International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 4(3), February, 2012

Pages: 26-31

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ARE LIFESTYLE DISORDERS A RISK FOR PERIODONTAL DISEASE?

Author: Manoj Raja

Category: Healthcare

Abstract:The main objective of this study was to identify certain lifestyle disorders like diabetes mellitus and other medical conditions like hypertension and hyperlipidemia in an older adult population and to verify their relationship with the periodontal health status in the same group of individuals. A total number of 600 patients between 35-75 years were selected for this study. Their lifestyle habits were obtained through a questionnaire. It was followed by a periodontal examination, blood pressure re cording and a biochemical analysis of the blood samples taken from them. Results of MLRA showed that diabetes mellitus, was clearly associated with attachment loss. Hypertension was not associated with attachment loss, and elevated blood cholesterol levels (hyperlipedemia) were associated only in univariate models. It could be concluded that in the selected group of subjects aged 35-75 years, only diabetes mellitus was associated with attachment loss in this cross-sectional study.

Keywords: Diabetes, Attachment loss, Hypertension, Hyperlipedemia

Full Text:

INTRODUCTION Diabetes mellitus is a bonafied risk factor in periodontal disease. Type 2 is the form of diabetes present in 90-95% of patients with the disease and the risk of developing this form of diabetes, increases with age, obesity, previous history of gestational diabetes and lack of physical activity. (Brian L. Mealey and Gloria L.Ocampo) 1 The association between diabetes and periodontal disease has been reported for more than forty years. ?Chronic Periodontitis? is now considered the sixth complication of diabetes mellitus.2 Other general disorders like hypertension and elevated blood cholesterol levels (hyper lipedemia) often go hand in hand with diabetes mellitus. They are proving to be health epidemic in middle age populations causing many reasons to panic. This cross sectional survey aims to correlate elevated blood sugar levels, hypertension and elevated blood cholesterol levels with Gingival and Periodontal disease. It also helps to include patient education and motivation in the treatment plan, thus keeping a check on these life style disorders in the long run.

MATERIALS AND METHODS The present study was using a stratified randomly selected sample of 600 persons, aged 35 to 75 years from the patients in a private Dental College and Hospital. A William‘s probe and a Shepherd‘s Crook explorer were used for the examination of the periodontal parameters in the study namely Gingival Index (GI), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). The blood pressure reading (both systolic and diastolic blood pressure) was recorded for all the subjects, using a conventional sphygmomanometer with the help of a general physician. The blood pressure was recorded in the morning time. Each subject was then taken to the biochemical laboratory of the hospital for the assessment of Fasting blood sugar and Total blood cholesterol levels. The biochemical analysis was done in the morning time. The subjects who were included in the study were instructed to come on an empty stomach (i.e) they should not have consumed food for the past 12 hours. 3 ml of venous blood was drawn, from the Median-cubital vein of each subject using a 20- gauge needle connected to a 10 ml syringe.

Statistical Methods The association of the three periodontal parameters namely Gingival Index (GI), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL) with three variables namely hypertension, diabetes and total cholesterol levels was estimated using ?Chi-square test? to calculate the p - value.

RESULTS
348 subjects who did not have hypertension showed a gingival index score less than or equal to 2, where as 24 subjects who did not have hypertension showed a gingival index score greater than 2.216 subjects who had hypertension showed a gingival index score less than or equal to 2, where as 12 subjects who had hypertension showed a gingival index score greater than 2. The difference was not statistically significant in both the subjects who did not have hypertension and the subjects who had hypertension (p = 0.68). 514 subjects who did not have diabetes showed a gingival index score less than or equal to 2, where as 26 subjects who did not have diabetes showed a gingival index score greater than 2. 50 subjects who diabetes had showed a gingival index score more than 2, where as 10 subjects who had diabetes showed a gingival index score greater than 2. The difference was found to be statistically significant in both diabetics and non diabetics (p 200mg/dl (p<0.0001).

366 subjects who did not have hypertension had a probing pocket depth less than or equal to 5mm, where as 6 subjects who did not have hypertension had a probing pocket depth greater than 5mm. 222 subjects who had hypertension had a probing pocket depth less than or equal to 5mm, where as 6 subjects who had hypertension had a probing pocket depth greater than 5mm. The difference was not statistically significant in both the subjects who did not have hypertension and the subjects who had hypertension. (p< 0.39).540 subjects who did not have diabetes had a probing pocket depth less than or equal to 5mm, where as no subject who did not have diabetes had a probing pocket depth greater than 5mm. 48 subjects who had diabetes had a probing pocket depth less than or equal to 5mm, where as12 subjects who had diabetes had a probing pocket depth greater than 5mm. The difference was found to be statistically significant in both diabetics and non diabetics (p200mg/dl (p200mg/dl (p200mg /dl (OR = 3.1, p200mg/dl, were not significantly associated with Clinical Attachment Loss.

DISCUSSION Chronic periodontitis is ?an infectious disease resulting in inflammation within the supporting tissues of the teeth; progressive attachment loss, and bone loss? (Flemmig TF 1999)3. Risk assessment is defined by numerous components4. Risk is the probability that an individual will develop a specific disease in a given period. The risk of developing the disease will vary from individual to individual. Genetic factors, age, gender socioeconomic status and stress are categorized as risk determinants 5. Diabetes mellitus is an extremely important disease from a periodontal standpoint. This complex metabolic disorder, characterized by chronic hyperglycemia, is an established risk factor for periodontitis 6 and periodontitis is now considered to be the sixth complication in diabetes mellitus 2.Of the systemic risk factors, it has been well established that patients with diabetes have atleast a two-fold increase in the severity of periodontal disease as compared to nondiabetics 7-9. Overall, in the present study, there were 60 diabetics. Patients, who had a Fasting Blood Sugar level (FBS) 126mg/dl, were considered as diabetics. Their inclusion was further substantiated through a questionnaire, wherein 55 out of the 60 subjects confirmed their diabetic status. Only 5 out of the 60 subjects came to know their condition, after our present study. There was a significant association between the 3 periodontal parameters and the diabetic patients in the study. Results showed 24 diabetics, had CAL > 4mm as against 36 diabetics, with CAL < 4mm. Similarly 12 subjects with diabetics had PPD > 5mm and 10 diabetic subjects had a GI score 2. These values were highly significant.

