Novel Insight into the Mechanisms of the Bidirectional Relationship between Diabetes and Periodontitis

Abstract

Periodontitis and diabetes are two major global health problems despite their prevalence being significantly underreported and underestimated. Both epidemiological and intervention studies show a bidirectional relationship between periodontitis and diabetes. The hypothesis of a potential causal link between the two diseases is corroborated by recent studies in experimental animals that identified mechanisms whereby periodontitis and diabetes can adversely affect each other. Herein, we will review clinical data on the existence of a two-way relationship between periodontitis and diabetes and discuss possible mechanistic interactions in both directions, focusing in particular on new data highlighting the importance of the host response. Moreover, we will address the hypothesis that trained immunity may represent the unifying mechanism explaining the intertwined association between diabetes and periodontitis. Achieving a better mechanistic insight on clustering of infectious, inflammatory, and metabolic diseases may provide new therapeutic options to reduce the risk of diabetes and diabetes-associated comorbidities.

Primary dental care treatment in primary Sjögren's syndrome: a possible role in improving salivary flow rate

“…Furthermore, age (41) and the socioeconomic factor may also influence some periodontal parameters (42). In the same way, current smoking (33) and diabetes (34) (9,24,43). We also calculated the DMFT index, which was higher in pSS patients than in control participants, as also reported in a previous study that evaluated Danish pSS patients (24).…”

“…At both time points of the study (D0 and D90), the investigators recorded all treatments in current use through face-to-face interviews with patients. A questionnaire on comorbidities, hypertension, dyslipidemia, diabetes and smoking was also applied to pSS patients and controls, since the last two conditions can influence oral health (33,34).…”

Periodontitis and Its Inflammatory Changes Linked to Various Systemic Diseases: A Review of Its Underlying Mechanisms

“…P. gingivalis had its effect on intestinal microbiota and adipose tissue inflammation, and played a role in the regulation of downstream genes (such as mTOR, S6K-1) in the branched-chain amino acids (BCAAs)-induced insulin resistance signal pathway [ 40 ]. A recent study showed that periodontitis is exacerbated by diabetes in three ways: (i) IL-17 increases periodontal dysbiosis and bacterial pathogenicity, (ii) the host’s response to the bacterial challenge is improved, and (iii) periodontal damage is increased [ 41 ]. Diabetes inhibits new bone formation by increasing the death of bone-forming cells and reducing the proliferation and differentiation of periodontal ligament stem cells (PLSCs) in osteoblasts [ 41 ].…”

“…A recent study showed that periodontitis is exacerbated by diabetes in three ways: (i) IL-17 increases periodontal dysbiosis and bacterial pathogenicity, (ii) the host’s response to the bacterial challenge is improved, and (iii) periodontal damage is increased [ 41 ]. Diabetes inhibits new bone formation by increasing the death of bone-forming cells and reducing the proliferation and differentiation of periodontal ligament stem cells (PLSCs) in osteoblasts [ 41 ].…”

Síndrome de Sjögren primária: impacto do tratamento odontológico de atenção primária e estudo dos anticorpos anti-DNase I

“…Da mesma forma, o tabagismo atual (Kassirer, 1994;Jiang et al, 2019;Watt et al, 2019;Kapila, 2021) e o diabetes (Coelho et al, 2020;Luong et al, 2021;Barutta et al, 2022) podem influenciar o estado de saúde dental e gengival.…”