Assessment of radiographic and periodontal status among obese patients with and without type-2 diabetes and systemically healthy subjects
DOI:
https://doi.org/10.2340/aos.v84.44957Keywords:
Alveolar bone loss, body mass index, obesity, type-2 diabetes mellitus, probing depthAbstract
Objective: The objective was to assess the radiographic and periodontal status among obese patients with and without type-2 diabetes and systemically-healthy subjects.
Methods: Participants were divided into four groups: (a) Non-diabetic obese patients; (b) Type-2 diabetic obese patients; and (c) self-reported systemically healthy controls. Demographic data, daily oral hygiene maintenance protocols and education status (ES) were collected using a questionnaire. Information regarding family history of diabetes mellitus and obesity was recorded. Hemoglobin A1c (HbA1c) levels and body mass index (BMI) were recorded. Plaque index (PI), bleeding-on-probing (BoP), probing depth (PD), clinical attachment loss (CAL), marginal bone loss (MBL) and number of missing teeth (MT) were recorded. Group comparisons were done, and the correlation between BMI, HbA1c and periodontal parameters was assessed using linear regression models. Level of significance was set at P < 0.05.
Results: Sixty-three individuals (21 non-diabetic obese, 22 type-2 diabetic obese and 20 systemically healthy controls) were included. Percentages of sites that demonstrated plaque (P < 0.05) and BoP
(P < 0.05), and scores of CAL (P < 0.05), PD (P < 0.05), MBL (P < 0.05) and MT (P < 0.05) were higher among non-diabetic obese and type-2 diabetic obese patients than controls. There was no difference in these parameters among type-2 diabetic and non-diabetic obese patients. There was a significant correlation between HbA1c (P < 0.05) and BMI (P < 0.05) and PD in type-2 diabetic and non-diabetic obese patients. There was no correlation between HbA1c and BMI in all groups.
Conclusions: Periodontal tissue destruction is more pronounced in obese individuals, irrespective of diabetic status. This suggests that excess adiposity plays a central role in periodontal breakdown, regardless of diabetic status.
Downloads
References
Newton JT, Asimakopoulou K. Managing oral hygiene as a risk factor for periodontal disease: a systematic review of psycholog-ical approaches to behaviour change for improved plaque control in periodontal management. J Clin Periodontol. 2015;42 Suppl 16:S36–46. https://doi.org/10.1111/jcpe.12356 DOI: https://doi.org/10.1111/jcpe.12356
Tonetti MS, Eickholz P, Loos BG, Papapanou P, van der Velden U, Armitage G, et al. Principles in prevention of periodontal diseases: consensus report of group 1 of the 11th European Workshop on Periodontology on effective prevention of periodon-tal and peri- implant diseases. J Clin Periodontol. 2015;42 Suppl 16:S5–11. https://doi.org/10.1111/jcpe.12368 DOI: https://doi.org/10.1111/jcpe.12368
Enteghad S, Shirban F, Nikbakht MH, Bagherniya M, Sahebkar A. Relationship between diabetes mellitus and periodon-tal/peri- implant disease: a contemporaneous review. Int Dent J. 2024;74: 426–45. https://doi.org/10.1016/j.identj.2024.03.010 DOI: https://doi.org/10.1016/j.identj.2024.03.010
Fi C, Wo W. Periodontal disease and systemic diseases: an overview on recent progresses. J Biol Regul Homeost Agents. 2021;35:1–9.
John V, Alqallaf H, De Bedout T. Periodontal disease and systemic diseases: an update for the clinician. J Indiana Dent Assoc. 2016;95:16–23.
