Impact of periodontitis on diabetic complications

Background + Aims

• Chronic periodontitis is a common inflammatory disease that causes progressive bone loss and, if untreated, can lead to tooth loss.
• Beyond its local effects, periodontitis triggers systemic inflammation, impacting distant organs, including the cardiovascular system. Studies have linked periodontitis to increased carotid intima-media thickness and peripheral vascular disease, suggesting that periodontitis affects large blood vessels through inflammatory pathways.
• It is likely that these low-grade systemic inflammatory effects also influence smaller vessels, such as retinal microvasculature.
• Non-mydriatic funduscopy and static vessel analysis (SVA) are non-invasive methods used to measure retinal vessel diameters and assess cardiovascular risk.
• Recent research shows an association between severe periodontitis and larger retinal venular diameters. However, few studies have examined the relationship between dental diseases and retinal microvasculature.
• This study aims to evaluate the association between periodontal conditions and retinal vessel diameters in the population-based SHIP-TREND study, where dental and ophthalmologic examinations were mandatory.

Materials + Methods

• This study utilised data from the SHIP-TREND cohort in Germany (2008–2012). Of 4,420 participants, 3,013 were included after excluding those with unreadable or missing data.
• Retinal vessel health: Examined through retinal photography and software analysis of vessel diameters. Key measurements included arteriolar (CRAE) and venular (CRVE) diameters, and the arterio-venous ratio (AVR).
• Periodontal health was evaluated by calibrated dentists following CDC/AAP criteria, categorising periodontitis as none/mild, moderate, or severe. Dental examinations included probing depth, clinical attachment loss, and tooth count.
• The primary outcome was the arterio-venous ratio (AVR), with a value <0.8 indicating an increased cardiovascular risk.
• Covariates such as type 2 diabetes mellitus (T2DM), body mass index (BMI), smoking status, alcohol consumption, blood pressure, and high-sensitivity C-reactive protein (hsCRP) were collected through interviews and anthropometric measurements.
• Statistical analyses included linear and logistic regression models adjusted for age, sex, smoking, alcohol intake, BMI, systolic blood pressure, hsCRP, and T2DM.
• Sex-stratified analyses were conducted due to observed interactions between periodontal markers and retinal outcomes.
• Statistical significance set at p < 0.05.

Results

• The study included 3,183 participants.
• Participants with AVR ≤0.8 had wider venular diameters, higher blood pressure, and more antihypertensive medication use compared to those with AVR >0.8.
• In men, severe periodontitis was linked to narrower retinal arterioles and wider venules, resulting in a reduced AVR.
• No significant associations were found for women or between the number of teeth and retinal vessel measurements.
• Participants with AVR <0.8 were not significantly associated with any level of periodontitis in either gender. Sensitivity analyses confirmed these findings, including subgroups of younger participants and non-diabetic individuals.
• No significant associations were found between periodontitis and retinal measurements in participants with T2DM.

Limitations