Stage III/IV periodontitis comes with HbA1c of 6.8 percent against 5.8 in stage I/II

Advanced periodontitis goes with a worse metabolic picture

The team around M. E. O. Rodrigues published in the Journal of Applied Oral Science a cross-sectional study of 74 adults diagnosed with periodontitis under the 2018 classification. All underwent a full-mouth examination, laboratory work-up and measurement of body mass index, and the analysis was stratified by whether or not they had type 2 diabetes. Inflammatory burden was quantified through PISA, the periodontal inflamed surface area.

Participants in stage III/IV had significantly higher HbA1c (6.8 percent against 5.8 percent; p = 0.007), higher triglycerides (142.0 against 100.5 mg/dL; p = 0.016) and lower HDL cholesterol (46.0 against 52.0 mg/dL; p = 0.012) than those in stage I/II. Poor glycaemic control (HbA1c above 8.5 percent) and diabetes duration of ten years or more were associated with advanced stages.

For body mass index, LDL, total cholesterol, high-sensitivity C-reactive protein and HOMA-IR, the differences between groups were not significant. In people with diabetes, PISA correlated positively with total cholesterol and LDL, and in those without diabetes primarily with triglycerides.

Limitations

A cross-sectional design in 74 participants shows association, not causation: it cannot say whether periodontitis worsened the metabolic picture or the other way round.

For the practice

• When you diagnose stage III/IV periodontitis, ask for the most recent HbA1c and lipid panel; the stage is a reason to talk about systemic risk, not only about hygiene.
• For a patient with diabetes of more than ten years, plan a tighter periodontal recall; such patients were over-represented in the advanced stages.
• Body mass index did not distinguish the stages in this study, so do not use it as a shortcut when assessing periodontal risk.