摘要：Objectives . We explored the association between diabetes mellitus and oral disease in a low-socioeconomic-status urban population. Methods . Dental records of 150 adults with diabetes and 150 nondiabetic controls from the dental clinic at Columbia University in Northern Manhattan matched by age and gender were studied. Results . There was a 50% increase in alveolar bone loss in diabetic patients compared with nondiabetic controls. Diabetes, increasing age, male gender, and use of tobacco products had a statistically significant effect on bone loss. Conclusions . Our findings provide evidence that diabetes is an added risk for oral disease in this low-income, underserved population of Northern Manhattan. Oral disease prevention and treatment programs may need to be part of the standards of continuing care for patients with diabetes Periodontal diseases are bacterially induced chronic inflammatory diseases affecting the tissues surrounding and supporting the teeth. The lesion begins as gingivitis, an inflammation of the gingival tissues only, and may progress to periodontitis, where destruction of connective tissue attachment and alveolar bone can eventually lead to tooth loss. In 1993, periodontitis was referred to as the sixth complication of diabetes mellitus 1 ; in the 1997 report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, it was cited as one of the pathological conditions often found in patients with diabetes. 2 Indeed, multiple studies have provided conclusive evidence that the prevalence, severity, and progression of periodontal disease are significantly increased in patients with diabetes. 3 Other oral complications have been reported in patients with diabetes, such as caries, xerostomia, and mucosal lesions. However these associations are weaker, and conflicting data have been reported. 4 – 8 If left untreated, periodontitis can lead to tooth loss, thereby compromising a patient’s ability to maintain a proper diet and affecting the quality of life. Furthermore, longitudinal studies have reported that severe periodontal disease in diabetic patients at baseline is associated with poor metabolic control and other diabetic complications at follow-up. 9 , 10 There also has been a suggestion in the literature that mechanical periodontal therapy in conjunction with systemic antibiotics may result in improved metabolic control in some patients with diabetes, especially those with poor metabolic control and severe periodontitis at baseline. 11 As previous studies have reported an overall high degree of agreement between radiographic and clinical assessments of destructive periodontal disease, 12 we explored the association between oral/periodontal disease and diabetes using dental and radiographic records of patients seen at the Comprehensive Care Clinic at Columbia University School of Dental and Oral Surgery. Most individuals served by this clinic, and included in this retrospective case–control study, reside in Northern Manhattan. The Northern Manhattan communities of Washington Heights/Inwood and Harlem had a population of 500 000 in 2000; residents’ incomes were among the lowest in New York City. 13 An estimated 34% of this population was living at or below the federal poverty level as of 1990, and Northern Manhattan is identified as a Medical and Dental Health Manpower Shortage Area by the Health Resources Services Administration of the Department of Health and Human Services. Forty-nine percent of the residents are Hispanic (mostly of Dominican origin), 44% are African American, and the balance represents other ethnic/racial groups. 14
