Periodontal Disease and Diabetes Mellitus: A Two‐Way Relationship

Abstract

Severe periodontal disease often coexists with severe diabetes mellitus. Diabetes is a risk factor for severe periodontal disease. A model is presented whereby severe periodontal disease increases the severity of diabetes mellitus and complicates metabolic control. We propose that an infection-mediated upregulation cycle of cytokine synthesis and secretion by chronic stimulus from lipopolysaccharide (LPS) and products of periodontopathic organisms may amplify the magnitude of the advanced glycation end product (AGE)-mediated cytokine response operative in diabetes mellitus. In this model, the combination of these 2 pathways, infection and AGE-mediated cytokine upregulation, helps explain the increase in tissue destruction seen in diabetic periodontitis, and how periodontal infection may complicate the severity of diabetes and the degree of metabolic control, resulting in a 2-way relationship between diabetes mellitus and periodontal disease/infection. This proposed dual pathway of tissue destruction suggests that control of chronic periodontal infection is essential for achieving long-term control of diabetes mellitus. Evidence is presented to support the hypothesis that elimination of periodontal infection by using systemic antibiotics improves metabolic control of diabetes, defined by reduction in glycated hemoglobin or reduction in insulin requirements.

Effect of Non-Surgical Therapy on Salivary Nitric Oxide and Lipid Peroxidation Levels in Type Ii Diabetic and Non Diabetic Patients With Periodontal Disease

“…This result is in agreement with various other studies [5,7,41]. In periodontitis, the elevated NO is due to the increased expression of iNOS by the PMNs, macrophages, and endothelial cells.…”

Obesity and periodontal disease in diabetic pregnant women

“…It has been shown that periodontal infections can change the metabolic-endocrine status of the host, leading to difficulties in the control of blood sugar levels, which can contribute to insulin-resistance, hyperglycemia and complications in the metabolic control of diabetes mellitus 2,11,15 . Moreover, periodontal treatment improves diabetes control 2 .…”

Expression of MRP8/MRP14 mRNA in Monocytes of Periodontitis: Comparison between Diabetic and Non Diabetic Patients

“…15 The existence of vascular changes in the form of capillary basal membrane thickening due hyperglicemic conditions, also causes disruption of the nutrients and the migration of immune cells into the periodontal tissue. 12 Calprotectin (MRP8 /MRP14) is cytosolic protein that has important functions as chemotactic factor associated with the activation of monocytes and neutrophils, and accumulation of cells of innate immunity in areas of inflammation as well as an antibacterial protein.…”