geospatial health C D A J O U R N A L , V O L 4 9 , Nº 7
Local Geographic Variation of Periodontitis and Self-Reported Type 2 Diabetes Mellitus Tobias K. Boehm, DDS, PhD; Dalia Seleem, DDS, PhD; and Finosh G. Thankam, PhD
abstract Tooth loss, periodontitis, Type 2 diabetes mellitus, age, race/ethnicity and gender are all correlated, and previous researchers developed mathematical models suggesting geographic disparities for these conditions for the Inland Empire region of California. By performing geospatial analysis of the medical charts from patients attending the dental center of the Western University of Health Sciences, the researchers provide further evidence for geographic health disparities to the ZIP code level in the northern half of the Inland Empire. Key words: Geospatial health, periodontitis, Type 2 diabetes mellitus, tooth loss, demographics
AUTHORS Tobias K. Boehm, DDS, PhD, is an associate professor and periodontist at the Western University of Health Sciences College of Dental Medicine. Conflict of Interest Disclosure: None reported. Dalia Seleem, DDS, PhD, is an assistant professor at the Western University of Health Sciences Colleges of Dental Medicine. Conflict of Interest Disclosure: None reported.
Finosh G. Thankam, PhD, is an assistant professor in tissue engineering and regenerative medicine at the department of translational research at the Western University of Health Sciences. Conflict of Interest Disclosure: None reported.
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eriodontitis is a chronic inflammatory condition caused by a reciprocally reinforced interaction between polymicrobial communities inside periodontal sulci and a dysregulated host inflammatory response.1 Type 2 diabetes mellitus (T2DM) is characterized by multiple disturbances in glucose homeostasis, including impaired insulin secretion, insulin resistance and splanchnic glucose uptake leading to chronic hyperglycemia.2 Generally, hyperglycemic individuals exhibit 1.86 times more likely to develop periodontitis compared to nondiabetic individuals.3 In turn, periodontitis is associated with poorer glycemic control in T2DM and with higher insulin resistance as determined by the homeostatic model assessment of insulin resistance (HOMA-IR) levels.4 Potential mechanisms of uncontrolled T2DM exacerbating periodontitis include an altered periodontal microflora and immune
dysfunction and periodontal extracellular matrix mineralization disorganization triggered by diverse pathological mediators including advanced glycosylation end products, oxidative stress and adipokines. Likewise, it is thought that bacterial irritants released from periodontal tissues and the chronic elevation of inflammatory mediators such as interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP) and oxygen radicals exacerbate diabetes in untreated periodontitis.5 Periodontitis experience and T2DM are common in males, Hispanics and older individuals in the U.S. as reported respectively by National Health and Nutrition Examination Surveys and National Center of Health Statistics at the Centers for Disease Control and Prevention.6,7 Self-reported T2DM status is a valid and reliable substitute for clinical diagnosis of diabetes in epidemiologic studies, with self-reported diabetes matching JULY 2 0 2 1
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