Association Between Periodontal Health and Perioperative Glycemic Outcomes in Diabetic Patients Undergoing Dental Procedures Under General Anesthesia: A Retrospective Cohort Study.

Introduction Periodontitis and diabetes are closely related, but the influence of periodontal disease severity on perioperative glycemic outcomes during dental procedures under general anesthesia remains unclear. This study evaluated the association between periodontal disease severity and perioperative glycemic outcomes in diabetic patients. Materials and methods This retrospective study included 72 patients with diabetes who underwent elective dental procedures under general anesthesia between January 2015 and December 2018. The patients were categorized into mild periodontitis (n = 43) and severe periodontitis (n = 29) groups. Demographic, diabetic, periodontal, anesthetic, and perioperative data were retrieved from the electronic medical records. Periodontal parameters included plaque index, bleeding on probing, probing pocket depth, clinical attachment loss, and the number of remaining teeth. Perioperative glycemic outcomes were assessed using preoperative, intraoperative, and postoperative blood glucose levels; glycemic variability; and the incidence of hyperglycemia and hypoglycemia. Postoperative complications were also assessed. Statistical analysis was then performed. Results Patients with severe periodontitis had significantly higher glycated hemoglobin (HbA1c) levels than those with mild disease (8.9 ± 1.3% vs. 7.6 ± 1.2%; p < 0.001). Mean preoperative (185.6 ± 42.4 vs. 142.3 ± 38.1 mg/dL), intraoperative (210.8 ± 48.2 vs. 155.4 ± 41.5 mg/dL), postoperative (225.1 ± 52.3 vs. 161.2 ± 45.8 mg/dL), and mean perioperative blood glucose levels (207.2 ± 43.5 vs. 153.0 ± 38.2 mg/dL) were significantly higher in patients with severe periodontitis (all p < 0.001). Glycemic variability was also significantly greater (41.3 ± 14.2 vs. 28.5 ± 10.1; p < 0.001). Perioperative hyperglycemia was observed in 22 (75.9%) patients with severe periodontitis compared with 12 (27.9%) patients with mild periodontitis (p < 0.001). Surgical site infection occurred in 9 (31.0%) and 3 (7.0%) patients (p = 0.014), delayed wound healing in 11 (37.9%) and 4 (9.3%) patients (p = 0.006), and hospital stay exceeding 24 hours in 15 (51.7%) and 8 (18.6%) patients (p = 0.004), respectively. The periodontal destruction and perioperative glycemic parameters showed a significant positive correlation (r = 0.58-0.67; all p < 0.001). Conclusion Severe periodontitis was associated with poorer perioperative glycemic control, greater glycemic variability, and more frequent postoperative complications in diabetic patients undergoing dental procedures under general anesthesia. These findings indicate an association between periodontal disease severity and perioperative outcomes but do not establish a causal relationship. Prospective studies are needed to determine whether periodontal management can improve perioperative outcomes.