Periodontal Disease and Diabetes Mellitus

Diabetes mellitus, type 1 and 2, are well established as increasing the risk for severe periodontal disease. Periodontal disease has an earlier onset and is more severe in diabetic patients, especially those who are poorly controlled metabolically. The mechanisms are unclear; however, possibilities include a generalized hyperinflammatory response associated with advanced glycation endproducts, triggering inflammatory cells. Other mechanisms include altered vascular physiology, reduced immune response (particularly protective immune responses by neutrophils), and reduced ability for tissues to heal. The clinical consequences of the increased susceptibility of diabetic patients are that periodontal disease will be better managed in diabetic patients who are well-controlled diabetically. Intense monitoring, prevention, and early treatment are often necessary for those suffering from diabetes, to prevent the ravaging effects of periodontal disease. Periodontal infections also worsen glycemic control in diabetic patients. It appears that aggressive periodontal therapy, especially using adjunctive systemic antibiotics, is effective in treating periodontal disease in diabetic patients, and results in reduced glycated hemoglobin. Further studies are needed to determine the extent to which this reduction in glycated hemoglobin can be maintained and the subsequent effects, if any, on other diabetic complications. Keywords: diabetic complications; periodontitis; oral infection; dental plaque; dental abscesses; xerostomia; dental treatment