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Relation between periodontal disease and diabetics - Research Paper Example

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It was written by Dr. Brian L. Mealey and was published in the October 2006 issue of the Journal of the American Dental Association. This…
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Relation between periodontal disease and diabetics
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PERIODONTAL DISEASE AND DIABETES ID Number: of of School Word Count: 632
Date of Submission: January 26, 2012
This paper is a critical review of an epidemiological peer-reviewed journal article on the relationship of diabetes and periodontal diseases. It was written by Dr. Brian L. Mealey and was published in the October 2006 issue of the Journal of the American Dental Association. This short paper analyzes the contents of the said article and tries to find some biases and weaknesses in the said article to determine if there are any confounders within said article. The author tried to emphasize the seriousness of any possible relationships between these two chronic ailments.
The said article being reviewed here sought to find causal relationships between two chronic diseases which are diabetes and the two main periodontal diseases, which are gingivitis and periodontitis. The first pertains to a non-destructive inflammation of the gum tissues and is a very common form of periodontal disease while periodontitis is a severe form of the periodontal disease. Both forms are inflammation types of periodontal disease (itis is a medical suffix which means inflammation). Dr. Mealey had sought to find a link between periodontal diseases and the other very common affliction of most Americans, which is diabetes. Incidentally, diabetes affects approximately twenty million Americans, of whom some 35%-40% are not aware that they have diabetes (these figures translate to about 9% of the total adult American population).
The main difficulty encountered in most of the medical research studies on diabetes and periodontal diseases is that the relationship between these two ailments is bi-directional. In other words, one disease affects the other disease in a circular sort of way. In this article, the two periodontal diseases (gingivitis and periodontitis) were found to have a marked influence on the pathogenesis of diabetes and the numerous complications arising from diabetes. But on the other hand, diabetes was also found to have an impact as risk factor on the two periodontal diseases.
Possible Bias – after reviewing this article, one possible bias is the authors emphasis on diabetes as the causative factor in the prevalence, severity and extent for both gingivitis and periodontitis but as the author himself stated in his conclusions, the studies he had reviewed were all merely suggestive of this causal link. Numerous studies failed to conclusively find the direct link between diabetes and the two chronic inflammation periodontal diseases because the studies done previously failed to eliminate certain factors or confounders that affected those results. It is quite well known that dental caries is chiefly caused by eating a lot of sweetened foods that can cause lactic acid and so it is easy to suggest a link on diabetes and the two periodontal diseases. Caries is chiefly caused by common bacteria like Lactobacillus and Streptococcus mutans. Both diabetes and the periodontal diseases have inflammatory components, so a bias here is expected.
Probable Confounders – despite the sheer number of articles previously published on this topic (more than 200 so far and counting), many of the studies lacked adequate control. This was made more complicated by the varying definitions of what constitutes diabetes (based on the glycemic controls) and in the case of the two periodontal diseases, different classifications based on evolving clinical and radiographic data or criteria (Mealey, 2006, p. 275). Moreover, it is also suggested by the same studies that there is high variability between individual patients in degree of glycemic control and so diabetes could merely be a modifying factor rather than a primary one as far as periodontal diseases are concerned, given their multi-factorial nature (ibid., p. 285).
Suggestions – there is clearly a need to impose greater control on future studies so as to avoid or eliminate confounders. It is suggested that a more homogeneous group of two sample populations be utilized (control and experimental groups) and increase sample size in next trials.
Mealey, B. L. (2006, October). Periodontal disease and diabetes: a two-way street. The Journal of the American Dental Association, 137, 265-315. Read More
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