Type of manuscript: cross-sectional observational

study
Title of article: Pattern of tooth mobility in diagnosed
diabetic patients in University of Benin Teaching
Hospital (UBTH), Benin City, Nigeria
Running title: Pattern of tooth mobility in diagnosed
diabetic patients

Name of authors
P.I Ojehanon (FWACS)
Associate professor
Department of Periodontics,
University of Benin, Benin City, Nigeria
C.C Azodo (FMCDS)
Senior lecturer
Department of Periodontics,
University of Benin, Benin City, Nigeria

Name of authors
P. Erhabor (BDS)
Senior Registrar
Department of Periodontics,
University of Benin Teaching Hospital, Benin City, Nigeria
V. Orhue (BDS)
Senior Registrar
Department of Periodontics,
University of Benin Teaching Hospital, Benin City, Nigeria

Correspondence
D. P.I Ojehanon
Department of Periodontics
Prof. Ejide Dental Complex
University of Benin Teaching Hospital
Benin City, Nigeria 300001
Phone: 08023396736
E-mail: Patrickojehanon@yahoo.com
Fax: None

 Source(s) of support in the form of grants,

equipment, drugs or all of these: no external
funding was received for the conduct of this study

outline
Introduction
Relationship between periodontal diseases and DM
Methodology
Discussion
Conclusion
Recommendation
Study limitation
Reference

Introduction
Diabetes Mellitus (DM) is a clinical syndrome
characterized by hyperglycemia due to an
absolute or relative deficiency of insulin
(Edwards and Rafaelle 1996).
The Prevalence of undiagnosed DM in UBTH
dental clinic is 4.5% (Ojehanon and Akhionbare
2006).
The Prevalence of DM in South Western Nigeria is
4.76% with 2.38% as undiagnosed DM

Introduction continued
DM can result in tissue damage including the
periodontium.
Periodontal complications has been referred to
as the 6th complication of DM (Loe 1993).
Periodontal complications in DM can lead to
tooth mobility (Dombret and Marcos 1989).
The mechanism through which periodontitis
cause tooth mobility include inflammatory
distruption of the periodontal tissues, widening
of the periodontal ligament, attachment loss,

Relationship between periodontal diseases and DM

Reducing sugars resulting from DM form

reversible products with blood and tissue protein
by non enzymic glycation and oxidation. These
compounds undergo irreversible structural
changes to become advanced glycated end
products (AGES) that promote inflammatory
responses (Wautier et al., 2004).
Studies of monocytes from people with diabetes
have shown a hyperresponsive phenotype with
overexpression of pro-inflammatory mediators

 Conversely,
inflammatory
mediators, particularly
cytokines, can potentially contribute to insulin
resistance in a number of ways, including modification
of
insulin
receptor
substrate-1
by
serine
phosphorylation, alteration of adipocyte function with
increased production of free fatty acids and diminution
of endothelial nitric oxide production.
Thus, the interrelationships between diabetes and
periodontal disease provide an example of systemic
disease predisposing to oral infection, and once that
infection is established, the oral infection exacerbates
the progression of systemic disease.

 The increased glucose levels in the gingiva

crevicular fluid and saliva may favor the growth
of some microbial species ( Mashimo, 1981;
Mandell et al, 1992).
In uncontrolled diabetes, it has been observed
that there is polymorphonucletide (PMNs)
deficiency and this results in impaired
chemotaxis, defective phagocytosis and
impaired adherence resulting in a diminishing of
the primary defence against bacterial pathogens
and more bacterial proliferation. (Rajkumar
2012).
The AGEs cross link collagen and fibronectin

It can be seen that DM and Periodontal

disease are associated biologically

Methodology

Study location: This study was carried out at

the Periodontology Clinic of the University of
Benin Teaching Hospital (UBTH), Nigeria.
Study design: It was a cross-sectional
observational study.
Ethical considerations: The study was
explained to the participants at the first visit.
Informed consent forms were duly completed
and signed by willing participants.
A total of 54 adult patients with DM and varying
degrees of severity of periodontal diseases

 Sample size calculation was

N=Z2Pq/d2, (Cochran, 1977)

determined

using

the

formula

Where: N = the desired sample size

Z = the standard normal deviate, set at 1.96 corresponding to 95%
confidence level,
P = the prevalence rate of periodontal disease in Nigeria (Akhionbare
et al., 2007) = 0.967 (96.7%)
q = 1.0-P
d = degree of accuracy desired (error margin) = 5% = 0.05.
Therefore, N = (1.96)2 x 0.967 x (1-0.967) = 49.04
(0.05)2
N was adjusted to 54 to give room for attrition i.e. 10% of N will be
added.

