Article Text


Periodontitis as a possible early sign of diabetes mellitus
  1. Wijnand J Teeuw1,
  2. Madeline X F Kosho1,
  3. Dennis C W Poland2,
  4. Victor E A Gerdes3,4,
  5. Bruno G Loos1
  1. 1Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
  2. 2Department of Clinical Chemistry, MC Slotervaart, Amsterdam, The Netherlands
  3. 3Department of Vascular Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
  4. 4Department of Internal Medicine, MC Slotervaart, Amsterdam, The Netherlands
  1. Correspondence to Dr Wijnand J Teeuw; W.Teeuw{at}


Objective The early diagnosis of (pre)diabetes mellitus is essential for the prevention of diabetes complications. It has been suggested that gum disease (periodontitis) might be an early complication of diabetes and may be a useful risk indicator for diabetes screening. Therefore, a dental office could be a good location for screening for (pre)diabetes in patients with periodontitis using a validated glycated hemoglobin (HbA1c) dry spot analysis.

Research design and methods A total of 313 individuals from a university dental clinic participated. From 126 patients with mild/moderate periodontitis, 78 patients with severe periodontitis and 109 subjects without periodontitis, HbA1c values were obtained by the analysis of dry blood spots. Differences in mean HbA1c values and the prevalence of (pre)diabetes between the groups were analyzed.

Results The mild/moderate and severe periodontitis groups showed significantly higher HbA1c values (6.1%±1.4% (43 mmol/mol±15 mmol/mol) and 6.3%±1.3% (45 mmol/mol±15 mmol/mol), respectively) compared with the control group (5.7%±0.7% (39 mmol/mol±8 mmol/mol), p=0.003). In addition, according to the American Diabetes Association (ADA) guidelines for diagnosis, there was a significant over-representation of subjects with suspected diabetes (23% and 14%) and pre-diabetes (47% and 46%) in the severe periodontitis group and mild/moderate periodontitis groups, respectively, compared with the control group (10% and 37%, p=0.010). Notably, 18.1% of patients with suspected new diabetes were found among subjects with severe periodontitis compared with 9.9% and 8.5% among subjects with mild/moderate periodontitis and controls, respectively (p=0.024).

Conclusions The dental office, with particular focus on patients with severe periodontitis, proved to be a suitable location for screening for (pre)diabetes; a considerable number of suspected new diabetes cases were identified. The early diagnosis and treatment of (pre)diabetes help to prevent more severe complications and benefit the treatment of periodontitis.

  • Dentistry
  • Non-Insulin Dependent Diabetes Mellitus

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors WJT and BGL designed the study, analyzed the data, and wrote the manuscript. MXFK designed the study, analyzed the data, and contributed to the discussion. DCWP and VEAG designed the study, contributed to the discussion, and reviewed and edited the manuscript.

  • Funding This research was supported in part by a grant from the University of Amsterdam for the focal point ‘Oral Infection and Inflammation’.

  • Competing interests None declared.

  • Ethics approval The Medical Ethical Committee of the VU University Medical Center approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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