The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 11 , ISSUE 3 ( May, 2010 ) > List of Articles


Serum Immunoglobulin Levels in Type 2 Diabetes Patients with Chronic Periodontitis

Fatin Awartani

Citation Information : Awartani F. Serum Immunoglobulin Levels in Type 2 Diabetes Patients with Chronic Periodontitis. J Contemp Dent Pract 2010; 11 (3):1-8.

DOI: 10.5005/jcdp-11-3-1

License: CC BY-NC 3.0

Published Online: 01-06-2016

Copyright Statement:  Copyright © 2010; The Author(s).



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.

Methods and Materials

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.

Clinical Significance

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:// awartani.

PDF Share
  1. Diabetes mellitus and periodontal diseases J Periodontol. 2006;77(8):1289-303
  2. Exploring interrelationships between diabetes and periodontal disease in African Americans. Compend Contin Educ Dent. 2001; 22(3 Spec No):42-8.
  3. The relationship between periodontal diseases and diabetes: an overview. Ann Periodontol. 2001; 6(1):91-8.
  4. The relationship between diabetes and periodontal disease. J Can Dent Assoc. 2002; 68(3):161-4.
  5. Diabetes in Canada: strategies towards 2000. Toronto (Ont.): Canadian Diabetes Advisory Board; 1997. p. 3.
  6. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997; 20(7):1183-97.
  7. Diabetes mellitus–a modifier of periodontal disease expression. J Int Acad Periodontol. 2004; 6(1):13-20.
  8. Heightened gingival inflammation and attachment loss in type 2 diabetes with hyperlipidemia. J Periodontol. 1999: 70(11):1313-21.
  9. Periodontal disease and diabetes mellitus: a two-way relationship. Ann Periodontol. 1998; 3(1):51-61.
  10. The diabetic dental patient. Dent Clin North Am. 1994: 38(3):447-63.
  11. Defective neutrophil function in an insulindependent diabetes mellitus patient. A case report. 1991; 62:394-401.
  12. Relationship between neutrophil functions and severity of periodontitis in obese and/or type 2 diabetic chronic periodontitis patients. Quintessence Int. 2008; 39(6):485-9.
  13. The effect of diabetes mellitus on chemotactic and bactericidal activity of human polymorphonuclear leukocytes. Diabetes Res Clin Pract. 1987; 4(1):27-35.
  14. Bactericidal function of neutrophils from patients with acute bacterial infections and from diabetics. J Infect Dis. 1980; 142(6): 869-75.
  15. An immunological evaluation of type II diabetic patients with periodontal disease. J Diabetes Complications. 1999; 13(1):23-30.
  16. Periodontal disease related to diabetic status. A pilot study of the response to periodontal therapy in type 1 diabetes. J Clin Periodontol. 1997; 24(7):505-10.
  17. Immunoglobulin concentration in gingival tissue of type 2 diabetic patients with periodontitis. Indian J Dent Res. 2006; 17(4):151-4.
  18. Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population. Community Dent Oral Epidemiol. 2002; 30(3):182-92.
  19. Prevalence of medically compromised patients referred for periodontal treatment to a teaching hospital in Central Saudi Arabia. Saudi Med J. 2003; 24(11):1242-5.
  20. Prevalence of diabetes mellitus in a Saudi community. Saudi Med J. 2000; 21(5):438-42.
  21. Saudi Med J. 1998; 4:58-67.
  22. The plaque control record. J Periodontol. 1972; 43(1):38.
  23. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975; 25(4):229-35.
  24. Comparison of tests for glycated haemoglobin and fasting and two hour plasma glucose concentrations as diagnostic methods for diabetes. BMJ. 1994; 308(6940):1323-8.
  25. Neutrophil functional activity in juvenile and adult onset diabetic patients with mild and severe periodontitis. J Periodontal Res. 1982; 17(5):500-2.
  26. Periodontal disease progression in type II non-insulin-dependent diabetes mellitus patients (NIDDM). Part I–Probing pocket depth and clinical attachment. Braz Dent J. 1996; 7(2):65-73.
  27. Microbiological and immunological studies of adult periodontitis in patients with noninsulindependent diabetes mellitus. J Periodontol. 1988; 59(1):23-31.
  28. Cellmediated and humoral immune response in diabetic patients with periodontitis. Oral Surg Oral Med Oral Pathol. 1990; 70(1):44-8.
  29. Periodontal disease, diabetes, and immune response: a review of current concepts. J West Soc Periodontol Periodontal Abstr. 1996; 44(3):69-77.
  30. Immunological studies of young adults with severe periodontitis. I. Medical evaluation and humoral factors. J Periodontal Res. 1981; 16(4):390-402.
  31. Serum IgA and IgG antibodies to Treponema vincentii and Treponema denticola in adult periodontitis, juvenile periodontitis and periodontally healthy subjects. J Clin Periodontol. 1986; 13(8): 752-7.
  32. Serum antibodies to plaque bacteria in subjects with dental caries and gingivitis. Scand J Dent Res. 1997; 85(2):106-13.
  33. Assessing the levels of immunoglobulins in the saliva of diabetic individuals with periodontitis using checkerboard immunodetection. Oral Dis. 2008; 14(1):51-9.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.