Current Diabetes Reports

, Volume 13, Issue 3, pp 445–452 | Cite as

Diabetes Mellitus and Periodontal Diseases

  • Corneliu Sima
  • Michael Glogauer
Diabetes and Other Diseases—Emerging Associations (D Aron, Section Editor)


A bidirectional relationship between diabetes mellitus (DM) and periodontal diseases (PDs) has been established. It is estimated that patients with poorly controlled DM are 3 times more likely to develop chronic PD compared with normoglycemic individuals despite similar composition in subgingival biofilms. Furthermore, these patients present with increased severity and rapid progression of attachment loss around teeth resulting in edentulism. Treatment of PD results in a modest but significant improvement in glycemic control in patients with DM reflected by a 0.4 % reduction in HbA1cglycated hemoglobin levels. Compelling evidence from in vitro and animal studies supports a plausible biological explanation for the relationship between the 2 conditions centered on systemic low-grade inflammation. However, the limited number of comparable large randomized clinical trials is reflected in the limited specific guidelines offered by the international organizations for DM and PD regarding the management of the 2 diseases in an individual.


Diabetes mellitus Periodontal diseases Inflammation Glycemic control HbA1c 


Conflict of Interest

Corneliu Sima declares that he has no conflict of interest.

Michael Glogauer declares that he has no conflict of interest.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Glavind L, Lund B, Loe H. The relationship between periodontal state and diabetes duration, insulin dosage and retinal changes. J Periodontol. 1968;39(6):341–7.PubMedGoogle Scholar
  2. 2.
    Belting CM, Hiniker JJ, Dummett CO. Influence of diabetes mellitus on the severity of periodontal disease. J Periodontol. 1964;35(11/12):476–80.Google Scholar
  3. 3.
    Löe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993;16(1):329–34.PubMedGoogle Scholar
  4. 4.
    Califano JV, Research SATCAAOP. Position paper: periodontal diseases of children and adolescents. J Periodontol. 2003;74(11):1696–704.PubMedCrossRefGoogle Scholar
  5. 5.
    Ranney RR. Discussion: pathogenesis of gingivitis. J Clin Periodontol. 1986;13(5):356–9.CrossRefGoogle Scholar
  6. 6.
    Lang NP, Schätzle MA, Löe H. Gingivitis as a risk factor in periodontal disease. J Clin Periodontol. 2009;36:3–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Kantarci A, Van Dyke TE. Resolution of inflammation in periodontitis. J Periodontol. 2005;76(11-s):2168–74.Google Scholar
  8. 8.
    Van Dyke TE. Control of inflammation and periodontitis. Periodontol. 2007;45(1):158–66.CrossRefGoogle Scholar
  9. 9.
    The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.CrossRefGoogle Scholar
  10. 10.
    UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352(9131):854–65.CrossRefGoogle Scholar
  11. 11.
    UKDPS RG. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998;317(7160):703–13.CrossRefGoogle Scholar
  12. 12.
    Mealey BL, Ocampo GL. Diabetes mellitus and periodontal disease. Periodontol. 2007;44(1):127–53.CrossRefGoogle Scholar
  13. 13.
    Demmer RT, Desvarieux M, Holtfreter B, Jacobs DR, Wallaschofski H, Nauck M, et al. Periodontal Status and A1C Change: longitudinal results from the Study of Health in Pomerania (SHIP). Diabetes Care. 2010;33(5):1037–43.PubMedCrossRefGoogle Scholar
  14. 14.
    Soskolne WA, Klinger A. The relationship between periodontal diseases and diabetes: an overview. Ann Periodontol. 2001;6(1):91–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Taylor G, Borgnakke W. Periodontal disease: associations with diabetes, glycemic control and complications. Oral Dis. 2008;14(3):191–203.PubMedCrossRefGoogle Scholar
  16. 16.
    Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective. Ann Periodontol. 2001;6(1):99–112.PubMedCrossRefGoogle Scholar
  17. 17.
    • Chávarry NG, Vettore MV, Sansone C. The relationship between diabetes mellitus and destructive periodontal disease: a meta-analysis. Oral Health Prev Dent. 2009;7:107–27. This study provides a comprehensive review and meta-analysis of the relationship between diabetes and periodontal disease.PubMedGoogle Scholar
  18. 18.
    Lalla E, Bin C, Lal S, Tucker S, Greenberg E, Goland RS, et al. Periodontal changes in children and adolescents with diabetes: a case-control study. Diabetes Care. 2006;29(2):295–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Lalla E, Cheng B, Lal S, Kaplan S, Softness B, Greenberg E, et al. Diabetes mellitus promotes periodontal destruction in children. J Clin Periodontol. 2007;34(4):294–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Mattout C, Bourgeois D, Bouchard P. Type 2 diabetes and periodontal indicators: epidemiology in France 2002-2003. J Periodont Res. 2006;41(4):253–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Novak KF, Taylor GW, Dawson DR, Ferguson JE, Novak MJ. Periodontitis and gestational diabetes mellitus: exploring the link in NHANES III. J Public Health Dent. 2006;66(3):163–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Sarelius IH. Macromolecule permeability of in situ and excised rodent skeletal muscle arterioles and venules. AJP: Heart Circ Physiol. 2005;290(1):H474–80.CrossRefGoogle Scholar