The results of ULRA for CAL showed an odds ratio of 5.33, in diabetic‘s subjects while the results of MLRA for CAL had the highest odds ratio of 4.33. Considering the above results, diabetes mellitus, was found to be most significantly association with periodontal disease progression, in our present study. The mean FBS level, in subjects with PPD > 5mm was found to be greater than 213mg/dl. This was in accordance with a study by Richard C Oliver et al10, wherein an increased prevalence and extent of periodontal pockets was a consistent finding of diabetics versus non-diabetics. The Oulu study, reported more gingival bleeding, as metabolic control worsened in diabetics, despite similar plaque and calculus scores in the diabetic subgroup. Other studies also reported extensive gingival inflammation in diabetics 8. These results were similar to the one in our present study. Hyperlipidemia is essentially not a well acknowledged risk factor for periodontal disease11. It plays a larger role in cardiovascular disease and stroke12.The results in ULRA for CAL in our present study showed an odds ratio of 3.1 for subjects with a Total Blood Cholesterol level >200mg/dl (42 subjects). However, 38 subjects in the group had an FBS level > 126mg/dl. So, the independent role of high Total Blood Cholesterol level (>200mg/dl), in periodontal disease could not be established in our present study, as the results of MLRA for CAL did not include subjects with Total Blood Cholesterol levels >200mg/dl as significant variables. The role of hypertension in periodontal disease progression was clearly negative, from our present study. The results clearly indicated that hypertension was a non significant parameter in our present study in periodontitis.These results in our study, was in accordance to a similar study done by Mattout C et al13, who included arterial hypertension as a parameter, on a population of 2144 adults, in France. The results from the study yielded similar nonsignificant values for hypertension.

Thus we can infer that certain risk elements like Diabetes Mellitus play a major role in increasing the probability for chronic periodontal disease among older adults. One possible bias which could have occurred in our study is the relatively small sample size of subjects, belonging to a highly similar geographic area, and all of them being subjects, seeking some form of dental therapy, as they were selected from a patient pool, at a dental hospital.

ACKNOWLEDGMENTS
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript. The authors are also grateful to authors / editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. I also wish to thank my professors T.Ramakrishnan, N.Ambalavanan, Pamela Emmadi and D.Deepalakshmi for their able guidance provided for my study. The study was conducted on a self financing basis by the author Dr. Manoj Raja.

References:

1. Brian L. Mealey and Gloria L.Ocampo: Diabetes mellitus and periodontal disease, Periodontology 2000: 127-153, 2007.

2. Loe H: Periodontal disease: the sixth complication of diabetes mellitus, Diabetes Care 16 (suppl 1):329, 1993.

3. Flemmig TF: Periodontitis, Ann Periodontal 4:32, 1999

4. Page RC, Beck JD; Risk assessment for periodontal diseases, Int Dent J 47:61, 1997.

5. Michalowicz BS, Diehl SR, Gunsolley JC. Evidence of a substantial genetic basis for risk of adult periodontitis. J Clin Periodontol. 2000;71:1699–1707

6. Robert J Genco: Current view of risk factors for periodontal diseases. J Periodontol 1996; 67:1041 -1049

7. Tervonen T, and Knuuttila M: Relation of diabetes control to periodontal pocketing and alveolar bone level Oral Surgery, Oral Medicine, Oral Pathology 1986:61,346 -349

8. Taylor GW. Bidirectional interrelationships. between diabetes, and periodontal diseases: an epidemiologic perspective. Annals of Periodontology2001;6:99–112.

9. Soskolne W A and Klinger A: The relationship between periodontal diseases and diabetes an overview. Annals of Periodontology 2001:6,91 - 98.

10. Richard C Oliver and Tellervo Tervonen: Diabetes – A risk factor for periodontitis in adults? J Periodontol 1994;65:530 -538.

11. Moeintaghavi A, Haerian-Ardakani A, Talebi-Ardakani M, Tabatabaie I. Hyperlipidemia in patients with periodontitis. J Contemp Dent Pract. 2005 Aug 15; 6(3):78-85.

12. Moise Desvarueyx, Christial Schwahn and Thomas Kocher. Gender differences in relationship between periodontal disease, tooth loss, and atherosclerosis. Stroke, 2004; 35, 2029.

13. Mattout C, Bourgeois D, Bouchard P. Type 2 diabetes and periodontal indicators: epidemiology in France 2002-2003. J Periodontal Res. 2006 Aug;41(4):253-8.

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

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Best Article Award

A study by Dorothy Ebere Adimora et al. entitled \"Remediation for Effects of Domestic Violence on Psychological well-being, Depression and Suicide among Women During COVID-19 Pandemic: A Cross-cultural Study of Nigeria and Spain\" is awarded Best Article of Vol 14 issue 23
A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
A study by Saurabh Suvidha entitled \"A Case of Mucoid Degeneration of Uterine Fibroid with Hydrosalphinx and Ovarian Cyst\" is awarded Best article of Vol 14 issue 21
A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
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A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
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A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
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A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
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A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
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A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
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A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
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A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
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A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
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A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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