Periodontitis and diabetes: a two-way relationship (original) (raw)
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Interrelationships of periodontitis and diabetes: A review of the current literature
Journal of Dental Sciences, 2012
Diabetes and periodontitis are common chronic diseases in the world, and abundant epidemiological evidence implies a bidirectional relationship between the two diseases. It appears that diabetes is a risk factor for greater periodontal destruction, whereas managing periodontitis can also contribute to better glycemic control. The underlying regulatory mechanisms are also bidirectional. The hyperglycemic status may directly alter subgingival microbial compositions, impair cellular function, and change collagen metabolism. The formation of advanced glycation end-products (AGEs) can further modify the extracellular matrix, and establishment of cellular receptor binding can amplify inflammation. Moreover, periodontitis also induces hyperlipidemia and insulin resistance. This cyclical relationship converges via overproduction of proinflammatory cytokines, such as tumor necrosis factor-a and interleukin-1b. Thus, this article highlights the importance of maintaining periodontal health to eliminate systemic complications and meticulous metabolic control to prevent further periodontal destruction. From a systemic aspect, targeting proinflammatory cytokines or receptors of AGEs could be a potential modality for treating periodontitis.
Impact of periodontitis on the diabetes-related inflammatory status
Journal (Canadian Dental Association), 2010
Wide-ranging activation of the innate immune system causing chronic low-grade inflammation is closely involved not only in the pathogenesis of type 2 diabetes mellitus and its complications, through an ongoing cytokine-induced acute-phase response, but also in the pathogenesis of periodontal diseases, whereby cytokines play a central role in the host's response to the periodontal biofilm. Although there is extensive knowledge about the pathways through which diabetes affects periodontal status, less is known about the impact of periodontal diseases on the diabetes-related inflammatory state. This review attempts to explain the immunobiological connection between periodontal diseases and type 2 diabetes mellitus, exploring the mechanisms through which periodontal infection can contribute to the low-grade general inflammation associated with diabetes (thus aggravating insulin resistance) and discussing the impact of periodontal treatment on glycemic control in people living with b...
Periodontitis and Diabetes Interrelationships: Role of Inflammation
Annals of Periodontology, 2001
Diabetes mellitus is a systemic disease with several major complications affecting both the quality and length of life. One of these complications is periodontal disease (periodontitis). Periodontitis is much more than a localized oral infection. Recent data indicate that periodontitis may cause changes in systemic physiology. The interrelationships between periodontitis and diabetes provide an example of systemic disease predisposing to oral infection, and once that infection is established, the oral infection exacerbates systemic disease. In this case, it may also be possible for the oral infection to predispose to systemic disease. In order to understand the cellular/molecular mechanisms responsible for such a cyclical association, one must identify common physiological changes associated with diabetes and periodontitis that produce a synergy when the conditions coexist. A potential mechanistic link involves the broad axis of inflammation, specifi‐cally immune cell phenotype, ser...
Periodontitis in Patients with Diabetes A Complication that Impacts on Metabolic Control
US Endocrinology, 2012
Diabetes and periodontal diseases (PDs) exhibit a bidirectional relationship centered on an enhanced inflammatory response that manifests both locally and systemically. Diabetes is an established risk factor for PD, whereas the treatment of the latter has been shown to improve glycemic control in diabetic patients. Although compelling evidence fromin vitroand animal studies supports a plausible biological explanation for the relationship between the two conditions centered on systemic low-grade inflammation, the limited number of comparable large randomized clinical trials is reflected in the limited specific guidelines offered by the international organizations for diabetes and periodontitis regarding the management of the two diseases in an individual. Further understanding of the biological phenomena underlying PDs and diabetes is critical for individual therapeutic approaches to patients with both conditions by endocrinologists and periodontists.
