Diabetes Mellitus & Dentistry

Pathogenesis

It is now quite clear that diabetes and periodontal disease provide an example of systemic disease predisposing to oral ‘infection’, and once oral ‘infection’ is established, this exacerbates systemic infection. More recent research has shown that:

  • Diabetics and non-diabetics have a similar oral flora.
  • Diabetics have an increased susceptibility to infection and delayed wound healing.
  • There is a common pathogenesis between diabetes and periodontal disease involving an enhanced inflammatory response at both local and systemic level. This is caused by the chronic effects of hyperglycaemia and formation of glycated proteins and lipids that promote the inflammatory response.
  • This interrelationship between diabetes and periodontal disease provides an example of systemic diseases predisposing to oral ‘infection’, and once that ‘infection’ is established there is an exacerbation of systemic disease.
  • Diabetics have significantly higher levels of local inflammatory mediators, especially cytokines, when compared with systemically healthy people with periodontal disease.
  • The severity and progression of periodontal disease and diabetes often does not correlate with the presentation in non-systemically challenged patients.
  • The severity of periodontal disease in diabetics may not correspond to levels of bacterial plaque observed clinically.
  • C reactive protein levels are raised in both diabetes and periodontal disease.

Various mechanisms for this altered immune response in the periodontal tissues of diabetics have been suggested, including:

  • Microvascular disease
  • Changes in crevicular fluid
  • Changes in collagen metabolism
  • Altered host response
  • Altered subgingival flora
  • Genetic predisposition
  • Non-enzymatic glycation

In summary, periodontal disease and diabetes mellitus affect each other. There is some early evidence to suggest that individuals with periodontal disease may be at higher risk of developing Type II diabetes, that is to say, there is a two-way street between these diseases. The one affects the other to the extent that, when periodontal disease is brought under control, the HbA1C level falls, and there can be a reduced requirement for insulin dosage. It also follows that diabetics who smoke have a significantly higher, ten times, risk of developing periodontal disease than non-smokers.

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