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Standardized screening for periodontitis as an integral part of multidisciplinary management of adults with type 2 diabetes: an observational cross-sectional study of cohorts in the USA and UK
  1. Andrew S Pumerantz1,2,
  2. Susan M Bissett3,4,
  3. Fanglong Dong5,
  4. Cesar Ochoa1,
  5. Rebecca R Wassall3,
  6. Heidi Davila1,
  7. Melanie Barbee1,
  8. John Nguyen1,
  9. Pamela Vila2,
  10. Philip M Preshaw3,4
  1. 1 Western Diabetes Institute, Western University of Health Sciences, Pomona, California, USA
  2. 2 College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
  3. 3 School of Dental Sciences, Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
  4. 4 Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
  5. 5 Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, California, USA
  1. Correspondence to Dr Andrew S Pumerantz; apumerantz{at}


Objective To determine prevalence and factors predictive of periodontitis by using a standardized assessment model in adults with type 2 diabetes.

Research design and methods We performed an observational cross-sectional study to determine the burden of periodontitis in adults with type 2 diabetes attending urban, ambulatory referral centers in the USA and UK. Full-mouth probing was performed and periodontitis was diagnosed based on either a low (≥5 mm at ≥1 site) or high pocket probing-depth threshold (≥6 mm at ≥1 site). Results were stratified into a five-stage schema and integrated with other clinical variables into the novel Diabetes Cross-Disciplinary Index to function as a balanced health scorecard. Corresponding demographic and routinely collected health data were obtained and comparisons were made between patients with and without periodontitis. Multivariable logistic regression was performed to identify factors predictive of the presence or absence of periodontitis.

Results Between our two cohorts, 253 patients were screened. Caucasians comprised >90% and Hispanic Americans >75% of the UK and US cohorts, respectively. Males and females were equally distributed; mean age was 53.6±11 years; and 17 (6.7%) were edentulous. Of the 236 dentate patients, 128 (54.2%) had periodontitis by low threshold and 57 (24.2%) by high threshold. Just 17 (7.2%) were periodontally healthy. No significant differences in age, HbA1c, blood pressure, body mass index, low-density lipoprotein cholesterol, or smoking status (all p>0.05) were identified between those with or without periodontitis (regardless of threshold) and none was found to be a significant predictor of disease.

Conclusions Periodontitis is frequent in adults with type 2 diabetes and all should be screened. Periodontal health status can be visualized with other comorbidities and complications using a novel balanced scorecard that could facilitate patient–clinician communication, shared decision-making, and prioritization of individual healthcare needs.

  • type 2 diabetes
  • comorbidity of chronic diseases
  • periodontal disease
  • multidisciplinary
  • screening strategies

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 ASP and PMP are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. ASP and PMP researched data, conducted data analysis and wrote the manuscript. SB, CO, RW, HD, MB, JN and PV all researched data and contributed to the discussion. FD researched data and contributed to the data analysis.

  • Competing interests PMP reports grants from Dunhill Medical Trust, UK, and the UK Department of Health during the conduct of the study. ASP is the inventor of DXDI.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board of Western University of Health Sciences Protocol #13/IRB/017; UK Research Ethics Service Sunderland Ethics Committee #06/Q0904/8. All data analyzed and reported in this study are anonymized as per IRB protocol.

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

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