Interplay between Periodontal Disease and diabetes mellitus
Indian Journal of Medical Specialities, 2021
Progress in the management of diabetes mellitus is turning attention toward comorbidities and conditions such as periodontal diseases. This article aims to present the evidence linking diabetes and periodontal disease. The potential effects of modifying factors of inflammatory origin on diabetic control are also discussed. Increased prevalence, extent, and severity of gingivitis and periodontitis are correlated with diabetes. Moreover, many plausible mechanisms have been exemplified to explain the effect of diabetes on the periodontium. While inflammation plays an important role in periodontal diseases, evidence in the medical literature also supports the role of inflammation as an important component in the pathogenesis of diabetes and its complications. Research suggests that periodontal disease has a large amount of inflammatory components that can negatively affect the metabolic control of diabetes. Conversely, treatment of periodontal disease and decrease in oral inflammation have a positive effect on the diabetic control. Diabetic patients who have periodontal disease have two chronic conditions ‑ diabetes and periodontal disease, each of which can impact the other and require regular professional evaluations, patient education, and consistent educational reinforcement by healthcare providers both medical and dental
An update on the evidence for pathogenic mechanisms that may link periodontitis and diabetes
Journal of Clinical Periodontology, 2017
Aim: To provide an update of the review by Taylor et al (2013) regarding the scientific evidence of the biological association between periodontitis and diabetes. Methods: Literature searches were performed using MeSH terms, keywords, and title words and were published between 2012 to November 2016. All publications were screened for their relevance. The data from the articles were extracted and summarized in tables and a narrative review. Results: Small-scale molecular periodontal microbiome studies indicate a possible association between altered glucose metabolism in pre-diabetes and diabetes and changes in the periodontal microbiome, with no evidence for casual relationships. Clinical and animal studies found elevated gingival levels of IL1-β, TNF-α, IL-6, RANKL/OPG and oxygen metabolites in poorly controlled diabetes. In addition, individuals with diabetes and periodontitis exhibit high levels of circulating TNF-α, CRP and mediators of oxidative stress, and successful periodontal treatment reduces their levels. Conclusions: the elevated pro-inflammatory factors in the gingiva of patients with poorly controlled diabetes, suggest a biological pathway that may aggravate periodontitis. Some evidence suggests that the systemic inflammatory burden in periodontitis has the potential to affect diabetes control, but no studies addressed the impact of successful periodontal therapy on the pathophysiological mechanisms involved in systemic complications of diabetes. Clinical relevance Scientific rational for the study: Our aim was to look for the current evidence of biological mechanism that may link periodontitis to diabetes and vice-versa, by updating the review of Taylor et al, (2013).
The relationship of diabetes, periodontitis and cardiovascular disease
Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2019
Cardiovascular complications in diabetic patients comprise of interaction between traditional and nontraditional risk factors. This interaction is thought to play role in four-times increment of cardiovascular mortality risk in diabetic patients, compared to non-diabetics. Chronic inflammation is known to be one of atherosclerosis non-traditional risk factor and has a role on every phase of atherogenesis. Periodontitis is the most common cause of chronic inflammation in diabetic patient. Both periodontitis and diabetes have detrimental effect on each other in terms of alveolar bone destruction and poor metabolic control, by continuous inflammatory mediator activation. Defect of bacteria elimination ability and monocyte hyper-responsiveness in diabetic patients leads to persistent elevation of systemic inflammatory mediators. This process give rise to prolonged and augmented exposure to inflammatory cytokines. This exposure interacts with traditional risk factor could lead to initiation of endothelial dysfunction, the first phase of atherogenesis.
BMC oral health, 2015
Pathological changes in periodontal tissues are mediated by the interaction between microorganisms and the host immune-inflammatory response. Hyperglycemia may interfere with this process. The aim of this study was to compare the levels of 27 inflammatory molecules in the gingival crevicular fluid (GCF) of patients with type 2 diabetes, with and without chronic periodontitis, and of chronic periodontitis subjects without diabetes. A putative correlation between glycated haemoglobin (HbA1c) and levels of the inflammatory molecules was also investigated. The study population comprised a total of 108 individuals, stratified into: 54 with type 2 diabetes and chronic periodontitis (DM + CP), 30 with chronic periodontitis (CP) and 24 with type 2 diabetes (DM). Participants were interviewed with the aid of structured questionnaire. Periodontal parameters (dental plaque, bleeding on probing and periodontal pocket depth) were recorded. The GCF levels of the 27 inflammatory molecules were mea...
