Diabetes mellitus and periodontal disease: some perspectives in care. A Review
DOI:
https://doi.org/10.62486/agodonto2025206Keywords:
Diabetes, periodontitis, risk assessment, interprofessional collaborationAbstract
While the incidence of diabetes mellitus varies between populations and countries type 2 is becoming an increasing burden for health care professionals.
First recorded in 1928, people living with diabetes mellitus (DM) are at a 3-4 times higher risk of developing periodontal disease (PD) than non-diabetics; for those who smoke this risk is up to 10 times. However, many doctors are not aware of this.
DM and PD are bidirectionally linked, the one affecting the other and vice versa, although the mechanism is not fully understood and may be linked to chronic infection. PD has an adverse effect on glycaemic control. That improves when periodontitis is successfully controlled.
Doctors should consider PD when their patients have persistently high glycated haemoglobin (HbA1c) levels, and dentists should consider diabetes or pre-diabetes when they have patients with unstable or progessive periodontitis.
Wherever possible, for optimum health outcomes doctors and dentists and their teams need to share results and work together. A traffic light system of red, amber and green for both medical and dental risks is proposed, and a pro forma designed, so that diabetics themselves can share their own results with their professional advisors.
Dentists need to find ways to teach their medical colleagues about the basics of PD, update their medical records, and understand more about medical risks. More research is required .
References
Williams J.
Diabetic periodontoclasia.
J Amer Dent Assoc 15: 523-529, 1928.
Stöhr J.
Biderectional association between periodontal disease and diabetes mellitus: a systematic review with meta-analysis of cohort studies.
Sci Rep 11: 136, 2021.
Doi:10.1038/s41598-021-93062-6
Tsaic C, Hayes C, Taylor GW.
Glycaemic control of type II diabetes and severe periodontal disease in the US adult population.
Community Dent Oral Epidemiol 30: 182-92, 2002.
Genko RJ, Borgnakke WS.
Risk factors for periodontal disease.
Periodontal 2000 62:59-94, 2013.
Doi:10.1111/j.1600-0757.2012.00457.x
Battancs E, Gheorghita D, Nyiraty S et al.
Periodontal disease in diabetes mellitus: A case- controlled study in smokers and non-smokers.
Diabetes Ther Nov 11(11): 2715-2728, 2020.
doi 10.1007/S13300-020-0093-8 EPub 2020 Sep 25
Southerland JH.
Diabetes and periodontal infection – making the connection.
Clinical diabetes 23: 171-178, 2009.
Doi:10.2337/diaclin.23.4.171
Liu R, Bal HS, Desta T et al.
Tumor necrosis factor-alpha mediates diabetes-enhanced apoptosis of matrix-producing cells and impairs diabetic healing.
Am J Pathol 168: 757-764, 2006.
Johnson DR, O’Connor JC, Satpathy A, Freund GG.
Cytokines in type II diabetes.
Vitam Horm 74: 405-441, 2006
Lappin DF, Robertson D, Hodge P et al
The influence of glycated haemoglobin on the cross-susceptibility between type I diabetes and periodontal disease.
J Periodont 86: 1249-1259, 2015.
Wu YY, Xioa E, Graves T.
Diabetes mellitus related bone metabolism and periodontal disease.
Int J Oral Sci 7: 63-72, 2015.
Löe H, Thielade E, Jensen SB
Experimental gingivitis in man.
Periodontol 36: 167, 1965.
Khumaedi AI, Purnamasari D, Wijaya P, Soeroso Y.
The relationship between diabetes, periodontal and cardiovascular disease.
Diabetes Metab Syndr 13: 1675, 2019.
Cekici A, Kantaria A, Hasturk H, Van Dyke E.
Inflammatory and immune pathways in the pathogenesis of periodontal disease.
Periodontology 2000 64: 57, 2014.
Genco RJ, Graziani F, Hasturk H.
Effects of periodontal disease on glycaemic control, complications and incidence of diabetes mellitus
Periodont 2000 83: 59-65, 2020.
Kumar A, Sharma Ds, Verma M et al.
Association between periodontal disease and gestational diabetes mellitus: a prospective cohort study.
J Clin Periodont 45: 920, 2018.
Taylor GW.
Bidirectional inter-relationship between diabetes and periodontal disease: an epidemiological perspective.
Ann Periodontol 1: 99, 2001.
Costa KI, Taboza ZA, Angelino GB, Siveira VR et al
Influence of periodontal disease on changes of glycated haemoglobin levels in patients with type 2 diabetetes mellitus: a retrospective cohort study
J Periodontol 88: 17 2017.
Wang TF, Jen IA, Chou C, Lei P.
Effects of periodontal therapy on the metabolic control of patients with type 2 diabetes and periodontal disease: a meta-analysis.
Medicine (Baltimore) 28: 292, 2014.
Gianos E, Jackson EA, Tejpal A et al.
Oral health and atherosclerotic cardiovascular disease: A review.
Am J Prev Cardiol 7: 100179, 2021.
Mahajan S, Bhaskar N, Kaur RK, Jain A.
