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Periodontal disease and diabetes mellitus

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Abstract

Infections of the tissue surrounding the teeth (periodontitis) are usually caused by anaerobic gram-negative microorganisms. This infection causes destruction of the supporting alveolar bone and can lead to tooth loss. Removal of these microorganisms can slow or arrest the progression of periodontitis. Diabetes patients are at greater risk of developing periodontitis, may not respond as well to periodontal therapy as nondiabetic patients, and may require more aggressive treatment to manage periodontitis. Microorganisms that cause periodontitis and the host response to these may increase insulin resistance in diabetic patients. Treatment of periodontitis could improve glycemic control. A model is presented in which periodontal pathogens may cause increases in proinflammatory cytokines that mediate increases in insulin resistance, resulting in an increase in blood glucose. Following periodontal therapy, this process may be reversed.

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References and Recommended Reading

  1. Loe H: Periodontaldisease: the sixth complication of diabetes mellitus. Diabetes Care 1993, 16(suppl 1):329–334.

    PubMed  CAS  Google Scholar 

  2. American Diabetes Association Clinical Practice Recommendations 2001 [no authors listed]. Diabetes Care 2001, 24(suppl 1):S1–S133.

  3. Armitage GC: Development of a classification system for periodontal diseases and conditions. Ann Periodontol 1999, 4:1–6.

    Article  PubMed  CAS  Google Scholar 

  4. Albandar JM, Kingman A: Gingival recession, gingival bleeding and dental calculus in adults 30 years of age and older in the United States, 1988–1994. J Periodontol 1999, 70:30–43.

    Article  PubMed  CAS  Google Scholar 

  5. Albander JM, Brunelle JA, Kingman A: Destructive periodontal disease in adults 30 years of age and older in the United States, 1988–1994. J Periodontol 1999, 70:13–29.

    Article  Google Scholar 

  6. Brown LJ, Loe H: Prevalence extent severity and progression of periodontal disease. Periodontol 2000 1993, 2:57–71.

    Article  PubMed  CAS  Google Scholar 

  7. Zambon JJ: Periodontal diseases: microbial factors. Ann Periodontol 1996, 1:879–925.

    PubMed  CAS  Google Scholar 

  8. Haffajee AD, Socransky SS: Microbial etiologic agents of destructive periodontal diseases. Periodontol 2000 1994, 5:78–111.

    Article  PubMed  CAS  Google Scholar 

  9. Socransky SS, Haffajee AD, Cugini MA: Microbial complexes in subgingival plaque. J Clin Periodontol 1998, 25:134–144.

    Article  PubMed  CAS  Google Scholar 

  10. Page R, Schroeder H: Pathogenesis of inflammatory periodontal disease: a summary of current work. Lab Invest 1976, 34:235–249.

    PubMed  CAS  Google Scholar 

  11. Page RC: The pathobiology of periodontal diseases may affect systemic diseases: inversion of a paradigm. Ann Periodontol 1998, 3:108–120.

    PubMed  CAS  Google Scholar 

  12. Silver JG, Martin AW, McBride BC: Experimental transient bacteremias in human subjects with varying degrees of plaque accumulation and gingival inflammation. J Clin Periodontol 1977, 4:92–99.

    Article  PubMed  CAS  Google Scholar 

  13. Armitage GC: Clinical evaluation of periodontal diseases. Periodontol 2000 1995, 7:39–53.

    Article  PubMed  CAS  Google Scholar 

  14. Nunn ME: Understanding the etiology of periodontitis: an overview of periodontal risk factors. Periodontol 2000 2003, 32:11–23.

    Article  PubMed  Google Scholar 

  15. Genco C, Potempa J, Mikolajczk-Pawlinska J, Travis J: Role of gingipains R in the pathogenesis of Porphyromonas gingivalis-mediated periodontal disease. Clin Infect Dis 1999, 28:456–465.

    PubMed  CAS  Google Scholar 

  16. Holt SC, Bramanti TE: Factors in virulence expression and their role in periodontal disease pathogenesis. Crit Rev Oral Biol Med 1991, 2:177–281.

    PubMed  CAS  Google Scholar 

  17. Hausmann E, Raiz LG, Miller WA: Endotoxin stimulation of bone resorption in tissue culture. Science 1970, 168:862–864.

