periodontitis were studied in 30 LD diabetics and 34 controls. All these bacterial species were recovered in diabetics as well as controls. More LD diabetics than controls harboured Porphyromonas gingivalis. In the control group the periopathogens were recovered more often in deep periodontal pockets. In the LD group, however, these bacterial species were recovered as often in shallow as in deep periodontal pockets. The medical status of 39 matched pairs of LD diabetics was analysed. One in each pair had severe periodontal disease while the other had no/minor symptoms of periodontal disease. Biochemical analyses and clinical variables routinely used in monitoring diabetics failed to discriminate between diabetics with severe and minor periodontal disease. Diabetics with severe periodontal disease, however, showed a higher prevalence of renal disease and cardiovascular complications such as stroke, transient ischemic attacks, angina, myocardial infarct, heart failure, and claudicatio intermittens than diabetics with only minor periodontal disease. This indicates that closer cooperation between the diabetologist and the dentist is necessary in monitoring the diabetic patient.