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Periodontal disease can begin early in diabetes
Levels of dental plaque, gingival inflammation and periodontal attachment loss were higher among children with diabetes.
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Periodontal disease, sometimes overlooked as a comorbidity of diabetes, can develop earlier than previously believed. Researchers at Columbia University found that periodontal destruction often begins during childhood in patients with diabetes and typically becomes more prominent during adolescence and adulthood.
Evanthia Lalla, DDS, MS, associate professor of dentistry at the Columbia University College of Dental Medicine, and lead investigator of the article published in a recent Diabetes Care, said programs designed to promote periodontal disease prevention and treatment should be implemented and aimed at young patients with diabetes.
“Previous research of the association between diabetes and periodontal disease has typically focused on adult patients,” Lalla told Endocrine Today. “Data in children and adolescents are limited and the suggestion in the literature was that periodontal destruction starts around puberty,” she said.
“Interestingly, in this study we found that periodontitis can start in childhood in diabetes, as early loss of tooth-supporting structures was significantly increased even in our 6 to 11-year-old subgroup.”
Assessing disease
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The researchers assessed 182 pediatric patients with diabetes for this study. A nondiabetic control group comprising 160 participants was also recruited. Study participants in both groups were aged 6 to 18 and were examined for the presence of dental cavities and periodontal disease. Recruitment is ongoing, Lalla said, with a target goal of 700 participants.
No differences were observed between the diabetes group and the control group in terms of the risk for dental cavities. But levels of plaque and gingival inflammation were higher among children with diabetes than they were in the nondiabetic control group.
Periodontal disease was assessed by examining teeth for evidence of attachment loss. Attachment loss was significantly higher among patients with diabetes. The average number of teeth with attachment loss was 5.79 among patients with diabetes and 1.53 among the control group.
Even after controlling for factors such as age, gender, ethnicity, gingival bleeding and frequency of dental visits, diabetes had a highly significant correlation to periodontitis. According to the researchers, this correlation was highest in patients aged 12 to 18.
Regular dental visits needed
Lalla told Endocrine Today that children with diabetes and their parents or guardians should be educated about the risks of periodontal disease and encouraged to pay attention to their teeth. “We recommend that they pay extra attention to proper brushing and flossing at home and that they visit a dentist on a regular basis,” she said.
“Early recognition of periodontal changes and appropriate therapy can increase the chances of slowing down or even stopping disease progression before too much irreversible destruction has occurred.”
Both patients with diabetes and health care providers need to be more aware of the risks of periodontal disease. “Periodontal evaluation and treatment programs should be incorporated into the standards of continuous care for patients with diabetes in all ages,” Lalla said.
“Physicians and health care providers that treat patients with diabetes should be aware of the oral complications of the disease and should educate their patients accordingly. Health care providers should also reinforce appropriate home care and regular visits to the dentist.” – by Jay Lewis
For more information:
- Lalla E, Cheng B, Lal S, et al. Periodontal changes in children and adolescents with diabetes: A case-control study. Diabetes Care. 2006;29:295-299.