Diabetes mellitus (DM) is a complex metabolic disease that results from defects in insulin secretion, action or both. In type 1 diabetes (T1DM) no insulin is produced while in type 2 diabetes (T2DM) not enough insulin is produced or the body’s cells do not respond to insulin. In the UK it is estimated that more than 1 in 15 of the population have diabetes with T2DM being the most common. A number of studies have shown that children and adolescents with DM have poorer periodontal status
The aim of this review was to compare the periodontal status of normal children with those living with diabetes regardless of type.
Methods
The review protocol was registered in PROSPERO. Searches were conducted in the EBSCO Medline Complete, PubMed and Science Direct databases. Case-controlled studies comparing periodontal health of diabetic and non-diabetic patient under the age of 19 and published between 2000 and 2019 were considered. Two reviewers independently searched and selected studies and extracting data. Study quality was also assessed independently using the National Heart, Lung, and Blood Institute and the National Institutes of Health (NIH) quality assessment tool for cross-sectional studies. Outcomes included Plaque Index (PI), Gingival Index (GI), Bleeding on Probing (BOP), Percentage of Bleeding Sites, Calculus Index, Clinical Loss of Attachment (CAL) and periodontal probing depth (PPD). These were reported as standardised mean differences (SMD) with 95% confidence intervals (CI) with meta-analyses where possible.
Results
- 11 studies were included.
- Studies were conducted in Belgium, Hong Kong, India, Iran, Kuwait, Lithuania, New York, Malaysia, Serbia and Turkey.
- Sample sizes ranged from 48 to 365 and ages ranged from 4- 18 yrs.
- 5 studies were considered to be at high risk of bias, 5 at moderate risk and one at low risk.
- Apart from the calculus index all outcomes were shown to be significantly higher in diabetics than non-diabetics (see table).
| No. of studies | No. of patients | SMD (95%CI) | |
| Plaque index | 10 | 1465 | 0.54 (0.20 to 0.87) |
| Gingival index | 12 | 1523 | 0.63 (0.39 to 0.87) |
| Bleeding on Probing | 3 | 252 | 0.32 (0.07 to 0.58) |
| Percentage of Bleeding Sites | 3 | 771 | 0.69 (0.55 to 0.84) |
| Clinical Loss of Attachment | 3 | 863 | 0.79 (0.55 to 0.84) |
| Calculus Index | 4 | 404 | 0.50 (-0.03 to 1.04) |
| Periodontal probing depth | 4 | 561 | 0.67 (0.23 to 1.11) |
Conclusions
The authors concluded: –
Children and adolescents with DM were found to have poorer periodontal status compared to their non- DM counterparts.
Comments
Several databases were searched with inclusions limited to case-controlled studies published in English so some relevant studies may have been excluded. All of the included studies had a case /control ratio of about 1:1 and assessed a number of periodontal parameters. Because of the cross-sectional nature of these studies the data collection will have been at a single point in time. So while the analyses indicated that patients with DM has poorer periodontal outcomes (with the exception of the calculus index) the temporal relationship between periodontal disease and PD cannot be determined. Only one of the studies was considered to be at low risk of bias with only one study mentioning blinding of the assessor. While some studies adjusted for potential confounders e.g., age, brushing frequency etc a majority (63%) did not. Consequently, the findings should be interpreted cautiously and additional studies are required to clarify the relationship between DM and periodontal disease.
Links
Primary Paper
Zainal Abidin Z, Zainuren ZA, Noor E, Mohd Nor NS, Mohd Saffian S, Abdul Halim R. Periodontal health status of children and adolescents with diabetes mellitus: a systematic review and meta-analysis. Aust Dent J. 2021 Apr 16. doi: 10.1111/adj.12845. Epub ahead of print. PMID: 33864280.
Other references
Dental Elf – 11th Nov 2015
Low quality evidence that periodontal treatment improves glycaemic control in diabetics