Javed F, Näsström K, Benchimol D, Altamash M, Klinge B, Engström PE. Comparison of periodontal and socioeconomic status between subjects with type 2 diabetes mellitus and non-diabetic controls. J Periodontol. 2007;78:2112–9. https://doi.org/10.1902/jop.2007.070186 DOI: https://doi.org/10.1902/jop.2007.070186
Kocher T, König J, Borgnakke WS, Pink C, Meisel P. Periodontal complications of hyperglycemia/diabetes mellitus: epidemio-logic complexity and clinical challenge. Periodontol 2000. 2018;78:59–97. https://doi.org/10.1111/prd.12235 DOI: https://doi.org/10.1111/prd.12235
Taylor GW, Burt BA, Becker MP, Genco RJ, Shlossman M. Glycemic control and alveolar bone loss progression in type 2 diabetes. Ann Periodontol. 1998;3:30–9. https://doi.org/10.1902/annals.1998.3.1.30 DOI: https://doi.org/10.1902/annals.1998.3.1.30
Zhao Z, Ming Y, Li X, Tan H, He X, Yang L, et al. Hyperglycemia aggravates periodontitis via autophagy impairment and ROS-inflammasome-mediated macrophage pyroptosis. Int J Mol Sci. 2023;24:6309. https://doi.org/10.3390/ijms24076309 DOI: https://doi.org/10.3390/ijms24076309
Akram Z, Alqahtani F, Alqahtani M, Al-Kheraif AA, Javed F. Levels of advanced glycation end products in gingival crevicular fluid of chronic periodontitis patients with and without type-2 diabetes mellitus. J Periodontol. 2020;91:396–402. https://doi.org/10.1002/JPER.19-0209 DOI: https://doi.org/10.1002/JPER.19-0209
Alasqah M, Mokeem S, Alrahlah A, Al-Hamoudi N, Abduljabbar T, Akram Z, et al. Periodontal parameters in prediabetes, type 2 diabetes mellitus, and non-diabetic patients. Braz Oral Res. 2018;32:e81. https://doi.org/10.1590/1807-3107bor-2018.vol32.0081 DOI: https://doi.org/10.1590/1807-3107bor-2018.vol32.0081
Thomas JT, Joseph B, Sorsa T, Mauramo M, Anil S, Waltimo T. Expression of advanced glycation end products and their re-ceptors in diabetic periodontitis patients. Oral Dis. 2024;30:2784–96. https://doi.org/10.1111/odi.14769 DOI: https://doi.org/10.1111/odi.14769
Boutari C, DeMarsilis A, Mantzoros CS. Obesity and diabetes. Diabetes Res Clin Pract. 2023;202:110773. https://doi.org/10.1016/j.diabres.2023.110773 DOI: https://doi.org/10.1016/j.diabres.2023.110773
Leitner DR, Frühbeck G, Yumuk V, Schindler K, Micic D, Woodward E, et al. Obesity and type 2 diabetes: two diseases with a need for combined treatment strategies – EASO can lead the way. Obes Facts. 2017;10:483–92. https://doi.org/10.1159/000480525 DOI: https://doi.org/10.1159/000480525
Ruze R, Liu T, Zou X, Song J, Chen Y, Xu R, et al. Obesity and type 2 diabetes mellitus: connections in epidemiology, patho-genesis, and treatments. Front Endocrinol (Lausanne). 2023;14:1161521. https://doi.org/10.3389/fendo.2023.1161521 DOI: https://doi.org/10.3389/fendo.2023.1161521
Singh S, Facciorusso A, Singh AG, Vande Casteele N, Zarrinpar A, Prokop LJ, et al. Obesity and response to anti-tumor necro-sis factor-α agents in patients with select immune-mediated inflammatory diseases: a systematic review and meta-analysis. PLoS One. 2018;13:e0195123. https://doi.org/10.1371/journal.pone.0195123 DOI: https://doi.org/10.1371/journal.pone.0195123
Yudkin JS, Kumari M, Humphries SE, Mohamed-Ali V. Inflammation, obesity, stress and coronary heart disease: is interleu-kin-6 the link? Atherosclerosis. 2000;148:209–14. https://doi.org/10.1016/S0021-9150(99)00463-3 DOI: https://doi.org/10.1016/S0021-9150(99)00463-3
Bastard JP, Maachi M, Lagathu C, Kim MJ, Caron M, Vidal H, et al. Recent advances in the relationship between obesity, in-flammation, and insulin resistance. Eur Cytokine Netw. 2006;17:4–12.