A comparison of oral health status in diabetic and non-diabetic patients receiving haemodialysis – a systematic review and meta-analysis.
Diabetes Metab Syndr 15: 102256, 2021.
Doi:10.1016/j.dsx.2021.102256
Preshaw PM, Alba AL, Herrera D et al.
Periodontitis and diabetes: a two-way relationship.
Diabetologia 2012 Jan 55 (1) 21-31
Yoshioka M, Okamoto Y, Murata M et al.
Association between oral health status and diabetic neuropathy-related indices in Japanese middle-aged men.
J Diabetes Res June 7, 2020. Online p.4042129. doi:10.1155/2020/4042129
Bornakke WS, Anderson PF, Shannon C, Jivanescu A.
Is there a relationship between oral health and diabetic neuropathy?
Curr Diab Rep 11: 93,2015.
Moore PA,Weyant RJ, Mongelluzzo MB et al.
Type 1 diabetes, xerostomia and salivary flow rates.
Oral Surg Oral Med Oral Path Oral Radiol Endodod 92: 281, 2001.
Doi:10.1067/moe.2001.117815
Tandon A, Kamath YS, Gopalkrishna P et al.
The association between diabetic retinopathy and periodontal disease.
Saudi J Ophthalmol 34: 167-170, 2021.
Nguyen ATM, Akhtar R, Garde S et al
The association of periodontal disease with the complications of diabetes mellitus.
Diabetes Res Clin Prac 2020, Jul 165, 108244.
Yamamoto Y, Morozumi T, Hirata T et al
Effect of periodontal disease on diabetic retinopathy in type 2 diabetic patients. A cross-sectional pilot study.
J Clin Med 9: 3234, 2020.
Alvarenga MOP, Miranda GHN, Ferreira RO et al.
Association between diabetic retinopathy and periodontitis – A systematic review.
Front Public Health 8: 550614, 2020.
Löe H.
Periodontal disease. The sixth complication of diabetes mellitus.
Diabetes Care 16: 329-334, 1999
Tse SY.
Diabetes mellitus and periodontal disease awareness and practice among doctors working in public general outpatient’s clinics in Kowloon West Cluster.
BMC Fam Prac 19:199, 2018.
NICE.org.uk/guidance/NG17/chapter/recommendations NICE (2015). Recommendations | Type 1 diabetes in adults: diagnosis and management | Guidance | NICE. [online] www.nice.org.uk. Available at: https://www.nice.org.uk/guidance/ng17/chapter/Recommendations
NICE.org.uk/guidance/NG28/chapter/recommendations NICE (2015). Recommendations | Type 2 Diabetes in adults: Management | Guidance | NICE. [online] www.nice.org.uk. Available at: https://www.nice.org.uk/guidance/ng28/chapter/Recommendations
Siddiqi J, Zafar S, Sharma A, Quaranta A.
Diabetes mellitus and periodontal disease. The call for inter-professional education and inter-professional collaborative care. A systematic review of the literature
J Interprof Care 36: 93-101, 2022
Turner CH.
Diabetes mellitus and dental health: a review
Geriatric Med J, 16 November 2021.
https://www.gmjournal.co.uk/diabetes-and-dental-health-a review.
Turner CH
Diabetes mellitus and periodontal disease; the profession’s choices.
Brit Dent J 223: 537-538, 2022.
Doi 10.1038/s41415-022-5029-5
Turner CH.
Diabetes mellitus and periodontitis: A new method for risk assessment.
Wor Jour of Dia Res and Pract 1: 1-3, 2024.
Goode SJ, Turner CH
Diabetes mellitus and periodontal disease: A pilot investigation into patient awareness of glycated haemoglobin levels and periodontal screening scores and their associated risk factors in general dental practice.
Int J Diabetol Vas Dis Res 11: 287-290, 2024.
Strain WD, Down S, Brown P, Puttana A et al
Diabetes and Frailty: An expert concensus Statement on the Management of Older Adults with Type 2 Diabetes
Diabetes Ther 12: 1227-1247, 2021.
Barmes D.
CPITN – a WHO initiative.
Int Dent J 44: 523-525, 1994.
Turner CH, Bouloux P-M
Diabetes mellitus and periodontal disease: education, collaboration and information sharing between doctors, dentists and patients.
Brit Diabetes J: 23: 35-38, 2023.
doi.org/10.15277/bjd.2023.
Turner CH.
Periodontal disease and diabetes melllitus: An update and case report.
J Med Case Rep Case Series doi.org/10.38207/MCRCS/2023/NOV041901141.
Turner CH.
Implant maintenance.
The Dentist pp62, 2011.
Simpson TC, Clarkson JE, Worthington HV et al
Treatment of periodontitis for glycaemic control in people with diabetes mellitus.
The Cochrane database of systematic reviews 2022 Apr14 CD004714.
Turner CH.
An updated medical history form for people living with diabetes mellitus.
Brit Dent J 237: 280-281, 2024.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Christopher Turner (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
The article is distributed under the Creative Commons Attribution 4.0 License. Unless otherwise stated, associated published material is distributed under the same licence.