Cross-Sectional Comparative Assessment of Periodontal Status in Diabetic and Non-Diabetic Individuals Within a Romanian Cohort

Background/Objectives: Periodontitis and diabetes mellitus are known to exert a bidirectional pathogenic influence characterized by metabolic dysregulation, exaggerated inflammatory response, and accelerated periodontal breakdown. Despite the increasing prevalence of both conditions in Eastern Europe, comparative clinical data from Romanian populations remain limited. This study aimed to assess differences in periodontal status, systemic comorbidities, smoking exposure, and local periodontal risk factors between diabetic and non-diabetic individuals in a Romanian cohort. Methods: This cross-sectional study included 345 adults (152 with diabetes; 193 non-diabetic individuals) all diagnosed with periodontitis. Although participants were recruited to achieve comparable distributions of sex and smoking status, individuals with diabetes were significantly older than controls. Full-mouth periodontal examination was performed following the 2018 EFP/AAP classification criteria. Clinical parameters included probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP). Periodontal staging and grading were determined, and local risk factors were recorded using a multiple-response approach. Systemic comorbidities and smoking exposure were also evaluated. Statistical analyses involved t-tests, chi-squared tests, and Spearman correlations; significance was set at p < 0.05. Results: Diabetic patients exhibited significantly higher mean PPD (4.33 ± 1.22 mm vs. 3.70 ± 0.86 mm; mean difference 0.63 mm, 95% CI: 0.45–0.81), greater CAL (mean difference 0.19 mm, 95% CI: 0.01–0.37), and elevated PI and BOP (PI mean difference 18.97%, 95% CI: 12.44–25.50; BOP mean difference 17.23%, 95% CI: 10.86–23.60). Advanced stages (III–IV) and Grade C periodontitis were more prevalent among diabetic individuals. Diabetic participants also presented a higher burden of local plaque-retentive factors and systemic comorbidities (notably hypertension and cardiovascular disease), as well as higher smoking intensity. Conclusions: Diabetes mellitus is associated with markedly poorer periodontal status, greater systemic disease burden, and increased prevalence of plaque-retentive local factors. These findings reinforce the bidirectional relationship between diabetes and periodontitis and support the integration of periodontal assessment into metabolic disease management protocols.