Diabetes mellitus promotes susceptibility to periodontitis—novel insight into the molecular mechanisms

Abstract

Diabetes mellitus is a main risk factor for periodontitis, but until now, the underlying molecular mechanisms remain unclear. Diabetes can increase the pathogenicity of the periodontal microbiota and the inflammatory/host immune response of the periodontium. Hyperglycemia induces reactive oxygen species (ROS) production and enhances oxidative stress (OS), exacerbating periodontal tissue destruction. Furthermore, the alveolar bone resorption damage and the epigenetic changes in periodontal tissue induced by diabetes may also contribute to periodontitis. We will review the latest clinical data on the evidence of diabetes promoting the susceptibility of periodontitis from epidemiological, molecular mechanistic, and potential therapeutic targets and discuss the possible molecular mechanistic targets, focusing in particular on novel data on inflammatory/host immune response and OS. Understanding the intertwined pathogenesis of diabetes mellitus and periodontitis can explain the cross-interference between endocrine metabolic and inflammatory diseases better, provide a theoretical basis for new systemic holistic treatment, and promote interprofessional collaboration between endocrine physicians and dentists.

Association between carotenoid intake and periodontitis in diabetic patients

“…For diabetic patients with ≤ 5 missing teeth, patients without cardiovascular disease, non-smoking patients, and patients receiving anti-diabetic drugs, α-carotene, lutein and zeaxanthin, or β-cryptoxanthin was also found to be related to periodontitis. Over 5 missing teeth, cardiovascular disease, smoking, and uncontrolled diabetes are greatly correlated with the higher incidence and progression of periodontitis ( 40 – 43 ) , which might overshadow or mask the relationship between carotenoid intake and periodontitis. Importantly, these groups of diabetic patients should pay more attention to their oral health, and higher intake of α-carotene, lutein and zeaxanthin, or β-cryptoxanthin may become a reference strategy in hindering the occurrence and development of periodontitis, which requires future studies to confirm.…”

Features of Changes in Indicators of Local Immunity of the Oral Cavity and Blood Serum of Patients Against the Background of Generalized Periodontitis and Type 2 Diabetes Mellitus

“…An increase in the level of immunoglobulins in patients with diabetes mellitus and periodontitis occurs, most likely, due to stimulation of local production of immunoglobulins during prolonged activity of bacterial antigens in chronic periodontal diseases. Kranthi J. et al reported that an increase in Ig M concentration with a combination of diabetes and GP is associated with an enhanced immune system response to diabetic status in periodontitis [14,15,16]. The increased incidence of periodontitis in diabetic patients suggests that altered immune responses may contribute to the development of periodontitis in diabetic patients [17].…”

Periodontitis: An often-neglected complication of diabetes

“…Since 1993, severe periodontal disease has been considered the 6 th major complication of DM after CVD, eye disease, neuropathy, nephropathy, and peripheral vascular disease[ 13 ]. Being a state of immunocompromise, DM can worsen the virulence and invasiveness of pathogenic oral microbial flora aggravating the local inflammation and infection in those with periodontal disease[ 1 , 14 ]. Moreover, hyperglycemia-induced oxidative stress and the generation of reactive oxygen species in the periodontal tissues can aggravate local tissue damage and worsen periodontitis[ 14 ].…”

“…Being a state of immunocompromise, DM can worsen the virulence and invasiveness of pathogenic oral microbial flora aggravating the local inflammation and infection in those with periodontal disease[ 1 , 14 ]. Moreover, hyperglycemia-induced oxidative stress and the generation of reactive oxygen species in the periodontal tissues can aggravate local tissue damage and worsen periodontitis[ 14 ]. On the other hand, the chemical and immunological mediators released into the circulation as part of periodontal inflammation worsen systemic insulin resistance (IR) with worsening of DM.…”