 Calibration of the researcher with the clinical

parameters was done by the use of a pre-test on
10 patients outside the study sample
Exclusion criteria included patients with clinical
evidence of systemic diseases other than
diabetes mellitus; those who have had
antibiotics and steroids in the last six months
and those wearing dental appliances(prosthetic
and orthodontic)
Data was collected from January 2014-December
2015. All information collected was recorded on
a structured survey form which consisted of the

RESULT

Out of the 54 subjects recruited, 49 (90.7%)

completed the study, based on the set criteria
and were thus analyzed. The age of the subjects
ranged from 42 to 84 years with a mean age of
63.8 years. Male to Female ratio was 1.9:1.
Majority of the subjects (44.0%) had tertiary
education. Professionals constituted the majority
(63.2%) (Table 1)
The earliest and commonest teeth in the
dentition to become mobile in diagnosed
diabetic subjects were the upper 1st molars and
lower 1st incisors (Table 2).

characteristics

Frequency

Percentage

<44

2.0

45-54

14.3

55-64

18

36.7

65-74

17

34.7

75-84

12.3

Age

sex
Male

32

65.3

Female

17

34.7

Education
Tertiary

22

42.9

Secondary

16

32.7

Primary
non-formal

7
4

14.3
8.2

Occupation
Professionals

31

63.2

Table 2: Onset of mobile tooth in diabetic

mellitus patients
Tooth
Percentage (%)

Frequency (n)

11

4.0

12

2.0

13

0.0

14

0.0

15

0.0

16

18.4

17

0.0

21

4.0

22

2.0

23

0.0

24

0.0

25

0.0

26

16.3

31

16.3

32

4.0

33

0.0

34

0.0

35

0.0

36

4.0

37

0.0

41

10

20.0

42

4.0

43

0.0

44

0.0

45

0.0

46

4.0

47

0.0

Table 3: Relationship between the characteristics of subjects and the

number of mobile teeth in the dentition

Characteristics

Number of mobile teeth

mean

SD

P value

49

63.8

9.17

0.602

0.000

49

1.34

0.48

0.361

0.011

49

1.56

0.60

0.395

0.005

49

3.83

2.31

0.498

0.000

Mean SD

Age of subjects

4.12 1.81

(years)

Gender

4.12 1.81

Gingival index

BPE

4.12 1.81

4.12 1.81

DISCUSSION

The older age group that constitute the majority of subjects

is in tandem with previous study that reported that the older
age group had more periodontitis than the younger age
group (Umoh and Azodo, 2012; Heitz-Mayfield et al. 2003).
Our study indicated a significant relationship between the
age of subjects and the number of mobile teeth in the
dentition. Salvage (1992) reported incidence of 70% of
shallow or deep pockets among elderly Nigerian subjects.
Majority (67.5%) of the subjects in this study had tertiary
level of education and 60% were professionals. This could be
attributed to the study centre being in close proximity to the
university community.

 The fact that more males than females presented with

complaint of tooth mobility in our study suggests that
the male subjects took their periodontal condition less
seriously than their female counterpart resulting in more
periodontal complication of diabetes in the male fold.
This is consistent with previous study by Okunseri et al.
2004 that documented gender based differences in the
utilization of dental care, services and treatment
outcome, in favour of females.

 In this study, the earliest and commonest teeth

in the dentition to become mobile in diagnosed
diabetic subjects were the upper 1st molars and
lower 1st incisors and these are among the teeth
that erupt first.
This finding follows the clinical features of
localized aggressive periodontitis described by
Baer (1971). Moreover, like the clinical entity
reported by Baer, there is a characteristic
symmetrical distribution of the periodontal tissue
destruction and tooth mobility.
Arowojolu (2002) reported a higher prevalence

 This study reported a significant relationship between the

GI and BPE and number of mobile teeth in the dentition of
subjects.
Dental plaque plays a major role in the etiology of
periodontal diseases (Newman et al 2012).
Diabetes mellitus has been reported to be among the
systemic conditions that influence the host response to
plaque (Mealey and Ocampol 2007).

 Studies (Javed et al 2007, Taylor et al 1998) have

indicated an increased alveolar bone loss in
patients with diabetes compared to individuals
without diabetes.
Therefore, in the absence of effective home care
and continuing poor oral hygiene, periodontal
diseases as indicated by BPE AND GI may lead to
tooth mobility and eventual tooth loss in diabetic
patients

Conclusion
This study on the pattern of tooth mobility in diagnosed
diabetic patients in University of Benin Teaching Hospital
(UBTH), Benin City, Nigeria revealed the following:
The 1st molars and incisors were the earliest and commonest
teeth in the dentition to be affected by tooth mobility, in
subjects in this study.
There was a significant relationship between the age, gender,
GI, and the later stages of periodontal diseases as determined
by BPE and the number of mobile teeth in the dentition

Recommendation
In view of the findings of this study, the following
are recommended:
Diabetic patients should be encouraged to have
their oral hygiene and periodontal health
routinely assessed and managed in order to
improve their periodontal health status.
Periodontologists should be part of the team
that manages diabetic mellitus patients in order
to give total care to these patients

Study limitation
The study centre is not centrally located in Benin
City and also the subjects involved with this
study
were
selected
using
convenience
consecutive sampling method. This made it
difficult to have a good representation of the
community.
The recall capacity of the subjects in the onset of
tooth mobility may have varied among subjects
involved in this study and therefore was a
limitation.

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