    Article  PubMed  CAS  Google Scholar 

  18. Schenkein H: The pathogenesis of periodontal disease. J Periodontol 1999, 70:457–470.

    Article  Google Scholar 

  19. Offenbacher S: Periodontal diseases: pathogenesis. Ann Periodontol 1996, 1:821–878.

    PubMed  CAS  Google Scholar 

  20. Dennison DK, Van Dyke TE: The acute inflammatory response and the role of phagocytic cells in periodontal health and disease. Periodontol 2000 1997, 14:12–32.

    Article  Google Scholar 

  21. Stashenko P, Fujiyoshi P, Obernesser MS, et al.: Levels of interleukin-1 beta in tissue from sites of active periodontal disease. J Clin Periodontol 1991, 18:548–554.

    Article  PubMed  CAS  Google Scholar 

  22. Takahashi K, Takoshiba S, Nagai A, et al.: Assessment of interleukin-6 in the pathogenesis of periodontal disease. J Periodontol 1994, 65:147–153.

    PubMed  CAS  Google Scholar 

  23. Joshi N, Caputo GM, Weitekamp MR, et al.: Primary care: infections in patients with diabetes mellitus. N Engl J Med 1999, 341:1906–1912.

    Article  PubMed  CAS  Google Scholar 

  24. Wheat JL: Infection in diabetes mellitus. Diabetes Care 1980, 3:187–197.

    Article  PubMed  CAS  Google Scholar 

  25. Nishimura F, Takahashi K, Kurihara M, et al.: Periodontal disease as a complication of diabetes mellitus. Ann Periodontol 1998, 3:20–29.

    PubMed  CAS  Google Scholar 

  26. Zambon JJ, Reynolds H: Microbiological and immunological studies of adult periodontitis in patients with non-insulin dependent diabetes mellitus. J Periodontol 1988, 59:23–31.

    PubMed  CAS  Google Scholar 

  27. Rayfield EF, Ault MJ: Infection and diabetes: the case for glucose control. Am J Med 1982, 72:438–450.

    Article  Google Scholar 

  28. Marhoffer W, Stein M, Maeser E, Federlin K: Impairment of polymorphonuclear leukocyte function and metabolic control of diabetes. Diabetes Care 1992, 15:256–260.

    Article  PubMed  CAS  Google Scholar 

  29. Iacono JL, Singh S, Golub LM, et al.: In vivo assay of crevicular leukocyte migration. Its development and potential applications. J Periodontol 1985, 56(suppl 2):56–62.

    PubMed  CAS  Google Scholar 

  30. Lalla E, Lamster IB, Drury S, et al.: Hyperglycemia, glycoxidation and receptor for advanced glycation endproducts: potential mechanisms underlying diabetic complications, including diabetes-associated periodontitis. Periodontol 2000 2000, 23:50–62.

    Article  PubMed  CAS  Google Scholar 

  31. Lalla E, Lamster IB, Schmidt AM: Enhanced interaction of advanced glycation end products with their cellular receptor RAGE: implications for the pathogenesis of accelerated periodontal disease in diabetes. Ann Periodontol 1998, 3:13–19.

    PubMed  CAS  Google Scholar 

  32. Cianciola LJ, Park BH, Bruck E, et al.: Prevalence of periodontal disease in insulin dependent diabetes mellitus (juvenile diabetes). J Am Dent Assoc 1982, 104:653–660.

    PubMed  CAS  Google Scholar 

  33. Firatli E: The relation between clinical periodontal status and insulin dependent diabetes mellitus. J Periodontol 1997, 68:136–140.

    PubMed  CAS  Google Scholar 

  34. Shlossman M, Knowler WC, Pettitt DJ, Genco RJ: Type 2 diabetes mellitus and periodontal disease. J Am Dent Assoc 1990, 121:532–536.

    PubMed  CAS  Google Scholar 

  35. Taylor GW, Burt BA, Becker MP, et al.: Severe periodontitis and risk for poor glycemic control in patients with noninsulin dependent diabetes mellitus. J Periodontol 1996, 67:1085–1093.

