Original Article
Periodontal status of diabetics compared with nondiabetics: a meta-analysis

https://doi.org/10.1016/j.jdiacomp.2005.05.006Get rights and content

Abstract

Background

This meta-analysis was conducted to assess the association between diabetes mellitus and periodontal diseases by comparing the extent and severity of periodontal diseases between diabetics and nondiabetics.

Methods

A literature search was performed using MEDLINE database for published studies from January 1970 through October 2003 with manual search for references in relevant studies. This meta-analysis was based on 18 comparative cross-sectional studies, three prospective cohort studies and baseline data of two clinical trials that compared oral hygiene, gingival and periodontal status between diabetics and nondiabetics. Heterogeneity was obvious among included studies; therefore, the analysis using random-effects model was conducted.

Results

This study demonstrated that diabetics had significantly worse oral hygiene as measured by the average of plaque index (P1I), higher severity of gingival disease as measured by the average of gingival index (GI) and higher severity of periodontal disease as measured by the average of probing pocket depth (PPD) and clinical attachment loss (CAL). However, diabetics had similar extent of oral hygiene, gingival and periodontal disease as measured by percentages of surfaces or sites with specific scores of P1I, GI, bleeding on probing (BOP), PPD and CAL.

Conclusions

Diabetics had a significantly higher severity but the same extent of periodontal disease than nondiabetics.

Introduction

Several systemic factors are associated with an increased incidence and severity of periodontal disease or can modify the course of that disease. Studies that investigated the association between periodontal diseases and diabetes mellitus were conducted in different settings, with individuals from different populations, of variable ages and different diabetic types, and with a variety of periodontal measures. Several studies focused principally on children and adolescents with type I diabetes comparing them with groups of similar ages without diabetes (Cianciola et al., 1982, De Pomereau et al., 1992, Faulconbridge et al., 1981, Firatli, 1997, Firatli et al., 1996, Goteiner et al., 1986, Novaes et al., 1991, Pinson et al., 1995, Ringelberg et al., 1977). Other studies investigated the same relationship by including older subjects (Cohen et al., 1970, Hugoson et al., 1989, Rylander et al., 1987, Tervonen & Karjalainen, 1997, Tervonen et al., 2000, Thorstensson & Hugoson, 1993). There were fewer reports on the relationship between type II diabetes and periodontal disease (Almas et al., 2001, Collin et al., 1998, Emrich et al., 1991, Morton et al., 1995, Novaes Junior et al., 1996, Pohjamo et al., 1995, Shlossman et al., 1990, Taylor et al., 1998, Taylor et al., 1998, Unal et al., 1993). In addition, some studies included subjects without clear distinction between type I and type II diabetes (Alpagot et al., 2001, Bacic et al., 1988, Bridges et al., 1996, Oliver & Tervonen, 1993, Oliver et al., 1993, Tervonen et al., 1991), and other studies did not specify the type of diabetes (Campbell, 1972, Sznajder et al., 1978, Tervonen & Knuuttila, 1986). On the other hand, some investigators had reported a two-way connection between diabetes and periodontal disease proposing that not only diabetic patients are more susceptible to periodontal disease, but also the presence of periodontal disease affects the glycemic control (Grossi & Genco, 1998, Hugoson et al., 1989, Thorstensson & Hugoson, 1993).

This meta-analysis was conducted to summarize and quantify the effect of diabetes mellitus on the extent and severity of periodontal diseases in the observational and clinical studies (baseline data) and to explore the heterogeneity of different findings.

Section snippets

Selection of studies

Literature search was performed using the MEDLINE computerized database (for studies from January 1970 through October 2003) with medical subject headings (“periodontal disease”) and (“diabetes mellitus type I/type II” or “glycemic control”). Only full-text original journal articles were considered; no attempt was made to include abstracts or unpublished studies. The search was restricted to studies published in the English language, conducted on human subjects and classified as observational

Results

Eighteen comparative cross-sectional studies, three prospective cohort studies and baseline data of two clinical trials were included in this meta-analysis, after they met prestated inclusion criteria, to compare the oral hygiene, gingival and periodontal status between diabetic and nondiabetic subjects.

Discussion

In our meta-analysis, we used the differences in the averages of studied parameters between diabetics and nondiabetics, and the reciprocal of their variances from each study to estimate the overall difference.

This meta-analysis demonstrated that diabetics had poor oral hygiene as measured by the average of P1I, higher severity of the gingival disease as measured by the average of GI and BOP score, and higher severity of periodontal disease as measured by the average of PPD, CAL and BLI. On the

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