The Prevalence of Periodontal Disease among Diabetic Patients in Local Health Centers in Bahrain

Abstract

Introduction: The occurrence and progression of periodontal disease is associated with poor diabetic control. To date there have been no studies to assess the prevalence of periodontal disease in diabetic patients attending health centers in Bahrain.

Aims: 1. To compare the prevalence of periodontal disease among diabetic patients with and without diabetic complications. 2. To determine if there is a difference in prevalence of severe periodontitis in controlled and uncontrolled diabetic patients. 3. To determine if there is a difference in prevalence of severeperiodontitis in patients with history of diabetes more than five years and five years or less

Material and Methods Ethical approval and patient consent were obtained. Within the 5 health regions in Bahrain there are 24 non communicable disease clinics. A systematic stratified sampling technique was used to randomly select one clinic from each region and examine diabetics from each clinic for periodontal disease. The calculated sample size was 89. Two examiners screened for gingivitis or periodontitis using the Basic Periodontal Examination (BPE). Demographic and medical data including co-morbidities such as BMI, glycemic control level and diabetic complications were recorded.

Results A total of 243 diabetic subjects with an overall mean age of 55.4 years (±11.4) met the inclusion criteria. There were 109 males, mean age 56.6 years (±12.2) and 134 females, mean age 54.3 years (±10.8) with no statistically significant age difference. Most subjects were obese according to the BMI (61%) and had type 2DM (95.5%). 91 (46%) subjects had at least 1 co-morbidity, most commonly nephropathy. BPEcodes 3 or 4 were found in over 93% of subjects (n=228) indicative of a high point prevalence of periodontitis in this sample of diabetic patients attending health centersin Bahrain. Furthermore, a significantly greater proportion of uncontrolled diabetics (HbA1c≥64 mmol/mol) had severe periodontitis, OR=1.64 (95%CI 1.0-2.8) compared to controlled diabetes. Diabetic complications and duration of diabetes showed no significant association with severity of periodontal disease.

Conclusions Periodontitis was very prevalent in this sample of diabetics (93.8%). Uncontrolled diabetics were more likely to have severe periodontitis than well controlled diabetics. Nephropathy and obesity were the most common co-morbidities. Periodontal care should be an integral part of DM management.