Association Between Glycemic Parameters and Severity of Periodontitis in Nepal: A Hospital-Based Cross-Sectional
Shristi Kafle1, Abhishek Gupta2, Saurav Khatiwada3
1Department of Periodontology and Oral Implantology, Chitwan Medical College, Bharatpur 44207, Nepal, cmc.edu.np.
Background:
Periodontitis is a prevalent inflammatory disease affecting the supporting structures of the teeth and has been strongly associated with systemic conditions such as diabetes mellitus. Poor glycemic control has been reported to exacerbate periodontal tissue destruction; however, evidence from many developing countries remains limited. This study aimed to evaluate the association between glycemic parameters and periodontitis severity in a hospital-based population in Nepal.
Methods:
A hospital-based cross-sectional study was conducted among 396 adult patients attending the dental outpatient department of a tertiary care hospital in Nepal. Participants were categorized according to the severity into mild (n = 132), moderate (n = 132), and severe (n = 132) groups based on periodontal clinical examination. The terminology was aligned with the 2017 World Workshop classification of periodontal and peri-implant diseases and conditions. Full periodontal grading was not assigned because longitudinal data on disease progression were unavailable. Patients presenting with a molar-incisor pattern suggestive of the previously described aggressive periodontitis phenotype were excluded. Demographic variables, smoking status, periodontal clinical parameters, and glycemic indicators, including fasting blood glucose (FBG), postprandial blood sugar (PPBS), and glycated hemoglobin (HbA1c), were recorded. Descriptive statistics were used to summarize the study variables. Differences in glycemic parameters across periodontitis severity groups were assessed using the Kruskal-Wallis test. Spearman correlation analysis was applied to assess the association between glycemic markers and periodontal clinical parameters. Ordinal logistic regression was conducted to determine the independent predictors of increasing severity of periodontitis.
Results:
Glycemic parameters worsened with increasing severity of periodontitis. Patients with severe periodontitis had markedly increased levels of FBG, PPBS, and HbA1c in comparison to those with mild and moderate periodontitis (p < 0.001). Periodontal clinical parameters, such as probing depth and clinical attachment loss (CAL), were most strongly correlated with HbA1c (p < 0.001). Ordinal logistic regression analysis revealed that HbA1c was the most significant independent predictor of increasing severity of periodontitis, followed by age and current smoking status.
Conclusions:
Severe periodontitis was significantly associated with worsening glycemic status. Of all the assessed glycemic markers, HbA1c exhibited the most robust relationship with periodontal destruction. These findings highlight the importance of glycemic control in periodontal health and support the need for integrated medical-dental management strategies for patients with metabolic disorders.