THE ONSET OF DIABETES AND POOR METABOLIC CONTROL INCREASES GINGIVAL BLEEDING IN CHILDREN AND ADOLESCENTS WITH INSULIN-DEPENDENT DIABETES-MELLITUS

Gingival health (bleeding on probing) and oral hygiene (plaque percent ) were assessed in 2 groups of children and adolescents with insulin-d ependent diabetes mellitus (IDDM). 1st study group included 12 newly d iagnosed diabetic children and adolescents (age range 6.3-14.0 years, 5 boys and 7 girls). They are examined on the 3rd day after initial ho spital admission and at 2 weeks and 6 weeks after initiation of insuli n treatment. Gingival bleeding decreased after 2 weeks of insulin trea tment (37.8% versus 19.0%, p<0.001, paired t-test), and remained at th e same level when examined 1 month later while glucose balance was exc ellent. Another group (n = 80) of insulin-dependent diabetic children and adolescents (age range 11.7-18.4 years, 44 boys and 36 girls) with a mean duration of diabetes 6.0 years (range 0.3-15.0 years) were exa mined 2x at 3-month intervals. Subjects with poor blood glucose contro l (glycosylated haemoglobin, HbA(1), values over 13%) had more gingiva l bleeding (46.3% on examination 1, 41.7% on examination 2) than subje cts with HbA(1) values less than 10% (mean gingival bleeding 35.2% and 26.9%, respectively) or subjects with HbA(1) values between 10 to 13% (mean gingival bleeding 35.6% and 33.4%, respectively). Differences w ere significant on both examinations (p<0.05, Anova), and remained sig nificant after controlling the groups for differences in age, age at t he onset of diabetes, duration of diabetes and pubertal stage (Ancova) . Results were not related to differences or changes in dental plaque status, supporting the concept that imbalance of glucose metabolism as sociated with diabetes predisposes to gingival inflammation. An increa se in gingival bleeding in association with hyperglycaemia suggests th at hyperglycaemia-associated biological alterations, which lower host resistance toward plaque, have apparently taken place. Consequently, a lthough not all gingivitis proceeds into a destructive periodontal dis ease, prevention of plaque-induced proceeds into a destructive periodo ntal disease, prevention of plaque-induced gingival inflammation shoul d be emphasised, particularly in children and adolescents with poorly controlled diabetes.