The association between diabetes and periodontal disease has been well documented. Periodontitis is associated with alterations in immune responses in both diabetic and nondiabetic subjects. While diabetes is considered to be a risk factor for periodontal disease progression, few studies have demonstrated an association between the level of glycemic control and periodontal disease. Although poor glycemic control is significantly associated with poor periodontal health, few studies have been performed in Saudi Arabia to evaluate the immune responses in poor and better glycemic control and its effect on periodontal tissue. The aim of this study is to assess serum immunoglobulin levels (IgA, IgG, IgM) in type 2 diabetic (poor control and better control) and nondiabetic subjects with chronic periodontitis.

A total of 105 female patients were included in the study and they were divided into three groups, with 35 patients in each group. Group 1 was comprised of cases of diabetes exhibiting better control (HbA1c≤9%) and Group 2 was comprised of cases of diabetes exhibiting poorer control (HbA1c>9%). The third group was comprised of nondiabetic subjects with chronic periodontitis. In this study, clinical examination included plaque index, bleeding on probing, probing pocket depth, and attachment level (measured in all three groups). Serum immunoglobulin (IgA, IgG, IgM) levels were estimated and compared to the levels estimated for diabetic controls.

Mean plaque index, bleeding index, and probing pocket depth showed no significant differences among the three groups. However, mean clinical attachment loss was significantly higher for Group 2 as compared to Groups 1 and 3. IgA and IgG levels were found to be significantly higher in Group 2 (poorly controlled diabetes) as compared to Group 1 (better control) and Group 3 (control group).

There is a positive correlation between CAL and IgA and IgG, whereas there is a negative correlation between CAL and IgM.

The present study indicates that poor glycemic control may be associated with the increase in IgA and IgG serum antibodies. Elevated antibody levels may explain why poorly controlled diabetes exacerbates periodontal disease.

These findings demonstrate the importance of the immune system as well as good glycemic control, especially in patients diagnosed with periodontitis. The changes observed in immune response may be the cause or the effect of periodontal disease in diabetic patients. The increased incidence of periodontitis in diabetic patients suggests that the alteration in immune response may contribute to the pathogenesis of periodontitis in patients with poorly controlled diabetes.

Awartani F. Serum Immunoglobulin Levels in Type 2 Diabetes Patients with Chronic Periodontitis. J Contemp Dent Pract [Internet]. 2010 May; 11(3):001-008. Available from: http:// www.thejcdp.com/journal/view/volume11-issue3- awartani.