    PubMed  CAS  Google Scholar 

  36. Taylor GW, Burt BA, Becker MP, et al.: Non-insulin dependent diabetes mellitus and alveolar bone loss progression over 2 years. J Periodontol 1998, 69:76–83.

    PubMed  CAS  Google Scholar 

  37. Unal T, Firatli E, Sivas A, et al.: Fructosamine as a possible monitoring parameter in non-insulin dependent diabetes mellitus patients with periodontal disease. J Periodontol 1993, 64:191–194.

    PubMed  CAS  Google Scholar 

  38. Thorstensson H, Kuylenstierna J, Hugoson A: Medical status and complications in relation to periodontal disease experience in insulin dependent diabetics. J Clin Periodontol 1996, 23:194–202.

    Article  PubMed  CAS  Google Scholar 

  39. Stewart J, Wager KA, Friedlander AH, Zadeh HH: The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus. J Clin Periodontol 2001, 28:306–310.

    Article  PubMed  CAS  Google Scholar 

  40. Grossi SG, Skrepcinski FB: Treatment of periodontal disease in diabetics reduces glycated hemoglobin. J Periodontol 1997, 68:713–719.

    PubMed  CAS  Google Scholar 

  41. Sastowijoto SH, van der Velden U, van Steenbergen TJM, et al.:Improved metabolic control, clinical periodontal status and subgingival microbiology in insulin-dependent diabetes mellitus. A prospective study. J Clin Periodontol 1990, 17:233–242.

    Article  Google Scholar 

  42. Christgau M, Palitzsch KD, Schmalz G, et al.: Healing response to non-surgical periodontal therapy in patients with diabetes mellitus: clinical, microbiological and immunologic results. J Clin Periodontol 1998, 25:112–124.

    Article  PubMed  CAS  Google Scholar 

  43. Westfelt E, Rylander H, Blohme G, et al.: The effect of periodontal therapy in diabetics. Results after 5 years. J Clin Periodontol 1996, 23:92–100.

    Article  PubMed  CAS  Google Scholar 

  44. Tervonen T, Knuuttila M, Pohjamo L, Nurkkala H: Immediate response to non-surgical periodontal treatment in subjects with diabetes mellitus. J Clin Periodontol 1991, 18:65–68.

    Article  PubMed  CAS  Google Scholar 

  45. Ternoven T, Karjalainen K: Periodontal disease related to diabetic status. A pilot study of the response to periodontal therapy in type 1 diabetes. J Clin Periodontol 1997, 24:505–510.

    Article  Google Scholar 

  46. Taylor GW: Periodontal treatment and its effects on glycemic control. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999, 87:311–316. A review of the evidence, both supportive and contrary, regardingwhether periodontal treatment can affect glycemic control.

    Article  PubMed  CAS  Google Scholar 

  47. Gutske CJ: Treatment of periodontitis in the diabetic patient: a critical review. J Clin Periodontol 1999, 26:133–137.

    Article  Google Scholar 

  48. Sammelkorpi K: Glucose intolerance in acute infections. J Intern Med 1989, 225:15–19.

    Google Scholar 

  49. Yki-Jarvinen H, Sammalkorpi K, Koivisto VA, Nikkila EA:Severity, duration and mechanism of insulin resistance during acute infections. J Clin Endocrinol Metab 1989, 69:317–323.

    Article  PubMed  CAS  Google Scholar 

  50. Grossi SG, Genco RJ: Periodontal disease and diabetes mellitus: a two-way relationship. Ann Periodontal 1998, 3:51–61. Describes a bidirectional model between periodontal disease anddiabetes mellitus.

    CAS  Google Scholar 

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Authors and Affiliations

  1. Veterans Affairs Greater Los Angeles Healthcare System, Dental W160/ Building 500, 11301 Wilshire Boulevard, 90073, Los Angeles, CA, USA

    Jeffery Pucher DDS, MS & James Stewart DDS, PhD

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  1. Jeffery Pucher DDS, MS
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  2. James Stewart DDS, PhD
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Pucher, J., Stewart, J. Periodontal disease and diabetes mellitus. Curr Diab Rep 4, 46–50 (2004). https://doi.org/10.1007/s11892-004-0011-y

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  • DOI: https://doi.org/10.1007/s11892-004-0011-y

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