Periodontal Changes in Children and Adolescents With Diabetes

Periodontal Changes in Children and Adolescents With Diabetes
Received for publication July 21, 2005. Accepted for publication November 4, 2005.
Evanthia Lalla, DDS1, Bin Cheng, PHD2, Shantanu Lal, DDS1, Sid Tucker, DDS1, Ellen Greenberg, MS3, Robin Goland, MD3 and Ira B. Lamster, DDS1
Diabetes Care
© 2006 by the American Diabetes Association

Pathophysiology/Complications
Original Article

A case-control study

1 School of Dental and Oral Surgery, Columbia University Medical Center, New York, New York
2 Mailman School of Public Health, Columbia University Medical Center, New York, New York
3 Naomi Berrie Diabetes Center, Columbia University Medical Center, New York, New York

Address correspondence and reprint requests to Evanthia Lalla, DDS, MS, Associate Professor of Dentistry, Division of Periodontics, Columbia University School of DentalOral Surgery, 630 W. 168th St., PH7E-110, New York, NY 10032. E-mail: el94@columbia.edu

ABSTRACT

OBJECTIVE—To evaluate the level of oral disease in children and adolescents with diabetes.

RESEARCH DESIGN AND METHODS—Dental caries and periodontal disease were clinically assessed in 182 children and adolescents (6–18 years of age) with diabetes and 160 nondiabetic control subjects.

RESULTS—There were no differences between case and control subjects with respect to dental caries. Children with diabetes had significantly higher plaque and gingival inflammation levels compared with control subjects. The number of teeth with evidence of attachment loss (the hallmark of periodontal disease) was significantly greater in children with diabetes (5.79 ± 5.34 vs. 1.53 ± 3.05 in control subjects, unadjusted P < 0.001). When controlling for age, sex, ethnicity, gingival bleeding, and frequency of dental visits, diabetes remained a highly significant correlate of periodontitis, especially in the 12- to 18-year-old subgroup. In the case group, BMI was significantly correlated with destruction of connective tissue attachment and bone, but duration of diabetes and mean HbA1c were not.

CONCLUSIONS—Our findings suggest that periodontal destruction can start very early in life in diabetes and becomes more prominent as children become adolescents. Programs designed to promote periodontal disease prevention and treatment should be provided to young patients with diabetes.

INTRODUCTION

Periodontal diseases are bacterial infections of the tissues surrounding and supporting the teeth. Gingivitis, an inflammation of the soft tissues only, can progress to periodontitis, where destruction of connective tissue attachment and alveolar bone can eventually lead to tooth loss. The prevalence of severe periodontitis is 10–15% in most populations (1). In 1993, periodontal disease was identified as the sixth complication of diabetes (2), and in the 1997 report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, periodontal disease was referred to as one of the pathologic conditions often found in adults with diabetes (3).

The association between diabetes and periodontal diseases has been recognized in the dental literature for many decades. Indeed, multiple studies have demonstrated that the prevalence, severity, and progression of periodontal disease are significantly increased in patients with diabetes (4). Furthermore, longitudinal studies have shown that severe periodontal disease in diabetic patients at baseline is associated with poor metabolic control and other diabetes complications at follow-up (5,6). A number of reports on the relationship between diabetes and periodontal disease have included children and adolescents; however, these studies are limited with respect to the depth of data collected and analyses presented. Manouchehr-Pour and Bissada (7) reviewed periodontal conditions in individuals with diabetes and reported that in patients with childhood-onset diabetes, periodontitis seems to ensue around puberty and to progress with age. The goal of the present study was to define the oral disease burden in young children and adolescents with diabetes.

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