
2Prosthodontist and Oral Implantologist, Chairman of Dental center, King Fahd General Hospital, KSA
3Dental Hygienist, King Fahd General Hospital, KSA
The aim of this research is to study the severity of periodontal disease in Diabetes Mellitus Type 2 patients, its bidirectional effect, and the best way of treatment, in Saudi Arabia.
100 male and female patients who were diagnosed with uncontrolled D.M. and periodontal disease participated in this study. Their age ranged between 30-65 years old (Table 2). They were selected from the K.F.H., dental centre outpatients, Jeddah. Patients were grouped into four groups regarding the severity of the periodontal affection, 5 undiabetic patients for each group were used as control.




All the subjects were subjected to the following:
- Plaque index (PI) according to Silness and Loe 1964
- Gingival index (GI) according to loe and silness 1963.
- Clinical attachment level (CAL) according to Glavind and Loe, 1967.
- Thorough scaling to remove all calculus and plaque.
- Root planning and pockets evacuation.
- Systemic antibiotic was given for 5 days only, at the second week of treatment, to patients with uncontrolled diabetes.
- Oral hygiene regimen and follow up appointments were given to the patients.
Mean and SD | Gingivitis | Mild | Moderate | Severe |
PI – mean SD |
5.8 2.68 |
5.3 2.71 |
3.6 1.7 |
6.7 2.12 |
CAL – mean SD |
- | 1.2 0.525 |
2.8 0.55 |
4.46 0.159 |
GI – mean SD |
2 0.74 |
- | - | - |
30-39 | 40-49 | 50-59 | 60-69 | Total numbers of participants | Percentage | |
Male | 14 | 20 | 4 | 4 | 42 | 42% |
Female | 15 | 31 | 11 | 0 | 58 | 58% |
Total | 30 | 51 | 5 | 4 | 100 | 100% |
Severity | Frequency | Percentage |
Severe | 42 | 42% |
Moderate | 30 | 30% |
Mild | 15 | 15% |
Gingivitis | 13 | 13% |
Total | 100 | 100% |
Groups | Bld Sugar Level Before | Bld Sugar Level After |
Gl: Chronic Gingivitis | > 260 | < 160 |
Gll: Mild Chronic Periodontitis | > 320 | < 170 |
Glll: Moderate Chronic Periodontitis | > 370 | < 180 |
GlV: Severe Chronic Periodontitis | > 450 | < 200 |
Major effort should be directed towards preventing periodontal disease in patients with DM. More emphasis should be made on patient education and collaboration must be established between the endocrinologist/internist, the dental hygienist and the periodontist. Diabetic patients with poor metabolic control should be referred to the hygienist for oral consultation. The dental hygienist must detect any periodontal disease, determine its severity and administer the necessary care. High risk patients must be identified and put on regular follow up visits, especially if periodontal disease has already started to manifest itself. Patients with well controlled DM who have good oral hygiene should be on regular periodontal maintenance. Dentists should discuss with their patients the bidirectional relationship between diabetes and periodontal health, using the evidence as a basis for discussion.
- For the Dental Patient. JADA 133 (2002).
- Ira B., et al. “The Relationship between Oral Health and Diabetes Mellitus”. JADA 139.Suppl 5 (2008): 19S-24S.
- Tilg H and Moschen AR. “Inflammatory mechanisms in the regulation of insulin resistance”. Molecular Medicine 14.3-4 (2008): 222-231.
- Taylor GW., et al. “Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus”. Journal of Periodontology 67.10 Suppl (1996): 1085-1093.
- Lalla E. “Periodontal infections and diabetes mellitus: when will the puzzle be complete?” Journal of Clinical Periodontology 34.11 (2007): 913-916.
- Apoorva SM., et al. “Prevalence and severity of periodontal disease in type 2 diabetes mellitus (non-insulin-dependent diabetes mellitus) patients in Bangalore city: An epidemiological study”. Journal of Indian Society Periodontology 17.1 (2013): 25-29.
- Awartani F. “Evaluation of the relationship between type 2 diabetes and periodontal disease”.Saudi Medical Journal 30.7 (2009): 902-906.
- Haseeb M., et al. “Periodontal disease in type 2 diabetes mellitus”. Journal of College Physicians Surgery of Pakistan 22.8 (2012): 514-518.
- Karim A., et al. “Prevalence of diabetes mellitus in a saudi community”. Saudi Medical Journal21.5 (2000): 438-442.
- Shlossman M., et al. “Type 2 diabetes mellitus and periodontal disease”. The Journal of the American Dental Association 121.4 (1990) 532-536.
- Kim Eun K., et al. “Association between diabetes-related factors and clinical periodontal parameters in type-2 diabetes mellitus”. BMC Oral Health 13 (2013): 64.
- Khader YS., et al. “Periodontal status of diabetics compared with non-diabetics: a meta analysis”. Journal of Diabetes and its Complications 20.1 (2006): 59-68.
- Grossi SG and Genco RJ. “Periodontal Disease and Diabetes Mellitus: A Two-Way Relationship”. Annals of Periodontology 3 (1998): 51-61.
- Kiran M., et al. “The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus”. Journal of Clinical Periodontology 32 (2005): 266-272.
- Saremi A., et al. “Periodontal disease and mortality in type 2 diabetes”. Diabetes Care 28.1 (2005): 27-32.
- O'Dowd LK., et al. “Patients' experiences of the impact of periodontal disease”. Journal of Clinical Periodontology 37.4 (2010): 334-339.
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