The Relationship Between Periodontal Diseases and Diabetes: An Overview

Abstract

Diabetes mellitus, caused by the malfunction of insulin-dependent glucose and lipid metabolism, presents with the classical triad of symptoms: polydypsia, polyuria, and polyphagia which are often accompanied by chronic fatigue and loss of weight. Complications of diabetes mellitus include retinopathy, nephropathy, neuropathy, and cardiovascular disease. Periodontal diseases are infections affecting the periodontium and resulting in the loss of tooth support. The association between diabetes mellitus and periodontitis has long been discussed with conflicting conclusions. Both of these diseases have a relatively high incidence in the general population (diabetes 1% to 6% and periodontitis 14%) as well as a number of common pathways in their pathogenesis (both diseases are polygenic disorders with some degree of immunoregulatory dysfunction). On the one hand, numerous reports indicate a higher incidence of periodontitis in diabetics compared to healthy controls, while other reports fail to show such a relationship. Clarification of this dilemma is occurring as the diagnostic criteria for periodontitis and diabetes mellitus improve, controlled studies with increased sample sizes are carried out, and the studies take into account major confounding variables that impact on the pathogenesis of both diseases. Current studies tend to support a higher incidence and severity of periodontitis in patients with diabetes mellitus. The overview looks at the bidirectional relationship between periodontitis and diabetes. An analysis of the National Health and Nutrition Examination Survey (NHANES) III data set confirms the previously reported significantly higher prevalence of periodontitis in diabetics than in non-diabetics (17.3% versus 9%). The analysis of the data also shows that the prevalence of diabetes in patients with periodontitis is double that seen in the non-periodontitis patients (12.5% versus 6.3%) and that this difference is also statistically significant. The pathogenesis of the 2 diseases is reviewed with an emphasis on common genetic and immune mechanisms. On the basis of the overview, 2 hypotheses for testing the relationship between periodontitis and diabetes are discussed. The first proposes a direct causal or modifying relationship in which the hyperglycemia and hyperlipidemia of diabetes result in metabolic alterations that may then exacerbate bacteria-induced inflammatory periodontitis. The second hypothesis proposes that a fortuitous combination of genes (gene sets) could result in a host who, under the influence of a variety of environmental stressors, could develop either periodontitis or diabetes or both.

Salivary and microbiological parameters of chronic periodontitis subjects with and without type 2 diabetes mellitus: a case-control study

“…Studies have supported a two-way relation between diabetes and periodontal status [6][7][8][9] . Key public strategies such as primary prevention and early diagnosis require deep knowledge related to risk factors and to the etiopathogenesis of the disease or diseases under analysis.…”

“…The association between periodontal diseases and diabetes has been studied over the last decades and, today, there is enough scientific evidence to support the existence of a twoway relationship between them [6][7][8][9] . Diabetes increases the risk of incidence and severity for periodontitis 10 .…”

High Glucose Enhances Interleukin-6-induced Vascular Endothelial Growth Factor 165 Expression via Activation of Gp130-mediated p44/42 MAPK-CCAAT/Enhancer Binding Protein Signaling in Gingival Fibroblasts

“…Several studies have reported that hyperglycemia and subsequent biochemical events were correlated with the development of their diseases, although the precise mechanism of them remains unclear (3,4). It has been generally accepted that bacterial infection-induced inflammatory periodontal disease, so-called periodontitis, is one of the diabetic complications (5). Poor metabolic control of diabetes mellitus has often been associated with the severity of periodontitis (6).…”

Enfermedades gingivales: una revisión de la literatura

“…Se trata de una endocrinopatía con una serie de complicaciones típicamente asociadas, entre las cuales cada vez más autores optan por incluir la alteración periodontal y hablan de la periodontitis como la sexta complicación típica de la diabetes mellitus, al observar la elevada proporción de veces en las que ambas patologías confluyen en el mismo paciente (19,20).…”