Diabetes and periodontal disease are two chronic, inflammatory conditions that share a complex and bidirectional relationship. Both diseases are highly prevalent and have significant impacts on public health. In this article, we will explore the common ground between diabetes and periodontal disease, their interactions, and the clinical implications for dental professionals.
What Does Diabetes And Periodontal Disease Have in Common
Diabetes: A Major Risk Factor for Periodontal Disease
Epidemiological studies have consistently shown that diabetes, particularly if glycemic control is poor, is a major risk factor for periodontal disease. The risk of periodontitis is increased by approximately 2-3 fold in individuals with diabetes compared to those without.
The magnitude of the increased risk is dependent on the level of glycemic control. In well-controlled diabetes with HbA1c around 7% (53 mmol/mol) or lower, the effect of diabetes on periodontal disease risk is minimal. However, the risk increases exponentially as glycemic control deteriorates.
Diabetes increases the prevalence, extent, and severity of periodontal disease. Patients with diabetes may present with multiple recurring periodontal abscesses, although this is not a typical clinical feature.
The clinical presentation of periodontal disease in individuals with diabetes is generally similar to those without the condition.
The mechanisms linking diabetes and periodontal disease involve aspects of inflammation, immune functioning, neutrophil activity, and cytokine biology. Diabetes leads to increased inflammation in periodontal tissues, with higher levels of inflammatory mediators such as interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α).
SEE ALSO: What Is The Link Between Obesity And Periodontal Disease
Periodontal Disease and Glycemic Control
There is emerging evidence to support a two-way relationship between diabetes and periodontal disease. Not only does diabetes increase the risk for periodontal disease, but periodontal inflammation can also negatively affect glycemic control.
A prospective study of 2,973 non-diabetic individuals found that those with the most advanced periodontitis at baseline demonstrated an approximately fivefold greater absolute increase in HbA1c over 5 years compared to those with no periodontitis at baseline.
Periodontal treatment, such as conventional non-surgical periodontal therapy, has been associated with improvements in glycemic control in diabetic patients. Studies have reported reductions in HbA1c of approximately 0.4% following periodontal therapy.
The impact of periodontal disease on diabetes complications has also been investigated. Incidences of macroalbuminuria and end-stage renal disease are increased two-fold and three-fold, respectively, in diabetic individuals with severe periodontitis compared to those without severe periodontitis. Furthermore, the risk of cardiorenal mortality (ischemic heart disease and diabetic nephropathy combined) is three times higher in diabetic people with severe periodontitis than in those without severe periodontitis.
Clinical Implications for Dental Professionals
Given the bidirectional relationship between diabetes and periodontal disease, dental professionals have an important role to play in the management of these conditions. It is crucial for dental teams to be aware of the increased risk of periodontal disease in patients with diabetes and to assess and manage periodontal status accordingly.
Dental professionals should routinely inquire about a patient’s diabetes status and glycemic control. Patients should be asked about their most recent HbA1c values, which provide an indication of average blood glucose levels over the past 2-3 months. HbA1c values below 7% (53 mmol/mol) are generally considered well-controlled, while values above 9% (75 mmol/mol) indicate poor glycemic control.
When assessing periodontal status, dental professionals should pay particular attention to patients with diabetes.
Comprehensive periodontal examinations, including probing depths, bleeding on probing, and radiographic assessment of bone levels, should be performed. Patients with diabetes should be monitored more frequently for signs of periodontal disease progression.
In terms of periodontal treatment, patients with diabetes should be managed according to standard protocols, with an emphasis on achieving and maintaining optimal plaque control through oral hygiene instruction and professional cleaning.
Non-surgical periodontal therapy, such as scaling and root planing, should be performed as indicated.
Patients with diabetes and periodontal disease should be closely monitored, and treatment plans should be adjusted based on individual needs and responses to therapy. In some cases, referral to a periodontist may be warranted for more advanced or complex cases.
Diabetes Screening in Dental Settings
An emerging role for dental professionals is the use of diabetes screening tools to identify patients at high risk of undiagnosed diabetes or prediabetes. This could enable patients to seek further investigation and assessment from medical healthcare providers.
Several screening tools have been developed and validated for use in dental settings, such as the ADA Diabetes Risk Test and the CDC Prediabetes Screening Test. These tools assess risk factors like age, body mass index, family history, and history of gestational diabetes.
By incorporating diabetes screening into routine dental visits, dental professionals can play a proactive role in identifying individuals with undiagnosed diabetes or prediabetes. Early detection and intervention can lead to better management of both diabetes and periodontal disease, ultimately improving patient outcomes.
Conclusion
Diabetes and periodontal disease are two chronic, inflammatory conditions that share a complex and bidirectional relationship. Diabetes is a major risk factor for periodontal disease, with the risk increasing as glycemic control deteriorates.
Conversely, periodontal inflammation can negatively impact glycemic control and increase the risk of diabetes complications. Dental professionals have an important role in the management of patients with diabetes and periodontal disease. By routinely assessing and managing periodontal status, providing appropriate periodontal treatment, and potentially screening for diabetes, dental teams can contribute to the overall health and well-being of their patients.