Nutrition and Oral Medicine (Nutrition and Health)

Chapter 5 / Bidirectional Impact 672.1.6. CHRONIC PERIODONTITIS: DIABETES MELLITUS AS A RISK FACTORPeriodontitis is characterized by features similar to plaque-induced gingivitis but, inaddition, there is clinical attachment loss and often bone loss. Approximately 35% of thedentate US adults between 30 and 90 yr of age have periodontal disease (29). Periodontaldisease prevalence increases with age, reaching approx 50% among persons over the ageof 55 yr (30). Diabetes is considered a risk factor for periodontal diseases. Unlike gingivitis,periodontitis is uncommon in children. Children with T1DM do not appear to beat an increased risk of developing periodontitis. In adolescents, however, T1DM mayincrease the susceptibility to periodontitis (23,31). For example, one study reported thatnearly 10% of adolescents with T1DM had periodontitis compared to less than 2% ofadolescents without T1DM (23). During adolescence, there may be an amplified inflammatoryreaction of the gingiva to gingival plaque (32). It is therefore possible that thepresence of diabetes adds an additional element to this already-modified host response,resulting in periodontal breakdown.T2DM affects approx 15 million Americans (33). The prevalence of this conditionamong children younger than 10 yr of age, although historically low, is steadily increasingconcurrent with the rise in childhood obesity (34,35). The prevalence and characteristicsof periodontitis in children with T2DM has not received adequate study. To ourknowledge, there is only one study evaluating periodontal disease in children under 10yr of age (36), and unfortunately in that study, the data analysis aggregated periodontalfindings for children, adolescents, and young adults. Therefore, any conclusions relatingT2DM to periodontal disease in children cannot be drawn. Considering the lowprevalence of this condition among children, however, acquiring more data would bechallenging.The status of periodontal disease in adolescents with T2DM is also poorly defined.Among studies investigating the relationship between T2DM and periodontal disease,only four included adolescents, and all subjects were Pima Indians. One study includedonly three subjects aged 15–19 yr (37), and the other three investigations combinedpersons aged 15–34 yr of age in the presentation of study findings (38,39). Nevertheless,the prevalence of periodontal disease among subjects with diabetes aged 15–34 was fiveto six times higher than the prevalence among subjects without diabetes (38,39), suggestingthat younger people with T2DM are at particularly high risk of developing periodontaldisease. Further conclusions about the relationship between T2DM and periodontaldisease in adolescents would be premature.T2DM in adolescents is considered to have reached epidemic proportions, and it ispredicted that its incidence will continue to rise (40). There is a disproportionate increasein T2DM among children and adolescent minorities compared to whites (41), and thesepopulations are also at an increased risk for complications of diabetes. Therefore, complicationsrelated to their diabetes, including periodontal disease, are expected to rise.Moreover, some of the characteristics of these populations such as race, obesity, and poorglycemic control of their diabetes (40,42,43) may add additional risk factors for periodontalbreakdown (44–46), resulting in unusually aggressive periodontal diseases.Therefore, there is an imperative need to characterize the status of periodontal disease inadolescents with T2DM and to evaluate its magnitude as a health problem. Until additionalstudies are conducted, it is prudent, from a practical point of view, to assume thatchildren and adolescents with T2DM are at an elevated (high) risk of developing peri-