Periodontal Disease and Diabetes Mellitus
PERIODONTAL DISEASE AND
DIABETES MELLITUS
The relationship between diabetes mellitus and periodontal disease has been extensively examined. It is clear from epidemiologic research that diabetes increases
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the risk for and severity of periodontal diseases.59 The biologic mechanisms through which diabetes influences the periodontium are discussed in Chapter 12. The increased prevalence and severity of periodontitis commonly seen in patients with diabetes, especially those with poor metabolic control, led to the designation of periodontal disease as the "sixth complication of diabetes.""
In addition to the five "classic" complications of diabetes (Box 13-2), the American Diabetes Association has officially recognized that periodontal disease is common in patients with diabetes, and its Standards of
Care include taking a history of current or past dental infections as part of the physician's examination .2,3
Although many studies have examined the effects of diabetes on the periodontium, fewer have endeavored to examine the effect of periodontal infection on control of diabetes. The following questions remain:
• Does the presence or severity of periodontal disease affect the metabolic state in diabetic patients?
• Does periodontal treatment aimed at reducing the bacterial challenge and minimizing inflammation have a measurable effect on glycemic (blood glucose) control? In a longitudinal study of patients with type 2 (noninsulin- dependent) diabetes, severe periodontitis was associated with significant worsening of glycemic control over time.71 Individuals with severe periodontitis at the baseline examination had a greater incidence of worsening glycemic control over a 2- to 4-year period than did those without periodontitis at baseline. In this study, periodontitis is known to have preceded the worsening of glycemic control. Periodontitis has also been associated with the classic complications
DIABETES MELLITUS
The relationship between diabetes mellitus and periodontal disease has been extensively examined. It is clear from epidemiologic research that diabetes increases
Periodontal Medicine • CHAPTER 13
237
the risk for and severity of periodontal diseases.59 The biologic mechanisms through which diabetes influences the periodontium are discussed in Chapter 12. The increased prevalence and severity of periodontitis commonly seen in patients with diabetes, especially those with poor metabolic control, led to the designation of periodontal disease as the "sixth complication of diabetes.""
In addition to the five "classic" complications of diabetes (Box 13-2), the American Diabetes Association has officially recognized that periodontal disease is common in patients with diabetes, and its Standards of
Care include taking a history of current or past dental infections as part of the physician's examination .2,3
Although many studies have examined the effects of diabetes on the periodontium, fewer have endeavored to examine the effect of periodontal infection on control of diabetes. The following questions remain:
• Does the presence or severity of periodontal disease affect the metabolic state in diabetic patients?
• Does periodontal treatment aimed at reducing the bacterial challenge and minimizing inflammation have a measurable effect on glycemic (blood glucose) control? In a longitudinal study of patients with type 2 (noninsulin- dependent) diabetes, severe periodontitis was associated with significant worsening of glycemic control over time.71 Individuals with severe periodontitis at the baseline examination had a greater incidence of worsening glycemic control over a 2- to 4-year period than did those without periodontitis at baseline. In this study, periodontitis is known to have preceded the worsening of glycemic control. Periodontitis has also been associated with the classic complications