Diabetes and Periodontitis: A Two Way Relationship
Research Reviews Journal of Dental Sciences, 2014
Periodontitis is a destructive inflammatory disease of the supporting tissues of the teeth and is caused by specific microorganisms or group of specific microorganisms resulting in progressive destruction of periodontal ligament and alveolar bone with periodontal pocket formation, gingival recession or both. The link between periodontal disease and systemic diseases has been progressively recognized over the past two decades. Currently there is a large amount of data in epidemiological, clinical and laboratory studies that strongly correlate the role of periodontal pathogens on systemic organs by producing pro-inflammatory cytokines, chemokines and inflammatory mediators. Although the relationship between periodontal disease, inflammation and overall health has been suspected, numerous studies are providing more comprehensive evidence for this link. In this context, diabetes predisposes oral tissues to greater periodontal destruction but several studies have now identified that periodontal disease leads to poor glycemic control. It was hence predicted that there exists a two-way relationship between periodontal disease and diabetes mellitus. The regular use of Dental Air Force home dental cleaning system as an oral hygiene device is optimal for suppressing both periodontal infection and associated systemic diseases (Diabetes) as compared to conventional tooth brushing. Periodontitis: A Microbial Infection The oral cavity has the potential to harbor at least 600 different bacterial species, and in any given patient, more than 150 species may be present, surfaces of tooth can have as many as a billion bacteria in its attached bacterial plaque and good oral hygiene is the fundamental for oral integrity as it greatly affects the quality of life. [1] Periodontitis is a destructive inflammatory disease of the supporting tissues of the teeth and is caused by specific microorganisms or group of specific microorganisms resulting in progressive destruction of periodontal ligament and alveolar bone with periodontal pocket formation, gingival recession or both. Periodontal diseases are recognized as infectious processes that require bacterial presence and a host response and are further affected and modified by other local, environmental and genetic factors. [2] The host responds to the periodontal infections with an array of events involving both innate and adaptive immunity. [3] Dental plaque in oral cavity is now considered as biofilm, Dental biofilm forms via an ordered sequence of events, resulting in structured and functionally organized species of a rich microbial community and modern molecular biological techniques have identified about 1000 different bacterial species in the dental biofilm, twice as many as can be cultured. Bacteria in a biofilm have a physiology different from that of planktonic cells and live under nutrient limitation and often in a dormant state, thus a biofilm is organized to maximize energy, spatial arrangements and movement of nutrients and byproducts with advantages which includes a broader habitat range for growth, an enhanced resistance to antimicrobial agents and host defense and an enhanced ability to cause disease. [4] Periodontitis and Systemic Health: A Complex Linkage Association of periodontal infection with organ systems such as cardiovascular system, endocrine system, reproductive system, and respiratory system makes periodontal infection a complex multiphase disease. Inflamed periodontal tissues produce significant amounts of pro-inflammatory cytokines, mainly interleukin1 beta (IL-1β), IL-e
Journal of Clinical Periodontology, 2013
Background: Diabetes and periodontitis are complex chronic diseases with an established bidirectional relationship. There is long-established evidence that hyperglycaemia in diabetes is associated with adverse periodontal outcomes. However, given the ubiquity of periodontal diseases and the emerging global diabetes epidemic, the complications of which contribute to significant morbidity and premature mortality, it is timely to review the role of periodontitis in diabetes. Aims: To report the epidemiological evidence from cross-sectional, prospective and intervention studies for the impact of periodontal disease on diabetes incidence, control and complications and to identify potential underpinning mechanisms. Epidemiology: Over the last 20 years, consistent and robust evidence has emerged that severe periodontitis adversely affects glycaemic control in diabetes and glycaemia in non-diabetes subjects. In diabetes patients, there is a direct and dose-dependent relationship between periodontitis severity and diabetes complications. Emerging evidence supports an increased risk for diabetes onset in patients with severe periodontitis. Biological mechanisms: Type 2 diabetes is preceded by systemic inflammation, leading to reduced pancreatic b-cell function, apoptosis and insulin resistance. Increasing evidence supports elevated systemic inflammation (acute-phase and oxidative stress biomarkers) resulting from the entry of periodontal organisms and their virulence factors into the circulation, providing biological plausibility for the effects of periodontitis on diabetes. AGE (Advanced Glycation Endproducts)-RAGE (Receptor for AGEs) interactions and oxidative-stress-mediated pathways provide plausible mechanistic links in the diabetes to periodontitis direction. Interventions: Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal therapy associates with approximately a 0.4% reduction in HbA1C at 3 months, a clinical impact equivalent to adding a second drug to a pharmacological regime for diabetes. RCTs are needed with larger numbers of subjects and longer term follow-up, and if results are substantiated, adjunctive periodontal therapies subsequently need to be evaluated. There is no current evidence to support adjunctive use of antimicrobials for periodontal management of diabetes patients. Guidelines: Given the current evidence, it is timely to provide guidelines for periodontal care in diabetes patients for medical and dental professionals and recommendations for patients/the public.