Abstract
BACKGROUND: Several meta-analyses of children and adolescents with Type 1 diabetes mellitus (T1DM) have shown that periodontal disease (PD) is linked to metabolic control. In South Africa, the prevalence of PD and its impact on T1DM children is however unknown. This study aimed to assess the prevalence of PD in T1DM children and adolescents attending the Paediatric Diabetic Clinic at Tygerberg Hospital and to assess the impact of metabolic control on the periodontal status. METHODS: A cross-sectional study was conducted to assess the periodontal status of T1DM patients. A basic periodontal examination (BPE) was performed and information on the HbA1c level, type and duration of T1DM, age, sex, BMI percentile, and pubertal status was gathered from patient records. A logistic regression model was used to identify associations between periodontal health status and risk factors. RESULTS: All 169 T1DM participants [median age 11.0 (9.0, 14) years] presented with PD. Based on BPE codes, 124 (73%) had gingivitis and 45 (27%) had periodontitis. The median HbA1c was significantly higher in the periodontitis group [12.6% (IQR: 10.4-13.6)] compared to the gingivitis group [8.9% (IQR: 8.1-9.9)] was statistically significant p = <0.001. Age was identified as risk factors (OR = 1.23, 95% CI: 1.1-1.4; p = 0.002), with children in the periodontitis group being older [13.0 (10, 15) years] than those with gingivitis [11.0 (8.0, 13.5) years; p < 0.001].Additionally, the periodontitis group had a lower median BMI percentile [59 (IQR: 29-78)] than the gingivitis group [74 (IQR: 42-92); p < 0.001]. CONCLUSIONS: Besides the limitations inherent to the study design, every child and adolescent with T1DM presented with periodontal disease. Older age and poorer metabolic control were significantly associated with increased odds of periodontal disease, highlighting a strong link between metabolic control and periodontal health in this population. Longitudinal studies or clinical trials with adequate sample sizes are recommended. These findings underscore the need to intensify both diabetes management and dental care through integrated, long-term approaches.