GINGIVAL INFLAMMATION AS A SIGN OF DIABETIC SYSTEMIC CHRONIC COMPLICATIONS
Table 1 . Mean values and standard deviations ( X ± SD ) of PI , Izk , Ikon , Gi and PDI indexes and statistically important differences between groups according to HbA1c values
Groups according to HbA 1 c
N Pl Izk Ikon Gi PDI
1 ( 4 % -6 %) / / / / / 2 ( 6.1 % -7 %) 22 2.33 ± 0.58 2.00 ± 0.00 2.67 ± 0.58 1,00 ± 0,00 4.68 ± 0.79 3 ( 7.1 % -8 %) 16 2.57 ± 0.53 1.86 ± 0.69 2.57 ± 0.53 1,75 ± 0,46 def * 5.00 ± 0.00 4 (> 8 %) 62 2.28 ± 0.68 1.98 ± 0.66 2.58 ± 0.55 2,00 ± 0,00 5.25 ± 0.46 a
-1vs2 , b -1vs3 , c – 1vs4 , d -2vs3 , e -2vs4 , f – 3vs4 ; * - p < 0,05 , ** - p < 0,01 , *** - p < 0,001
Table 2 . Mean values and standard deviations ( X ± SD ) of PI , Izk , Ikon , Gi and PDI values and statistically important differences between groups according to chronic systemic DM complications
Groups according to DM complications
A ( with DM complications )
N Pl Izk Ikon Gi PDI
70 2.23 ± 0.69 1.63 ± 0.69 1.66 ± 0.76 1.92 ± 0.27 *** 4.91 ± 0.61
B ( without DM complications ) 30 a
-AvsB gr , * - p < 0.05 , ** - p < 0.01 , *** - p < 0.001
1.87 ± 0.74 1.47 ± 0.52 1.73 ± 0.96 1.64 ± 0.50 4.53 ± 0.83
5 . Discussion DM and periodontal disease are common chronic diseases in adults 22 , 23 . The general opinion is that there is no effect of gender on elevated blood glucose in diabetic patients , as noticed in this study , whereas both sexes were uniformly represented 24 . Diabetic patients with poor metabolic control are at a high risk for a poor periodontal prognosis 7 , 8 . Most studies suggest that the situation for periodontal disease is similar to that for the other systemic complications of DM 5 , 7 , 8 . The metabolic control in diabetic patients is an important variable in the onset and progression of periodontal disease and chronic systemic DM complications 5 . Lalla et al . 24 noticed that HbA1c was positively and significantly correlated with gingival bleeding . The presence of periodontal pockets and attachment loss were not significantly correlated with HbA1c higher values in diabetic patients . These findings suggest that changes in the periodontal microvasculature are related to the level of metabolic control . The results of this investigation were similar to literature data 25 . The ‘‘ poor metabolic control ’’ shown through the high values of HbA1c clearly increases the risk of activation of gingival inflammation and higher values of Gi index are present as the value of HbA1c was rising ( p < 0,001 ). Salvi 26 investigated diabetics with mean HbA1c of 8.1 %, and concluded that in diabetic patients with ‘‘ poor metabolic control ’’ the bleeding tendencies were higher than in those with lower values of HbA1c . Similar findings were noticed in the present investigation . Mean Gi values in groups with “ moderately poor ” and “ poor metabolic control ” were higher comparing to the values in group with “ good metabolic control ” ( p < 0,05 ). Lalla E et al . 24 measured attachment loss and gingival bleeding separately , and similarly as previous investigators noticed that HbA1c was positively and significantly correlated with gingival bleeding , but not with attachment loss alone 24 , 27 . Similar findings were noticed in the present investigation where mean Gi values in groups with “ moderate poor ” and “ poor metabolic control ” were higher comparing to group with “ good metabolic control ” ( p < 0,05 ). Some authors emphasize that an intensive gingival inflammation suggests the existence of poor glycemic control and multiple systemic diabetic complications 7-11 . Similar noticed in the present study where diabetics with chronic systemic diabetic complications also had higher values of Gi . The evidence suggests that mechanisms which account for the development of systemic diabetic chronic microvascular complications might also be operating in the pathogenesis of increased gingival inflammation in DM 12 , 13 . Potentially a number of factors could contribute to the periodontal disease in DM ( oral microflora , phagocytic and connective-tissue defects ) and exploring the complex pathogenic mechanisms underlying these associations was beyond the scope of this study . Further studies with larger sample sizes are needed to investigate the pathogenic mechanisms between gingival inflammation and systemic diabetic chronic complications . The general opinion is that diabetic patients exhibit poorer periodontal health and poorer therapeutic response than systemically health patients 28 . Good glycemic control might be essential in the prevention of periodontal complications in patients with DM 20 , 29 , 30 . During routine dental checkup , dentists detecting pronounced gingival inflammation in patients with DM can suspect the presence of undiagnosed diabetic chronic complications and refer a patient
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