title: Periodontal disease in pregnancy complicated by type 1 diabetes mellitus.
abstract: BACKGROUND
  Systemic disease and hormonal changes have been implicated as complicating factors for periodontal disease. Diabetes has been identified as a risk factor for periodontal disease, and diabetics can experience periodontal destruction at an earlier age than non-diabetic individuals. Increased hormone levels during pregnancy can contribute to increased gingival inflammation. The purpose of this study was to examine the association of type 1 diabetes mellitus (DM) on the periodontal status of pregnant women.
  
  
  METHODS
  Thirty-three (13 diabetic and 20 non-diabetic) subjects, 20 to 39 weeks gestation, participated in this study. The mean age of the diabetics and non-diabetics was 28.5 +/- 7.1 (SD) and 27.0 +/- 7.3 years, respectively. The following parameters were assessed at Ramfjord's reference teeth: plaque index (PI), gingival inflammation (GI), probing depth (PD), gingival margin (GM) location, and clinical attachment level (CAL).
  
  
  RESULTS
  Diabetic subjects had significantly (P<0.001) higher PI (1.48 +/- 0.69) and GI (1.77 +/- 0.44) scores than non-diabetics (PI = 0.63 +/- 0.38; GI = 0.93 +/- 0.48). Mean PD for diabetics (2.95 +/- 0.69 mm) was significantly different (P<0.024) from that of non-diabetics (2.44 +/- 0.32 mm). Although mean GM location was coronal to the cemento-enamel junction (CEJ) in both groups, gingival margins were at a more apical position (P<0.001) in the diabetics (-0.20 +/- 1.24 mm) compared to non-diabetics (-1.76 +/- 0.53 mm). Mean CAL values also varied significantly (P<0.001) between diabetics (2.60 +/- 1.54 mm) and non-diabetics (0.68 +/- 0.65 mm). Significant differences were seen for GI (P<0.001), PD (P=0.005), GM location (P<0.001), and CAL (P<0.001) when assessing the effect of diabetes and controlling for plaque. When assessing the effect of plaque and controlling for diabetes, the only significant difference was GI (P=0.001).
  
  
  CONCLUSIONS
  The results of this study demonstrate that periodontal inflammation and destruction are increased in pregnant diabetics as compared to non-diabetic pregnant patients. These findings may have implications for diabetic control and, hence, maternal and fetal outcomes in pregnant diabetic patients.
authors.affiliation: Department of Periodontics and Dows Institute for Dental Research, College of Dentistry, University of Iowa, Iowa City 52242, USA. janet-guthmiller@uiowa.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Guthmiller
authors.forename: J R
authors.initials: JR
authors.lastname: Hassebroek-Johnson
authors.forename: D R
authors.initials: DR
authors.lastname: Weenig
authors.forename: G K
authors.initials: GK
authors.lastname: Johnson
authors.forename: H L
authors.initials: HL
authors.lastname: Kirchner
authors.forename: F J
authors.initials: FJ
authors.lastname: Kohout
authors.forename: S K
authors.initials: SK
authors.lastname: Hunter
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003774:Dental Plaque Index; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D005881:Gingiva / Q000473:pathology; D005889:Gingival Recession / Q000145:classification; D005891:Gingivitis / Q000145:classification; D006801:Humans; D017622:Periodontal Attachment Loss / Q000145:classification; D010510:Periodontal Diseases / Q000145:classification* / Q000209:etiology; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000145:classification; D011247:Pregnancy; D011248:Pregnancy Complications; D011254:Pregnancy in Diabetics; D012307:Risk Factors; D016037:Single-Blind Method; D013223:Statistics as Topic; D019237:Tooth Cervix / Q000473:pathology