Diabetes-associated periodontitis progression — ORE Part 1 MCQ

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HardPeriodontologyDiabetes-associated periodontitis progressionORE Part 1

A 58-year-old patient has an HbA1c of 91 mmol/mol, generalised bleeding on probing, multiple 6 mm periodontal pockets, and radiographic bone loss that has progressed since radiographs taken 2 years earlier. Plaque levels are moderate. He reports dry mouth and does not smoke. Which factor most likely explains the increased risk of periodontal progression?

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Correct answer: A — Sub-optimally controlled diabetes mellitus

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · E = shown as D · A = shown as E

C is correct. An HbA1c of 91 mmol/mol indicates markedly sub-optimal glycaemic control. SDCEP identifies sub-optimally controlled diabetes as a risk factor for periodontitis, with evidence that it substantially increases the risk of progression and impairs periodontal treatment response. Thus, the diabetes provides the key explanation for progressive generalised disease despite only moderate plaque and no smoking history. Fluoride exposure affects dental hard tissues rather than causing progressive periodontal attachment and bone loss. Orthodontic movement may complicate plaque control locally but does not explain this generalised progressive presentation. Primary herpetic infection is an acute painful mucosal illness, not chronic periodontitis. Salivary duct obstruction is usually acute and localised; dry mouth may worsen plaque-related risk but is not the principal systemic driver demonstrated here.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Prevention and Treatment of Periodontal Diseases in Primary Care: Control of diabetes, 2026. https://www.periodontalcare.sdcep.org.uk/guidance/treatment-components/managing-risk-factors/modifiable-systemic-risk-factors/control-of-diabetes/