Study On The Correlation Among The Periondontal Health And Serum Lipids, Coagulation Of Elderly Diabetics

Obsjective:To know the periodontal health status and oral health behavior of the community and hospitalized elderly patients with diabetes. To analyze both the effect of periodontitis on serum lipid, blood glucose and blood coagulation index of elderly patients with diabetes and the correlation between them. To explore the influence of periodontitis on oral health related quality of life in elderly diabetics. To provide the basis and method for the elderly diabetics in community to maintain their periodontal health, thus to improve the oral health related quality of elderly diabetics’ life. Methods:The objective of this study is those over 60 years old and attended a medical examination from April 1, to May 1, 2013 in Xi’an Weiyang community health center. Those elderly over 60 years old and hospitalized in the Geriatrics of the Fourth Military Medical University between October 2013 to April 2014 are also included.We conducted oral health examination and questionnaire survey as well as inpatient medical records registration.Oral health examination including: sulcus bleeding index, calculus index simplified, clinical attachment loss, the number of missing tooth and community periodontal index. Qestionaire survey included general condition, history of disesase, oral health, periodontal disease, behavior habit, system disease and oral health related quality of life. Medical records registration included discharge records and inspection reports.The elderly in the community were divided into diabetics and non-diabetics groups. The hospitalized elderly patients were divided into Group 1, diabetics with periodontitis, Group 2, diabetics without periodontitis, Group 3, non-diabetics with periodontitis and Group 4, non-diabetics without periodontitis. Data were analyzed by SPSS 19.0 software, the mean of the two groups were compared by t-test, the rate of the two groups were compared by chi-square test. One-way ANOVA were used to compare the mean between multiple groups. None-normal data and homogeneity of variance were compared by non-parametric Wilcoxon test. Adopt Pearson correlation to analyze the relationship between bivariate normal distribution data. Use Logistic regression to analyze risk factors for elderly people suffering from diatetes. Results:A total of 560 elderly patients in the community were investigated, 546 valid questionnaires were gained. The brushing frequency a day, the average time to brush teeth, the frequency to see the dentist in a year between diabetics and non-diabetics were not different(p>0.05), but the overall oral health behavior of eldely is poor, 56.6% of the elderly brush once a day or less, only 43.4% of the elderly brush their teeth more than twice a day. 63.6% of the elderly brush their teeth less than 3 minutes, only 36.4% of the elderly brush 3 minutes. 32.4% of the elderly have never been to a dental clinic within a year. The periodontal treatmet, bleeding condition of gum, regularly check between the two groups were not different(P<0.05). The propotion of the non-diabetics who recepted regularly periodontal treatment is 15.1%, higher than that of the diabetics(6.8%). The propotion of the diabetics who often have gingival bleeding is 17.0%, higher than that of the non-diabetics(8.6%), those who once had gingival bleeding is 6.6%, higher than the non-diabetics(3.0%). Difference of CPI score, gingivitis and periodontitis prevalence between the two groups were statistically significant. The attachment loss, sulcus bleeding index of the diabetics were higher than non-diabetics.A total of 258 hospitalized elderly people were investigated, 246 valid questionnaires were gained, including 149 diabetics and 97 non-diabetics. There was no statistical difference of the brushing frequency between the two groups(P>0.05), answers of the question “Do you regularly go to the hospital to check your oral health” “periodontal treatment condition” “dental floss usage condition” were significantly different between the two groups. Oral health behavior of the diabetics was poorer than the non-diabetics(P<0.05). The propotion of the diabetics who feel good oral health is 39.6%, lower than the non-diabetics(64.9%).Whereas the propotion of the diabetics who feel poor oral health is 28.2%, higher than the non-diabetics(8.2%). SBI, CI-S, AL scores of the diabetics were higher than non-diabetics, the difference was statistically significant(P<0.001).246 hospitalized elderly were further divided into four groups. PLT, MPV, PT, APTT, FIB, FPG,Hb A1 c,WBC,TC,TG,HDL-C and LDL-C were different between the four groups, the difference was statistically significant(P<0.05). The HDL-C, LDL-C and triglyceride levels were abnormal, where the proportion was highest in Group 1.Oral Health Impact Profile scores indicate the total score of the diabetics with periodontitis is higher than diabetics without periodontitis, the difference was statistically significant(P<0.05). The scores of the diabetics with periodontitis in functional limitations, physical pain areas are highest, followed by that in the field of psychological discomfort and physiological disorders.The scores of the diabetics without perioodontitis in functional limitations, physical pain areas are highest, followed by that in the field of psychological discomfort and physiological disorders and social dysfunction. Multinomial logistic regression showed that periodontal therapy and regular exercise are protective factors for elderly suffering from diabetes, whereas periodontitis is the risk factor for elderly suffering from diabetes.Bivariate correlation analysis showed that the SBI, CI-S, AL, CPI and PLT, MPV, FBI, FPG, Hb A1 c, WBC, TC was positively correlated(P<0.05); PT, HDL and SBI, CI-S, AL, CPI was negatively correlated(P<0.05); APTT and SBI, CI-S, AL was negatively correlated(P<0.05); LDL and CI-S, CPI was positively correlated(P<0.05). Conclusion:Periodontitis has effect on the serum lipids, coagulation and FPG, Hb A1 c, etc of elderly diabetics. There is a certain correlation between periodontal index with certain serum lipids, coagulation and blood glucose, periodontitis is a risk factor for diabetes in the elderly. Periodontal treatment is a protective factor, suggesting that periodontitis affects diabetes through influencing serum lipids, coagulation and blood glucose, increasing the risk of microvascular compilications. However, both the oral heath behavior and oral health status of the diabetics are poor, their oral health-related quality of life is poor. So we propose some suggestion on periodontal maintenance for elderly diabetics to improve their periodontal health, thus control the development of diabetes and reduce the risk of microvascular occurrence.