Abstract
BackgroundTo systematically review the epidemiologic relationship between periodontitis and type 2 diabetes mellitus (T2DM).MethodsFour electronic databases were searched up until December 2018. The manual search included the reference lists of the included studies and relevant journals. Observational studies evaluating the relationship between T2DM and periodontitis were included. Meta-analyses were conducted using STATA.ResultsA total of 53 observational studies were included. The Adjusted T2DM prevalence was significantly higher in periodontitis patients (OR = 4.04, p = 0.000), and vice versa (OR = 1.58, p = 0.000). T2DM patients had significantly worse periodontal status, as reflected in a 0.61 mm deeper periodontal pocket, a 0.89 mm higher attachment loss and approximately 2 more lost teeth (all p = 0.000), than those without T2DM. The results of the cohort studies found that T2DM could elevate the risk of developing periodontitis by 34% (p = 0.002). The glycemic control of T2DM patients might result in different periodontitis outcomes. Severe periodontitis increased the incidence of T2DM by 53% (p = 0.000), and this result was stable. In contrast, the impact of mild periodontitis on T2DM incidence (RR = 1.28, p = 0.007) was less robust.ConclusionsThere is an evident bidirectional relationship between T2DM and periodontitis. Further well-designed cohort studies are needed to confirm this finding. Our results suggest that both dentists and physicians need to be aware of the strong connection between periodontitis and T2DM. Controlling these two diseases might help prevent each other’s incidence.
Highlights
To systematically review the epidemiologic relationship between periodontitis and type 2 diabetes mellitus (T2DM)
16 studies were excluded because of the study type (7 meta-analyses, 6 review articles and 3 case series reporting periodontal treatment for T2DM patients); 4 studies were excluded because the reported outcomes were insufficient; 2 studies were excluded because they included type 1 Diabetes mellitus (DM)
The results showed that periodontitis patients had significantly higher odds of T2DM prevalence than participants with no periodontitis (OR = 4.04, 95% confidence intervals (CIs) 2.48–6.59, p = 0.000, Fig. 2a)
Summary
To systematically review the epidemiologic relationship between periodontitis and type 2 diabetes mellitus (T2DM). Type 2 DM (T2DM) results from the body’s ineffective use of insulin and comprises 90% of people with DM worldwide [2]. Severe periodontitis, which is the sixth most prevalent chronic disease among the general population, affects nearly 750 million people. T2DM influences periodontitis initiation and progression by causing a hyperinflammatory response, impairing bone repair processes, and producing advanced glycation end products [9, 12, 13]. Two well-designed large-scale RCTs obtained contradictory results on whether periodontal treatment had an effect on glycated hemoglobin (HbA1c) in T2DM patients [16, 17]
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