Bidirectional Relationship Between Diabetes Mellitus and Periodontitis

Numerous oral changes have been described in diabetics. The influence of diabetes on the periodontium has been thoroughly investigated. Although it is difficult to make definitive conclusions about the specific effects of diabetes on periodontium, very severe gingival inflammation, deep periodontal pockets, rapid bone loss, and frequent periodontal abcesses often occur in diabetic patients with poor oral hygiene. Recent studies suggest that uncontrolled or poorly controlled diabetes is associated with an increased susceptibility and severity of infections including periodontitis. Studies showed that subjects with type 2 diabetes had approximately threefold increased odds of having periodontitis compared with non-diabetics. Recent data indicate periodontitis is much more than a localized oral infection. It is a chronic subclinical infection that may cause changes in systemic physiology. Periodontal disease has been reported as the sixth complication of diabetes, along with neuropathy, nephropathy, retinopathy, and micro-and macrovascular diseases. Both diseases are thought to share a common pathogenesis that involves an enhanced inflammatory response that can be observed at the local and systemic level. Many studies have been published describing the bidirectional interrelationship between diabetes and periodontal disease. The main influences of diabetes on periodontal disease appear to be related to alterations in host immunoinflammatory reactions and tissue homeostasis. The increased response of monocytes and macrophages from diabetic patients may be related to the interaction of elevated levels of advanced glycated end-products (AGEs) in the periodontium with AGE receptors on these immune cells. However, chronic gramnegative periodontal infections increase insulin resistance and negatively impact glycemic control.