An update on the evidence for pathogenic mechanisms that may link periodontitis and diabetes

Abstract

The elevated pro-inflammatory factors in the gingiva of patients with poorly controlled diabetes suggest a biological pathway that may aggravate periodontitis. Some evidence suggests that the systemic inflammatory burden in periodontitis has the potential to affect diabetes control, but no studies addressed the impact of successful periodontal therapy on the pathophysiological mechanisms involved in systemic complications of diabetes.

Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology

“…There is evidence from clinical studies to support the contention that elevated levels of pro‐inflammatory mediators in poorly controlled diabetes [interleukin [IL]‐1‐β, tumour necrosis factor [TNF]‐α, IL‐6, receptor activator of nuclear factor‐kappa B ligand/osteoprotegerin ratio and oxidative stress) within the gingival tissues of people (or animal models) with diabetes play a role in the observed increased periodontal destruction. This is supported by studies using cell cultures exposed to high glucose levels (Polak & Shapira, ).…”

“…Currently, there are no data supporting a causal relationship between the periodontal microbiome and the presence of diabetes. The majority of studies address type 2 diabetes (Polak & Shapira, ).…”

“…There is evidence from several controlled human studies, which shows that successful periodontal treatment reduces circulating levels of CRP and TNF‐α in people with diabetes (Polak & Shapira, ). There have been no studies addressing the impact of successful long‐term periodontal therapy upon the mechanisms involved in diabetes complications.…”

Impact of systemic diseases and tooth‐based factors on outcome of root canal treatment

“…). Marginal periodontitis is associated with systemic health disorders such as DM (Polak & Shapira ) and CVD (Lockhart et al . ).…”

Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: Case definitions and diagnostic considerations

“…The pathogenic mechanisms responsible for the effects of hyperglycemia on periodontitis have been extensively reviewed in the literature . It should be noted, however, that interpretation of these findings may be confounded by the effects of comorbidities often seen in individuals with metabolic syndrome, including obesity and hypertension.…”