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Bolstering previous research on the link between oral health and diabetes, investigators from the National Institute of Diabetes and Kidney Disease found a positive association between severity of periodontal disease and mortality in diabetes patients.

A study of 628 Pima Indians aged 35 years and older examined the effect of periodontal disease on mortality — cardiovascular and renal mortality, in particular — in patients with type 2 diabetes. Panoramic radiographs and examinations were used to rate the severity of periodontal disease in each subject, classified as none, mild, moderate or severe. Nearly 60 percent of the subjects had severe periodontal disease.

During a median follow-up of 11 years, 204 of the subjects had died. Adjusting for age and sex, the death rates for all natural causes expressed as the "number of deaths per 1,000 person-years" were 3.7 for no or mild periodontal disease, 19.6 for moderate periodontal disease and 28.4 for severe periodontal disease.

The investigators found that periodontal disease was a positive predictor for deaths from ischemic heart disease and diabetic nephropathy. After adjusting for factors such as duration of diabetes, hypertension, tobacco use and other factors, they noted that "subjects with severe periodontal disease had 3.2 times the risk of cardiorenal mortality" compared with the groups with no or mild to moderate periodontal disease combined.

"Periodontal disease is a strong predictor of mortality from ischemic heart disease and diabetic nephropathy in Pima Indians with type 2 diabetes," the investigators wrote. "The effect of periodontal disease is in addition to the effects of traditional risk factors for these diseases."

The full results of the study are published in the January 2005 issue of Diabetes Care.