Periodontal Status and Gestational Diabetes Mellitus: A Case-Control Study

Research Article

J Dent & Oral Disord. 2023; 9(1): 1177.

Periodontal Status and Gestational Diabetes Mellitus: A Case-Control Study

Estévez-Llorens R1*, Menéndez-Nieto I1, Baquero-Ruiz de la Hermosa MC2, Marcos-Puig B3 and Perales-Marín A3,4

1Department of Dentistry, Faculty of Health Sciences.Universidad Europea de Valencia, Spain

2Oral and Maxillofacial Surgery Service, Hospital U.P La Fe, Valencia, Spain

3Obstetrics and Gynecology Service, Hospital U.P La Fe, Valencia, Spain

4Pediatrics, Department of Obstetrics and Gynecology, Universidad de Valencia, Spain

*Corresponding author: Raquel Estévez LlorensUniversidad Europea de Valencia, Faculty of Health Sciences, Department of Dentistry, Paseo de la Alameda, 7, 46010, Valencia, Spain

Received: December 14, 2022; Accepted: January 20, 2023; Published: January 27, 2023


Background: Studies linking Periodontal Disease (PD) and Gestational Diabetes Mellitus (GDM) are not in agreement. Our main objective is to evaluate the possible association between PD and GDM.

Methods: 222 pregnant women participated, 111 with GDM, from Hospital La Fe de Valencia. Periodontal examination was performed, assessing the following parameters: number of teeth, plaque index, bleeding on probing, Pocket Probing Depth (PPD) and Clinical Attachment Level (CAL).

Results: The GDM had a higher value of PPD (p = 0.001) and CAL (p = 0.013). 75.7% of the patients with GDM had gingival inflammation compared to 56.8% of the non-diabetic patients. Periodontitis was more prevalent in patients with GDM (p < 0.05).

Conclusions: The results suggest that pregnant women with gestational diabetes associate more periodontal disease than those without such gestational disease. In our sample, the risk of GDM can be estimated from periodontitis, age and educational level. However, no relation of statistical significance has been found between a worse periodontal condition and the need of insulin in the treatment of GDM or having more adverse pregnancy outcomes in the GMD.

Keywords: Gestational diabetes mellitus; Periodontal disease; Gingivitis; Periodontitis; Pregnancy; Insulin


Periodontal Disease (PD) includes infectious pathologies that affect the supporting tissues of the tooth. Gingivitis only affects the gums and is a reversible inflammatory process, while periodontitis is a multifactorial bacterial infection that, in addition to gingival inflammation, causes irreversible destruction of the supporting structures of the tooth [1,2]. Periodontal diseases affect a large part of the population worldwide, with advanced periodontitis being the sixth most prevalent disease on the planet [3].

Gestational Diabetes Mellitus (GDM) is a glucose intolerance detected for the first time during pregnancy, with a prevalence of 10-25% of pregnancies, depending on the population studied and the diagnostic criteria used. It is the most common medical complication of pregnancy [4]. GDM is associated with preeclampsia, abortion, premature births and type 2 diabetes (DM2) in the future [5,6].

In pregnant women, periodontitis has been associated with premature births, low birth weight newborns, and preeclampsia [7-11]. There are different studies suggesting the relationship between periodontitis and GDM. However, the results are contradictory [12,13]. Establishing a relationship between poor periodontal health and GDM would help reduce the incidence of GDM and its associated adverse outcomes.

Our main goal is to study the possible relationship between GDM and PD. Secondary objectives are to analyze if patients with GDM and in worse periodontal condition have worse blood glucose control and more adverse pregnancy outcomes than gestational diabetic women with better periodontal health.

Material and Methods


This is an observational case-control and cross-sectional study, where we compare the periodontal status of 111 pregnant women with GDM (cases) and 111 without GDM (controls), controlled in the Obstetrics and Gynecology Service of the Hospital UP La Fe de Valencia.

The inclusion criteria were: gestational age greater than 24 weeks, complete GDM screening, over 18 years of age, informed consent. The exclusion criteria were: pregestational diabetes type 1 or 2, HIV and autoimmune diseases, less than 14 teeth, having received periodontal treatment during the three months prior to the study, use of drugs, insulin or oral antidiabetics before pregnancy, consumption of corticosteroids.