Liu L, Xia LY, Gao YJ, Dong XH, Gong RG, Xu J. Association between obesity and periodontitis in US adults: NHANES 2011–2014. Obes Facts. 2024;17:47–58. https://doi.org/10.1159/000534751 DOI: https://doi.org/10.1159/000534751
Abdellatif HM, Ali D, Divakar DD, BinShabaib MS, ALHarthi SS. Periodontal status and whole salivary adipokines after scaling and root planing with and without adjunct antimicrobial photodynamic therapy in obese patients with periodontitis. Photo-diagnosis Photodyn Ther. 2022;40:103112. https://doi.org/10.1016/j.pdpdt.2022.103112 DOI: https://doi.org/10.1016/j.pdpdt.2022.103112
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observation-al studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9. https://doi.org/10.1016/j.jclinepi.2007.11.008 DOI: https://doi.org/10.1016/j.jclinepi.2007.11.008
Ding L, Xu Y, Liu S, Bi Y, Xu Y. Hemoglobin A1c and diagnosis of diabetes. J Diabetes. 2018;10:365–72. https://doi.org/10.1111/1753-0407.12640 DOI: https://doi.org/10.1111/1753-0407.12640
Chen D, Feng J, He H, Xiao W, Liu X. Classification, diagnosis, and treatment of obesity-related heart diseases. Metab Syndr Relat Disord. 2024;22:161–9. https://doi.org/10.1089/met.2023.0134 DOI: https://doi.org/10.1089/met.2023.0134
Javed F, Al-Zawawi AS, Allemailem KS, Almatroudi A, Mehmood A, Divakar DD, et al. Periodontal conditions and whole salivary IL-17A and -23 levels among young adult cannabis sativa (Marijuana)-smokers, heavy cigarette-smokers and non-smokers. Int J Env Res Pub-lic Health. 2020;17:7435. https://doi.org/10.3390/ijerph17207435 DOI: https://doi.org/10.3390/ijerph17207435
Flegal KM, Kit BK, Graubard BI. Body mass index categories in observational studies of weight and risk of death. Am J Epi-demiol. 2014;180:288–96. https://doi.org/10.1093/aje/kwu111 DOI: https://doi.org/10.1093/aje/kwu111
Affret A, Griz LH, Cesse E, Specht Yda S, Carvalho EM, Fontbonne A. Assessment of a glycated hemoglobin point-of-care analyzer (A1CNow+) in comparison with an immunoturbidimetric method: a diagnostic accuracy study. Sao Paulo Med J. 2015;133:460–4. https://doi.org/10.1590/1516-3180.2013.9110911 DOI: https://doi.org/10.1590/1516-3180.2013.9110911
Jiang F, Hou X, Lu J, Zhou J, Lu F, Kan K, et al. Assessment of the performance of A1CNow(+) and development of an error grid analysis graph for comparative hemoglobin A1c measurements. Diabetes Technol Ther. 2014;16:363–9. https://doi.org/10.1089/dia.2013.0289 DOI: https://doi.org/10.1089/dia.2013.0289
Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand. 1963;21:533–51. https://doi.org/10.3109/00016356309011240 DOI: https://doi.org/10.3109/00016356309011240
Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condtion. Acta Odon-tol Scand. 1964;22:121–35. https://doi.org/10.3109/00016356408993968 DOI: https://doi.org/10.3109/00016356408993968
Armitage GC. Periodontal diagnoses and classification of periodontal diseases. Periodontol 2000. 2004;34:9–21. https://doi.org/10.1046/j.0906-6713.2002.003421.x DOI: https://doi.org/10.1046/j.0906-6713.2002.003421.x
Al Amri MD, Abduljabbar TS, Al-Kheraif AA, Romanos GE, Javed F. Comparison of clinical and radiographic status around dental implants placed in patients with and without prediabetes: 1-year follow-up outcomes. Clin Oral Implants Res. 2017;28:231–5. https://doi.org/10.1111/clr.12788 DOI: https://doi.org/10.1111/clr.12788
Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, et al. Periodontitis: consensus report of workgroup 2 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions. J Periodontol. 2018;89 Suppl 1:S173–82.
