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Abstract
The purpose of this study was to analyze the relationships among non-insulin-dependent diabetes mellitus (NIDDM), periodontitis, and tooth loss, using longitudinal data collected in the Gila River Indian Community, AZ. Three sets of hypotheses were tested: (1) the association of NIDDM with the occurrence of adult periodontitis, partial tooth loss and edentulism; (2) the association of NIDDM with the progression of periodontitis; and (3) the relationship between periodontitis and glycemic control.
Methods for testing these hypotheses included stratified contingency table analysis, logistic regression models, using both dichotomous and polytomous response variable formulations, and generalized estimating equations, using dichotomous responses.
Dependent variables included measures of incidence and progression of periodontitis and incidence of partial tooth loss, complete edentulism, and poor glycemic control. The principal exposure was glucose tolerance status, using a dichotomous specification separating subjects with NGT/IGT from those with NIDDM. Covariates assessed for confounding and effect modification included: variables relating to the presence, severity, duration, and degree of control of diabetes; diabetes specific complications and other concomitant systemic conditions; selected demographic and health-related behavioral variables; and measures of oral hygiene.
These analyses applied stringent selection criteria, including only subjects whose glucose tolerance status remained unchanged over the period of observation. For analyses involving measures of adult periodontitis, subjects who lost teeth between examinations were excluded.
This study concludes that NIDDM is associated with increased risk of: (a) occurrence and more severe progression of adult periodontitis, (b) partial tooth loss, and (c) complete edentulism. These risks may be modified by baseline age, number of teeth or periodontal status. There was insufficient evidence to conclude that an association between baseline complications of NIDDM and increased risk for progression of periodontitis exists. The analyses suggest, however, that the incidence of diabetes-specific complications, poor glycemic control, and more severe NIDDM are associated with increased risk for the progression of periodontitis. Finally, the analyses suggest there is an association between severe periodontitis and increased risk for poor glycemic control.
