Periodontitis and diabetes: a two-way relationship

Abstract

Periodontitis is a common chronic inflammatory disease characterised by destruction of the supporting structures of the teeth (the periodontal ligament and alveolar bone). It is highly prevalent (severe periodontitis affects 10–15% of adults) and has multiple negative impacts on quality of life. Epidemiological data confirm that diabetes is a major risk factor for periodontitis; susceptibility to periodontitis is increased by approximately threefold in people with diabetes. There is a clear relationship between degree of hyperglycaemia and severity of periodontitis. The mechanisms that underpin the links between these two conditions are not completely understood, but involve aspects of immune functioning, neutrophil activity, and cytokine biology. There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control. Incidences of macroalbuminuria and end-stage renal disease are increased twofold and threefold, respectively, in diabetic individuals who also have severe periodontitis compared to diabetic individuals without severe periodontitis. Furthermore, the risk of cardiorenal mortality (ischaemic heart disease and diabetic nephropathy combined) is three times higher in diabetic people with severe periodontitis than in diabetic people without severe periodontitis. Treatment of periodontitis is associated with HbA1c reductions of approximately 0.4%. Oral and periodontal health should be promoted as integral components of diabetes management.

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 .…”

Glycemic control and adipokines after periodontal therapy in patients with Type 2 diabetes and chronic periodontitis

“…5 Evidence indicates a "two-way" relationship between T2DM and CP. 6,7,8,9 A large number of epidemiological studies have demonstrated that T2DM may increase the risk of CP by two-to three-fold. 10,11,12 Conversely, CP may be a risk factor for worsened glycemic control in diabetic individuals and may increase the risk of related complications.…”

Association between periodontal condition and kidney dysfunction in Japanese adults: A cross‐sectional study

“…It is characterized by destruction of connective tissue, the periodontal ligament, and alveolar bone, leading to a significant increase of systemic exposure to bacteria (Okada et al, 1996). Many investigators have suggested a two‐way relationship between diabetes and periodontitis (Nagasawa et al, 2010; Nishimura et al, 2003; Preshaw et al, 2012). Interestingly, it has been reported that periodontal infection shows a positive correlation with endothelial dysfunction (Tonetti et al, 2007) and that infection with Porphyromonas gingivalis increases endothelial injury in obese mice (Ao et al, 2014).…”