Diabetes as a prognostic factor in periodontitis

Background + Aims

• Periodontitis is a widespread chronic disease that can lead to tooth loss if untreated. Tooth loss impacts individuals’ quality of life and generates substantial healthcare costs.
• Identifying predictors of tooth loss helps dentists plan treatments, manage risk, and communicate prognosis to patients. Predictors include both patient-level factors (e.g., age, smoking, diabetes) and tooth-level factors (e.g., bone loss, mobility).
• Previous studies report varying results about which predictors are significant and their magnitude of association with tooth loss.
• This study aimed to systematically review and analyse data on predictors of tooth loss in periodontitis patients receiving active periodontal treatment (APT) followed by supportive periodontal treatment (SPT). The aim was to evaluate consistency and strength of associations between predictors and tooth loss.

Materials + Methods

• Systematic review and meta-analysis of 20 longitudinal studies with a mean follow-up of 12 years.
• Inclusion criteria:
  • Studies involving dentate individuals diagnosed with periodontitis, treated with APT and SPT for at least 3 years.
  • Reported associations between predictors and tooth loss using statistical models, including odds ratios (OR) or risk ratios (RR).
• Predictors examined:
  • Patient-level: Age, compliance with treatment, smoking, diabetes, gender, IL-1 polymorphism.
  • Tooth-level: Bone loss, probing pocket depth (PPD), furcation involvement, tooth mobility, tooth type (e.g., molars), and endodontic treatment.
• Data was extracted on study characteristics, predictors, and outcomes were extracted by 2 reviewers independently.

Results

• Patient-level predictors with significant associations were found for:
  • Smoking (OR: 1.98, 95% CI: 1.58–2.48).
  • Diabetes (OR: 1.80, 95% CI: 1.26–2.57).
  • Non-compliance (OR: 1.51, 95% CI: 1.06–2.16).
  • Older age increased risk (OR: 1.05 per year, 95% CI: 1.03–1.08).
  • Gender showed no significant association (OR: 0.95, 95% CI: 0.86–1.05).
• Tooth-level predictors with significant associations included:
  • Bone loss (OR: 1.04 per %, 95% CI: 1.03–1.05).
  • High probing pocket depth (PPD) (OR: 3.19, 95% CI: 1.70–5.98).
  • Tooth mobility (OR: 3.71, 95% CI: 1.65–8.38).
  • Molar tooth-type (OR: 4.22, 95% CI: 2.12–8.39), especially with furcation involvement (OR: 2.68, 95% CI: 1.75–4.08).
  • Endodontic treatment did not show significant association (OR: 3.62, 95% CI: 0.99–13.2).
• Tooth-level predictors demonstrated stronger and more consistent associations with tooth loss compared to patient-level predictors.

Limitations