Koçak E, Sağlam M, Kayış SA, Dündar N, Kebapçılar L, Loos BG, et al. Nonsurgical periodontal therapy with/without diode laser modulates metabolic control of type 2 diabetics with periodontitis: a randomized clinical trial. Lasers Med Sci. 2016;31:343–53. https://doi.org/10.1007/s10103-016-1868-0 DOI: https://doi.org/10.1007/s10103-016-1868-0
Montero E, López M, Vidal H, Martínez M, Virto L, Marrero J, et al. Impact of periodontal therapy on systemic markers of in-flammation in patients with metabolic syndrome: a randomized clinical trial. Diabetes Obes Metab. 2020;22:2120–32. https://doi.org/10.1111/dom.14131 DOI: https://doi.org/10.1111/dom.14131
Katz J, Yoon TY, Mao S, Lamont RJ, Caudle RM. Expression of the receptor of advanced glycation end products in the gingival tissue of smokers with generalized periodontal disease and after nornicotine induction in primary gingival epithelial cells. J Periodontol. 2007;78:736–41. https://doi.org/10.1902/jop.2007.060381 DOI: https://doi.org/10.1902/jop.2007.060381
Al-Hamoudi N, Abduljabbar T, Mirza S, Al-Sowygh ZH, Vohra F, Javed F, et al. Non-surgical periodontal therapy reduces salivary adipocytokines in chronic periodontitis patients with and without obesity. J Investig Clin Dent. 2018;9:e12314. https://doi.org/10.1111/jicd.12314 DOI: https://doi.org/10.1111/jicd.12314
Kamil MA, Peeran SW, Basheer SN, Elhassan A, Alam MN, Thiruneervannan M. Role of resistin in various diseases with spe-cial emphasis on periodontal and periapical inflammation – a review. J Pharm Bioallied Sci. 2023;15:S31–5. https://doi.org/10.4103/jpbs.jpbs_655_22 DOI: https://doi.org/10.4103/jpbs.jpbs_655_22
Akram Z, Abduljabbar T, Abu Hassan MI, Javed F, Vohra F. Cytokine profile in chronic periodontitis patients with and with-out obesity: a systematic review and meta-analysis. Dis Markers. 2016;2016:4801418. https://doi.org/10.1155/2016/4801418 DOI: https://doi.org/10.1155/2016/4801418
Kangas S, Timonen P, Knuuttila M, Jula A, Ylöstalo P, Syrjälä AH. Waist circumference and waist-to-height ratio are associat-ed with periodontal pocketing-results of the Health 2000 Survey. BMC Oral Health. 2017;17:48. https://doi.org/10.1186/s12903-017-0336-y DOI: https://doi.org/10.1186/s12903-017-0336-y
Vohra F, Akram Z, Bukhari IA, Sheikh SA, Riny A, Javed F. Comparison of periodontal inflammatory parameters and whole salivary cytokine profile among Saudi patients with different obesity levels. Int J Periodontics Restorative Dent. 2018;38:e119–26. https://doi.org/10.11607/prd.3411 DOI: https://doi.org/10.11607/prd.3411
Lin W. The association between body mass index and glycohemoglobin (HbA1c) in the US population’s diabetes status. Int J Environ Res Public Health. 2024;21:517. https://doi.org/10.3390/ijerph21050517 DOI: https://doi.org/10.3390/ijerph21050517
Yamamoto T, Tanaka M, Kuribayashi N, Okuguchi F, Isotani H, Iwamoto M, et al. Low education is associated with poor periodontal status in patients with type 2 diabetes mellitus: a cross-sectional study. Clin Exp Dental Res. 2021;7:419–28. https://doi.org/10.1002/cre2.363 DOI: https://doi.org/10.1002/cre2.363
Published
Issue
Section
License
Copyright (c) 2025 Marwa Y. Shaheen, Amani M. Basudan, Abeer S. Alzawawi, Fatemah M. AlAhmari, Nouf Alshibani, Reem Al-kattan, Lamees Alssum, Fatima Alzahraa Yassin Shaheen, Arwa Ameen Talakey
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Odontologica Scandinavica publishes original research papers as well as critical reviews relevant to the diagnosis, epidemiology, health service, prevention, aetiology, pathogenesis, pathology, physiology, microbiology, development and treatment of diseases affecting tissues of the oral cavity and associated structures including papers on cause and effect or explanatory/associative relationships for experimental or observational studies.
