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Dear editor: Among the major chronic complications associated with poor metabolic control in people with diabetes is periodontal disease (36.4%). Some of the main risk factors for periodontal disease in persons with diabetes are disease duration, poor metabolic control, smoking, poor oral hygiene habits, and inadequate diet.1 Other suggested risk factor is dyslipidemia, some studies have found an increase in levels of total cholesterol, LDL cholesterol, and triglycerides in patients with severe periodontitis, as well as a rise in triglycerides in those without periodontal treatment.2 The objective of this study was to determine the association between dyslipidemia and severe periodontitis among patients with type 2 diabetes (T2DM).
This cross-sectional study included 78 participants diagnosed with T2DM receiving care at the Metabolic Syndrome Clinic at the Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER) in Mexico City, Mexico. Dyslipidemia was defined as triglycerides ≥150 mg/dL and HDL-cholesterol <50 mg/dL in women and <40 mg/dL in men. Oral clinical evaluation was performed by three dentists previously standardized (kappa coefficient ≥0.80) for measurement of dental plaque, dental calculus, and loss of attachment using a periodontal probe PCP2 (Hu-Friedy). Severe periodontitis was defined as at least two interproximal sites with ≥6 mm clinical attachment loss and at least one site with probing depth ≥5 mm.
Mean diabetes duration of the participants was 10.1 years (s.d. 6.6); 39.7% had dyslipidemia and 65.3% had severe periodontitis. The prevalence of severe periodontitis was higher in patients with diabetes duration ≥5 years (70.8%, 95%CI 58.2-80.8) and with dyslipidemia (77.4%, 95%CI 59.3-88.9) as compared with patients with diabetes duration <5 years (46.8%, 95%CI 24.0-70.9, p=1.32), and without dyslipidemia (58.5%; 95%CI 43.7-71.9, p=0.045). After adjustment for diabetes duration and dental calculus (table I), patients with dyslipidemia had 3.18 (95%CI 1.03-9.82, p=0.044) times the probability of severe periodontitis compared with patients without dyslipidemia. As well, patients with dyslipidemia had a greater probing depth (4.81 mm [95%CI 4.19-5.42], p<0.001) than those without. Also, probing depth was greater (3.73 mm [95%CI 2.76-4.70], p<0.001) in patients with high triglyceride levels and in those with low HDL-cholesterol (2.41 mm [95%CI 1.36-3.45], p<0.001).
Table I: Regression models for dyslipidemia and severe periodontitis, and probing depth among patients with type 2 diabetes. Metabolic Syndrome Clinic, INER, Mexico City, 2010
|
Periodontitis |
Adjusted OR (95%CI) |
p value |
Adjusted OR (95%CI) |
p value |
Adjusted OR (95%CI) |
p value |
|
Duration of diabetes ≥5 years |
5.68 (1.53-21.05) |
0.009 |
4.82 (1.34-17-36) |
0.016 |
4.09 (1.19-14.04) |
0.025 |
|
Dental calculus (poor hygiene) |
3.53 (1.12-11.07) |
0.030 |
2.84 (0.94-8.60) |
0.063 |
2.76 (0.93-8.18) |
0.067 |
|
High triglyceride levels* |
- |
- |
1.89 (0.67-5.29) |
0.224 |
- |
- |
|
Low HDL-cholesterol levels* |
- |
- |
- |
- |
1.73 (0.55-5.40) |
0.343 |
|
Dyslipidemia* |
3.18 (1.03-9.82) |
0.044 |
- |
- |
- |
- |
|
Probing depth |
Adjusted β (95%CI) |
p value |
Adjusted β (95%CI) |
p value |
Adjusted β (95%CI) |
p value |
|
Duration of diabetes ≥5 years |
0.31 (-0.30-0.93) |
0.315 |
0.24 (-0.83-1.31) |
0.654 |
-0.77 (-2.06-0.52) |
0.238 |
|
Dental calculus (poor hygiene) |
0.42 (-0.21-1.06) |
0.192 |
0.02 (-0.90-0.95) |
0.961 |
-0.48 (-1.59-0.62) |
0.386 |
|
High triglyceride levels* |
- |
- |
3.73 (2.76-4.70) |
<0.001 |
- |
|
|
Low HDL-cholesterol levels* |
- |
- |
- |
2.41 (1.36- 3.45) |
<0.001 |
|
|
Dyslipidemia‡ |
4.81 (4.19-5.42) |
<0.001 |
- |
- |
* Triglyceride levels: high was ≥150 mg/dL and normal <150 mg/dL. HDL-cholesterol: low was <40 mg/dL in men and <50 mg/dL in women; normal was ≥40 mg/dL in men and ≥50 mg/dL in women.
‡ Dyslipidemia was defined as high levels of triglycerides and low levels of HDL-cholesterol, and non-dyslipidemia as normal levels of HDL-cholesterol regardless of triglyceride levels.
Hosmer-Lemeshow goodness-of-fit test model: Model 1, p=0.821; Model 2, p=0.743; Model 3, p=0.935
INER:Instituto Nacional de Enfermedades Respiratorias
Perhaps the association between periodontitis and dyslipidemia is caused by the increase of cytokines as a response to the inflammatory process induced by dyslipidemia. This condition affects immunological and hormonal profiles and causes endotoxemia, leading to an increase in the levels of pro-inflammatory cytokines. This mechanism is exa cerbated in the case of patients with diabetes.3 Then, it is thus necessary to design strategies that consider comprehensive care of people with diabetes to reduce oral complications.
