Diabetes and Periodontal Diseases: Interplay and Links

Abstract

The association between diabetes and periodontal diseases is well-established. Diabetes is a risk factor for periodontal disease, with diabetic patients exhibiting an increased prevalence, extent and severity of gingivitis and perio- dontitis compared to healthy adults. Several mechanisms involved in the pathogenesis of diabetes have also been associated with periodontal disease progression. It is recognized today that there is a bidirectional relationship between diabetes and periodontal disease, with recent research showing that periodontal disease may affect the metabolic control of diabetes in diabetic patients. In this review, we present the current knowledge of the interplay between periodontal diseases and diabetes through the evaluation of randomized control and longitudinal cohort studies published in the past 15 years. Current data support the conclusion that diabetic patients are at increased risk for periodontal diseases, and that patients with poorly controlled diabetes are at risk for severe periodontitis. This results in the destruction of oral connective tissue and generalized bone loss, leading ultimately to tooth loss. Although the effect of periodontal disease on glycemic control in type 1 diabetic patients is controversial, evidence does show a direct correlation between periodontal health and glycemic control in type 2 diabetic patients. Furthermore, several studies have demonstrated the beneficial effect of periodontal treatment on metabolic control of type 2 diabetic patients.

Salivary and microbiological parameters of chronic periodontitis subjects with and without type 2 diabetes mellitus: a case-control study

“…Studies have supported a two-way relation between diabetes and periodontal status [6][7][8][9] . Key public strategies such as primary prevention and early diagnosis require deep knowledge related to risk factors and to the etiopathogenesis of the disease or diseases under analysis.…”

“…The association between periodontal diseases and diabetes has been studied over the last decades and, today, there is enough scientific evidence to support the existence of a twoway relationship between them [6][7][8][9] . Diabetes increases the risk of incidence and severity for periodontitis 10 .…”

Neutrophil Role in Periodontal Disease

“…Another correlation between periodontitis and diabetes also has been well documented. Higher plaque levels and higher incidence of chronic gingivitis are both found in adults and in children with diabetes [43,44]. Periodontal treatment showed a beneicial efect on metabolic control of type 2 diabetic patients.…”

Effects on Alveolar Bone of Diabetes Mellitus Induced by Streptozotocin in Rats. Histopathologic and Immunohistochemical Study

“…Type 2 diabetes mellitus (T2DM) is a multiple risk factor disease, and dyslipidemia, hyperglycemia and visceral obesity are the major determinants (Preshaw et al, 2012). Periodontal diseases are the six most common co-morbid condition in patients with diabetes mellitus (Löe, 1993;Al-Maskari et al, 2011) and evidence indicates a bidirectional relationship between these two pathologies (Lakschevitz et al, 2011;Awuti et al, 2012).The presence of diabetes influences the periodontal tissues by altering neutrophil function and collagen synthesis, inducing vascular abnormalities through genetic predisposition (Oliver & Tervonen, 1994). Relationship between diabetes and periodontitis is thought to be due to changes occurring in the alveolar bone structure.…”