Resumen de Effect of Glycemic Control on Self-Perceived Oral Health, Periodontal Parameters, and Alveolar Bone Loss Among Patients With Prediabetes
Background: The effect of glycemic control on severity of periodontal inflammatory parameters in patients with prediabetes is unknown. The aim of the present study is to assess the effects of glycemic control on self-perceived oral health, periodontal parameters, and marginal bone loss (MBL) in patients with prediabetes.
Methods: A total of 303 individuals were included. Hemoglobin A1c (HbA1c) and fasting blood glucose levels (FBGLs) were recorded. Participants were divided into three groups: 1) group A: 75 patients with prediabetes (FBGLs = 100 to 125 mg/dL [HbA1c =5%]); 2) group B: 78 individuals previously considered prediabetic but having FBGLs <100 mg/dL (HbA1c <5%) resulting from dietary control; and 3) control group: 150 medically healthy individuals. Self-perceived oral health, socioeconomic status, and education status were determined using a questionnaire. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and clinical attachment loss (AL) were recorded. Premolar and molar MBLs were measured on panoramic radiographs.
Results: Periodontal parameters (PI, BOP, PD, and AL) (P <0.01) and MBL (P <0.01) were worse among individuals in group A than those in group B. Self-perceived gingival bleeding (P <0.001), pain on chewing (P <0.001), dry mouth (P <0.001), and oral burning sensations (P <0.05) were worse among patients in group A than those in group B. There was no difference in periodontal parameters, MBL, and self-perceived oral symptoms among patients with prediabetes in group B and healthy controls.
Conclusions: Self-perceived oral health, severity of periodontal parameters, and MBL are worse in patients with prediabetes than controls. Glycemic control significantly reduces the severity of these parameters as well as the state of prediabetes in affected individuals.
Periodontal disease has been suggested as the �sixth complication of diabetes.�1 Studies2-4 have reported that periodontal inflammatory parameters and marginal bone loss (MBL) are worse in patients with poorly controlled diabetes compared with healthy controls. In addition, recent studies5-7 have reported that patients with impaired glucose tolerance (prediabetes) demonstrated more severe periodontal inflammatory parameters than healthy individuals. Although the exact mechanism through which hyperglycemia (in patients with diabetes and prediabetes) promotes periodontal inflammation remains unclear, it has been proposed that an interaction between the advanced glycation end products (AGEs) (produced as a result of hyperglycemia) and their receptors (RAGEs) in the periodontal tissues impairs the chemotactic and phagocytic function of polymorphonuclear leukocytes and produces proinflammatory cytokines, thereby leading to periodontal inflammation and bone loss in these individuals.8,9 In addition, function of potential cells involved in immunoinflammatory responses is impaired under chronic hyperglycemia.10 Manoucher-Pour et al.10 reported that chronic hyperglycemia impairs the chemotactic and phagocytic function of neutrophils that may prevent breakdown of bacteria in periodontal pockets, thereby increasing periodontal breakdown.
Diabetes is an important risk factor for periodontal inflammation,11,12 and severity of periodontal inflammatory parameters varies depending on the maintenance of blood glucose levels.2-4,13 In a previous clinical study,2 the authors of the present study demonstrated that periodontal inflammatory parameters were worse in patients with poorly controlled type 2 diabetes (T2D) compared to well-controlled T2D and healthy controls. Likewise, in another study,3 self-perceived gingival bleeding was reported more often by children with poorly controlled type 1 diabetes (T1D) compared with those with well-controlled T1D or medically healthy controls. Moreover, periodontal measures made in patients without diabetes and well-controlled patients with diabetes have been reported to be quite similar to one another.2,3 Therefore, it is postulated that the production of hyperglycemia-related AGEs and induction of the secretion of proinflammatory cytokines in the periodontal tissues of patients with well-controlled diabetes are significantly lower than those in patients with poorly controlled diabetes. This may be a part of the biologic rationale for the significant differences in periodontal inflammation in patients with well-controlled diabetes compared to those in patients with poorly controlled diabetes.2,3 However, with respect to prediabetes, studies in the indexed literature that focused on the effects of glycemic control on the severity of periodontal inflammatory parameters in patients with prediabetes could not be found.
In the present study, the following is hypothesized: 1) good glycemic control in patients with prediabetes correlates to status of self-perceived oral health and severity of periodontal inflammation compared with patients with prediabetes with poor glycemic control; and 2) the periodontal status of patients with prediabetes maintaining their serum glucose levels within or at least closer to the normal range will have self-rated oral health statuses and periodontal conditions similar to those found in medically healthy individuals. Therefore, the aim of the present study is to investigate the effects of glycemic control on self-perceived oral health, periodontal parameters, and MBL in patients with prediabetes.
