Inter-relationship between Prediabetes, Gutka chewing and periodontal inflammatory conditions in patients with chronic periodontitis

Background: Pre-diabetes is the precursor stage to diabetes mellitus in which not all of the symptoms required to label a person as diabetic are present, but blood sugar is abnormally high. This stage is often referred to as the ‘grey area’. Gutka, a smokeless tobacco; a mixture of powdered tobacco, areca nut and slaked lime is known to jeopardize periodontal health; however, severity of periodontal inflammation in gutka chewers with and without prediabetes remains unknown. The aim of this study is to investigate the inter-relationship between pre-diabetes, gutka chewing and periodontal inflammatory conditions. Methods: In this cross-sectional study, the effect of gutka use on periodontal health is investigated among 50 individuals with prediabetes and 50 without prediabetes. Demographic information regarding age, sex, duration of prediabetes, and gutka-chewing habits was collected using a questionnaire. Periodontal inflammatory conditions (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment level [CAL] and fasting blood glucose levels (FBGLs) were recorded. Results: Periodontal inflammatory parameters (PI, BOP, PD and CAL) were significantly higher in individuals with prediabetes irrespective of gutka-chewing habit (P <0.05). Periodontal inflammation in individuals with prediabetes were higher than in patients without prediabetes (<0.0001). Gutka chewing alone did not significantly increase the periodontal inflammatory conditions. Prediabetic patients were significantly more likely to have periodontal inflammation than individuals without prediabetes (<0.05). Conclusion: In patients with chronic periodontitis, periodontal inflammatory conditions are worse in gutka chewers compared to non-chewers; in patients with both chronic periodontitis and prediabetes, hyperglycemia governs the severity of periodontal inflammation when compared to habitual gutka usage.