Anil K, Vadakkekuttical RJ, Radhakrishnan C, Parambath FC. Correlation of periodontal inflamed surface area with glycemic status in controlled and uncontrolled type 2 diabetes mellitus. World J Clin Cases 2021; 9(36): 11300-11310 [PMID: 35071560 DOI: 10.12998/wjcc.v9.i36.11300]
Corresponding Author of This Article
Rosamma Joseph Vadakkekuttical, MDS, Professor, Department of Periodontics, Government Dental College (Affiliated to Kerala University of Health Sciences), Govt. Medical College Campus, Calicut 673008, Kerala, India. drrosammajoseph@gmail.com
Research Domain of This Article
Dentistry, Oral Surgery & Medicine
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 26, 2021; 9(36): 11300-11310 Published online Dec 26, 2021. doi: 10.12998/wjcc.v9.i36.11300
Correlation of periodontal inflamed surface area with glycemic status in controlled and uncontrolled type 2 diabetes mellitus
Krishna Anil, Rosamma Joseph Vadakkekuttical, Chandni Radhakrishnan, Fairoz Cheriyalingal Parambath
Krishna Anil, Rosamma Joseph Vadakkekuttical, Department of Periodontics, Government Dental College (Affiliated to Kerala University of Health Sciences), Calicut 673008, Kerala, India
Chandni Radhakrishnan, Department of Medicine, Government Medical College (Affiliated to Kerala University of Health Sciences), Calicut 673008, Kerala, India
Fairoz Cheriyalingal Parambath, Department of Microbiology, Government Medical College (Affiliated to Kerala University of Health Sciences), Calicut 673008, Kerala, India
Author contributions: Vadakkekuttical RJ has proposed the article’s conception; Vadakkekuttical RJ and Anil K has contributed to data analysis; Vadakkekuttical RJ, Radhakrishnan C and Parambath FC has contributed to intellectual content; all authors did the study design, data interpretation and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Institutional ethics committee government dental college Kozhikode on 29-11-2016, IEC No. 83/2016 DCC dated 29-11-16.
Informed consent statement: All the study participants were explained about the study and informed written consent was obtained prior to study enrollment.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest in this study.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rosamma Joseph Vadakkekuttical, MDS, Professor, Department of Periodontics, Government Dental College (Affiliated to Kerala University of Health Sciences), Govt. Medical College Campus, Calicut 673008, Kerala, India. drrosammajoseph@gmail.com
Received: April 24, 2021 Peer-review started: April 24, 2021 First decision: May 12, 2021 Revised: May 13, 2021 Accepted: August 23, 2021 Article in press: August 23, 2021 Published online: December 26, 2021 Processing time: 243 Days and 6.1 Hours
Abstract
BACKGROUND
The bidirectional link between periodontitis and diabetes mellitus (DM) has been established. Periodontitis causes systemic inflammatory burden through inflammatory mediators. The currently utilized tools [clinical attachment loss (CAL) and probing pocket depth (PPD)] are linear measurements, that do not exactly quantify the inflammatory burden of periodontitis. Periodontal inflamed surface area (PISA) quantifies the surface area of bleeding pocket epithelium and estimates the inflammatory burden. Studies relating to the periodontal status of diabetic patients with and without microvascular complications are scarce. This study assessed the proportion of periodontitis and correlation of PISA with glycemic status in controlled, uncontrolled type 2 DM (T2DM) with and without microvascular complications.
AIM
To assess the proportion of periodontitis and correlation of PISA with glycemic status in controlled, and uncontrolled T2DM with and without microvascular complications.
METHODS
This study comprised 180 T2DM patients. Based on glycated hemoglobin (HbA1c) levels, they were grouped into: (1) Controlled T2DMgroup: (HbA1c ≤ 7%); (2) Uncontrolled T2DM group: (HbA1c > 7%) without microvascular complications; and (3) Uncontrolled T2DM group: (HbA1c > 7%) with microvascular complications. Each group comprised 60 patients. All patients were assessed for periodontal parameters (Bleeding on Probing, PPD, CAL, Oral hygiene index simplified and PISA), and systemic parameters (HbA1c, fasting plasma glucose and post prandial plasma glucose).
RESULTS
The proportion of periodontitis among controlled T2DM group, uncontrolled T2DM group without microvascular complications, uncontrolled T2DM group with microvascular complications was 75%, 93.4% and 96.6% respectively. Extent and severity of periodontitis were high in the uncontrolled T2DM group. A significant positive correlation was found between PISA and HbA1c among all patients (r = 0.393, P < 0.001). The dose–response relationship between PISA and HbA1c was observed. An increase of PISA with 168 mm2 was associated with a 1.0% increase of HbA1c.
CONCLUSION
High proportion and severity of periodontitis, and increased inflamed surface area in uncontrolled T2DM may have contributed to the poor glycemic control and microvascular complications.
Core Tip: Poor glycemic control and diabetic complications result in severe periodontal destruction. Periodontitis causes systemic inflammatory burden through inflammatory mediators and affects glycemic control. Periodontal inflamed surface area (PISA) estimates periodontal inflammatory burden. This cross-sectional study assessed the proportion and severity of periodontitis and evaluated the correlation between PISA and glycated hemoglobin (HbA1c) in controlled, and uncontrolled type 2 diabetes mellitus (T2DM) with and without microvascular complications. There was a significant positive correlation between PISA and HbA1c. High proportion and severity of periodontitis, and increased inflamed surface area in uncontrolled T2DM may have contributed to poor glycemic control and microvascular complications.
