Diabetes as a prognostic factor in periodontitis

Background + Aims

• Periodontal treatment aims to control inflammation and preserve natural teeth, including those with reduced supporting bone. Long-term follow-up helps establish whether these benefits persist and which patients may require additional support
• This study aimed to:
  • Assess tooth loss over 20 years after active periodontal therapy and identify patient characteristics associated with poorer outcomes.

Materials + Methods

• Long-term observational follow-up at Heidelberg University Hospital, Germany.
• 70 of 100 patients previously examined at 10 years were re-examined approximately 20 years after treatment.
• Active periodontal therapy (APT) involved cleaning below the gumline, with surgery or antibiotics where indicated.
• Supportive periodontal therapy (SPT) included ongoing monitoring, oral-hygiene instruction, professional plaque removal and further treatment of affected sites.
• Records and examinations established tooth loss during the first and second decades. Wisdom teeth were excluded.
• Researchers assessed whether diabetes, heart disease, smoking, age and maintenance attendance were associated with tooth loss.
  • Diabetes status was recorded from medical history; the study did not report an analysis of HbA1c or glycaemic control.
• Poisson regression (a statistical method for analysing event counts) examined associations between patient characteristics and the number of teeth lost.

Results

• Patients had 1,639 teeth after APT. 201 were lost over 20 years, leaving approximately 88% retained.
  • Mean tooth loss was 2.87 teeth per patient, equivalent to 0.14 teeth per patient per year.
  • 27.1% lost no teeth, and 67.1% lost <4 teeth. Only 4.3% lost ≥10 more teeth.
• Average tooth loss increased from 1.20 teeth in the first decade to 1.67 in the second.
• Regular maintenance attendance was associated with a lower expected tooth-loss count: risk ratio (RR) 0.30 (95% CI 0.21–0.43).
• Smoking was associated with a higher tooth-loss count: RR 4.17 (95% CI 2.59–6.71).
• Older age, heart disease and being without a partner were also associated with greater tooth loss.
• These are observational associations and do not establish direct causes.
• Diabetes was statistically associated with tooth loss (RR: 0.26; p<0.001), but the direction requires caution

Limitations