Association between periodontitis and diabetes

Background + Aims

• Periodontitis destroys the tissues and bone supporting the teeth, with its severity influenced by bacterial infection, the immune response and environmental factors.
• Nutritional deficiencies and disturbances in glucose metabolism may contribute to periodontal damage, but their relationships are less well understood in populations without regular preventive dental care.
• This study aimed to:
• • Investigate associations between alveolar bone loss and nutritional, metabolic, inflammatory and microbial factors in a rural Indonesian population.

Materials + Methods

• This observational study examined 98 adults aged 39-50 years, including 53 women and 45 men, from a tea plantation community in West Java.
• Participants belonged to a longstanding periodontal research cohort. The present analysis related bone loss measured in 2011 to their current health and dietary characteristics.
• Full-mouth dental radiographs assessed bone loss as a percentage of tooth root length, averaged for each participant.
• Blood tests measured vitamin C, vitamin D, glycated haemoglobin (HbA1c) and C-reactive protein (CRP).
• Researchers also assessed bacteria beneath the gumline, smoking, body mass index (BMI) and food consumption during the previous month.
• Multiple regression analysis identified factors independently associated with bone loss.

Results

• Mean periodontal bone loss was 30.1% of root length, indicating substantial destruction of tooth-supporting bone.
• Nutritional deficiencies and abnormal glucose levels were common:
  • Aproximately 45% had vitamin C depletion or deficiency
  • 69 participants (70%) had HbA1c in the study’s pre-diabetes range and 6 (6%) had values in the diabetes range.
• 4 factors were significantly associated with bone loss:
  • Higher levels of Porphyromonas gingivalis were associated with greater bone loss (p = .028).
  • Higher CRP was associated with greater bone loss (p = .025).
  • Lower BMI was associated with greater bone loss (p = .001).
  • More frequent guava consumption was associated with less bone loss (p = .029).
• Together, these factors explained 19.8% of the variation in bone loss.
• HbA1c was not significantly associated with bone loss, despite the high prevalence of prediabetes. Blood vitamin C and vitamin D levels also showed no significant associations.
• The 10 participants with BMI ≤19 kg/m² had greater average bone loss than the remaining participants (34.6% versus 29.6%; p = .039).
  • All 10 were male smokers, highlighting possible confounding.

Limitations