Association of Periodontitis and Tooth Loss With Asymptomatic Carotid Atherosclerosis in Patients With Type 2 Diabetes: A Cross-Sectional Study

Objectives To investigate the association between periodontitis, tooth loss, and asymptomatic carotid atherosclerosis in patients with type 2 diabetes mellitus (T2DM), and to explore whether this relationship persists in patients with low traditional cardiovascular risk factors. Materials and methods A cross-sectional study was conducted involving 306 hospitalized T2DM patients without symptomatic atherosclerotic disease. Carotid intima-media thickness (cIMT) and plaque presence were assessed via ultrasonography. Periodontal status was evaluated through clinical examination and panoramic radiography. Salivary levels of tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), and matrix metalloproteinase 9 (MMP-9) were measured by enzyme-linked immunosorbent assay (ELISA). Multivariable logistic regression was used to adjust for confounders including age, sex, smoking, low-density lipoprotein cholesterol (LDL-C), glycosylated hemoglobin (HbA1c), body mass index (BMI), and diabetes duration. Results Patients with cIMT ≥1 mm or carotid plaques had significantly higher clinic attachment loss (CAL) values, more tooth loss, and a higher prevalence of severe periodontitis (P<0.05). Multivariable analysis confirmed that severe periodontitis and increased tooth loss were independently associated with both cIMT ≥1 mm and carotid plaque presence. These associations remained significant even in subgroups with lower LDL-C, lower BMI, younger age, shorter diabetes duration, or better glycemic control. Salivary TNF-α levels were significantly elevated in patients with carotid atherosclerosis. Conclusion Severe periodontitis and tooth loss are significantly associated with asymptomatic carotid atherosclerosis in T2DM patients, including those with low conventional cardiovascular risk profiles. Salivary TNF-α may be linked to subclinical atherosclerosis in this population.