Periodontal Status of Patients with Non -Insulin Dependent Diabetes Mellitus

Introduction: Association of Diabetes Mellitus and periodontal disease has been well established over the last few decades. It is a well established risk factor in the pathogenesis of periodontal disease. Objective: This study was conducted to assess the prevalence of periodontal disease in non-insulin dependent diabetes mellitus. Methods: Individuals with non-insulin dependent diabetes mellitus for the duration of at least five years were selected. Plaque Index (PII), Gingival Index (GI), Loss of attachment (LA) and Probing Depth (PD) were recorded using William’s Periodontal probe. Results: Patients with Non-Insulin Dependent Diabetes Mellitus demonstrated higher loss of attachment. Conclusion: The results showed statistically significant association between non-insulin dependent diabetes mellitus and periodontal disease thus supporting it as a risk factor for periodontitis.


INTRODUCTION
Periodontal Disease is an entity of chronic infection, which involves the supporting structures of teeth. There is extensive evidence that this infection is associated with various local and systemic factors. Studies have shown that individuals with diabetes have more gingival inflammation than individuals without. 1 Epidemiologic research have shown that diabetes mellitus increases the risk and severity of periodontal diseases. [2][3][4] Many previous studies have shown that individuals with controlled diabetes exhibit less severe periodontitis than the ones whose disease are not in control. [7][8][9][10][11][12] There exists a strong association with poorly controlled diabetes mellitus thus making periodontal disease the "sixth complication of diabetes." 13   To calculate PI, 0 to 3 scores for each surface were given.  Table 1 shows that majority (51.2%) of the patients belonged to the age group of 41 to 60 years (58.27 ± 11.09 years). More than half (61.6%) of the study participants were male.

RESULTS
In the current study, more than half of the individuals with diabetes had fair to poor plaque index scores with mean of      (Table 5).    Earlier studies have shown that individuals with diabetes have more gingival inflammation than healthy control individuals. 1 It has been observed that there is a increase in the prevalence and severity of the periodontal disease in patients with diabetes mellitus. 5,6 Many previous studies have shown that individuals with controlled diabetes exhibit less severe periodontitis than the ones whose disease are not in control. [7][8][9][10][11][12] An interesting trend was observed as diabetes history longer than 10 years showed greater loss of periodontal structures. 14 Further studies on this showed that it was not until the ages of 40 to 60 that the difference in the loss of attachment began to approach statistically significant. [15][16][17] Chronological age of the individuals with diabetes was found to be more significant than the duration of diabetes as regards to the severity of periodontal disease. 9 It was also noticed in one of the studies where in the age group 40 to 49 years old with long duration of diabetes showed significantly more probing depth of >6mm and alveolar bone loss. 18 Thus with these observations it becomes significant to note the duration of diabetes with special consideration to age of the subject.
In regards to the children, several studies have suggested that the ones with diabetes have higher gingival index scores than individuals without diabetess. 19,20 With all this evidence it is confirmed that irrespective of the duration of the disease there is higher prevalence of sites with periodontitis in individuals with diabetes.
The hospital runs a special diabetes clinic where substantial number of patients report every week. No such prevalence has been studied before in this population. Thus this cross sectional study was designed where age group between 20 to 70 years was selected to see the association between diabetes mellitus and periodontal disease with special consideration to poorly controlled diabetes mellitus.

CONCLUSION
The current study showed positive association between noninsulin dependent diabetes mellitus and periodontal disease.
The current study implies that compared to single measure of blood sugar levels, it is the duration of diabetes which is significantly associated with periodontal health. However to make this study more significant a bigger sample size would be preferred. Also it would be preferred if HB1Ac could be recorded for each patient to see the association.