Definition of Cases and Controls

The cases were pregnant women diagnosed with GDM following the diagnostic criterion recommended by the National Diabetes Data Group (NDDG) [14]. Whereas the controls had a normal oral glucose loads. Both cases and controls had the same gestational age.

Oral Health Examination

All periodontal records were made by a single dentist using a mouth mirror number 5 and PQ-W Williams periodontal probe (Hu-Friedy, Chicago, IL, USA). Each tooth was explored in 6 zones (mesiobuccal, buccal, distobuccal, mesiolingual, lingual, distolingual). The recorded parameters were: The number of teeth that each patient had (excluding third molars). The Plaque Index (PI) is calculated as the percentage of surfaces that present plaque in relation to the total number of dental surfaces evaluated. Oral hygiene was considered acceptable when the PI was < 20%. The Bleeding Index on Probing (BOP) was the method used to assess gingival inflammation. It was considered that there was gingival inflammation when the patient presented ≥ 10% of the bleeding locations [15]. Pocket Probing Depth (PPD) was measured as the distance from the gingival margin to the bottom of the periodontal pocket. And Clinical Attachment Level (CAL) was calculated from the measurements of gingival recession (distance from the cement-enamel line to the gingival margin) and probing depth. The mean attachment level and the mean probing depth were calculated.

Periodontitis was defined according to the clinical criterion of the CDC classification for population studies and the AAP (Centers for Disease Control and Prevention and the American Academy of Periodontology), also called the Page & Eke classification [16]. According to this classification, Severe Periodontitis is defined as the presence of 2 or more interproximal areas with clinical attachment loss ≥ 6 mm, not in the same tooth, and 1 or more interproximal areas with PS ≥ 5 mm. Moderate Periodontitis is described as the presence of 2 or more interproximal areas with attachment loss ≥ 4 mm, not in the same tooth or 2 or more interproximal areas with PS ≥ 5 mm not in the same tooth. Mild Periodontitis is defined as the presence of 2 or more interproximal areas with attachment loss ≥ 3mm and 2 or more interproximal areas with PS ≥ 4mm (not on the same tooth) or one area with PS ≥ 5mm. Periodontitis was considered as the presence of mild, moderate or severe periodontitis, Gingivitis as the absence of periodontitis and bleeding index on probing ≥ 10%, and Periodontal Health as the absence of periodontitis and bleeding index on probing < 10%.

To study the secondary goals, patients with GDM were separated into two groups: non-insulin dependent and insulin dependent following the ACOG (American College of Obstetricians and Gynecologists) classification according to whether or not they required insulin treatment to control the disease. These two groups were compared with the periodontal variables: PI, BOP, PPD, CAL and Periodontal criteria.

The adverse pregnancy outcomes that were analyzed were Premature Rupture of Membranes (PROM), preeclampsia, Low Birth Weight (LBW), preterm birth, macrosomia and intrauterine growth restriction (IUGR).Patients with GDM were classified into two groups according to whether they had one or more of these perinatal complications or not. These two groups were compared with the periodontal variables: PI, BOP, PPD, CAL and Periodontal criteria.


The study participants completed a supervised questionnaire to collect affiliation, sociocultural, and oral and general health data.

Statistical Analysis

A descriptive and inferential statistical analysis was performed. Quantitative variables were described by means and Standard Deviations (SD). Qualitative variables were described using frequencies and relative percentages. The Kolmogorov-Smirnov test was used to determine the normality of the quantitative variables. In the case of non-normality, the non-parametric Mann-Whitney U test was applied for independent samples of two groups. In the cases of normal variables, the Student’s t test was applied for independent groups. To analyze the bivariate relationships between the qualitative variables, contingency tables were constructed and the Chi-Square test was applied, logistic regression analysis was used to characterize the independent risk factor for GDM, also ROC curve was build. Statistical analysis was performed using IBM SPSS statistics v.23 and Medcap. The significance level was set at p <0.05.


On the total sample (n=222), the association of social, local, systemic factors and other factors in relation to GDM was studied (Table 1) shows the comparative analysis between cases and controls. The gestational age at which the study was performed was not different between the two groups. Pregnant women with GDM were significantly older, had higher BMI and lower educational level and relatives with diabetes history. There were no differences regarding the rest of the studied parameters.