  23. 23.
    Andriankaja OM, Barros SP, Moss K, Panagakos FS, DeVizio W, Beck JD, et al. Levels of serum interleukin (IL)-6 and gingival crevicular fluid of IL-1beta and prostaglandin E(2) among non-smoking subjects with gingivitis and type 2 diabetes. J Periodontol. 2009;80(2):307–16.PubMedCrossRefGoogle Scholar
  24. 24.
    • Salvi GE, Franco LM, Braun TM, Persson GAR, Lang NP, Giannobile WV. Pro-inflammatory biomarkers during experimental gingivitis in patients with type 1 diabetes mellitus: a proof-of-concept study. J Clin Periodontol. 2009;37(1):9–16. This is a proof-of concept study demonstrating a hyper-inflammatory response to subgingival biofilms in patients with diabetes.PubMedCrossRefGoogle Scholar
  25. 25.
    Tsai C, Hayes C, Taylor GW. Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population. Community Dent Oral Epidemiol. 2002;30(3):182–92.PubMedCrossRefGoogle Scholar
  26. 26.
    Firatli E. The relationship between clinical periodontal status and insulin-dependent diabetes mellitus. Results after 5 years. J Periodontol. 1997;68(2):136–40.PubMedCrossRefGoogle Scholar
  27. 27.
    Oliver RC, Tervonen T. Periodontitis and tooth loss: comparing diabetics with the general population. J Am Dent Assoc. 1993;124(12):71–6.PubMedGoogle Scholar
  28. 28.
    Novaes AB, Gutierrez FG, Novaes AB. Periodontal disease progression in type II non-insulin-dependent diabetes mellitus patients (NIDDM). Part I–Probing pocket depth and clinical attachment. Braz Dent J. 1996;7(2):65–73.PubMedGoogle Scholar
  29. 29.
    Seppälä B, Ainamo J. A site-by-site follow-up study on the effect of controlled versus poorly controlled insulin-dependent diabetes mellitus. J Clin Periodontol. 1994;21(3):161–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Botero JE, Yepes FL, Roldán N, Castrillón CA, Hincapie JP, Ochoa SP, et al. Tooth and periodontal clinical attachment loss are associated with hyperglycemia in patients with diabetes. J Periodontol. 2012;83(10):1245–50.PubMedCrossRefGoogle Scholar
  31. 31.
    • Costa FO, Miranda Cota LO, Pereira Lages EJ, Dutra Oliveira AMS, Oliveira PAD, Magalhães Cyrino R, et al. progression of periodontitis and tooth loss associated with glycemic control individuals under periodontal maintenance therapy: a 5-year follow-up study. J Periodontol. 2012. doi: 10.1902/jop.2012.120255. This study is a case-control in an open cohort study evaluating the role of glycemic control in the progression and severity of periodontitis in diabetic patients in maintenance phase.
  32. 32.
    de Pommereau V, Dargent-Paré C, Robert JJ, Brion M. Periodontal status in insulin-dependent diabetic adolescents. J Clin Periodontol. 1992;19(9 Pt 1):628–32.PubMedCrossRefGoogle Scholar
  33. 33.
    Bridges RB, Anderson JW, Saxe SR, Gregory K, Bridges SR. Periodontal status of diabetic and non-diabetic men: effects of smoking, glycemic control, and socioeconomic factors. J Periodontol. 1996;67:1185–92.PubMedCrossRefGoogle Scholar
  34. 34.
    Sastrowijoto SH, Hillemans P, van Steenbergen TJ, Abraham-Inpijn L, de Graaff J. Periodontal condition and microbiology of healthy and diseased periodontal pockets in type 1 diabetes mellitus patients. J Clin Periodontol. 1989;16(5):316–22.PubMedCrossRefGoogle Scholar
  35. 35.
    Cutler CW, Machen RL, Jotwani R, Iacopino AM. Heightened gingival inflammation and attachment loss in type 2 diabetics with hyperlipidemia. J Periodontol. 1999;70(11):1313–21.PubMedCrossRefGoogle Scholar
  36. 36.
    Al-Zahrani MS, Bissada NF, Borawskit EA. Obesity and periodontal disease in young, middle-aged, and older adults. J Periodontol. 2003;74(5):610–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Genco RJ, Grossi SG, Ho A, Nishimura F, Murayama Y. A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol. 2005;76(11 Suppl):2075–84.PubMedCrossRefGoogle Scholar
  38. 38.
    Nibali L, D'Aiuto F, Griffiths G, Patel K, Suvan J, Tonetti MS. Severe periodontitis is associated with systemic inflammation and a dysmetabolic status: a case–control study. J Clin Periodontol. 2007;34(11):931–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Grossi SG, Zambon JJ, Ho AW, Dunford RG, Machtei EE, Norderyd OM. Assessment of risk for periodontal disease. I. Risk indicators for attachment loss. J Periodontol. 1994;65(3):260–7.PubMedCrossRefGoogle Scholar
  40. 40.
    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(3 Pt 1):194–202.PubMedCrossRefGoogle Scholar
  41. 41.
    Saremi A, Nelson RG, Tulloch-Reid M, Hanson RL, Sievers ML, Taylor GW. Periodontal disease and mortality in type 2 diabetes. Diabetes Care. 2005;28(1):27–32.PubMedCrossRefGoogle Scholar
  42. 42.
    Shultis WA, Weil EJ, Looker HC, Curtis JM, Shlossman M, Genco RJ, et al. Effect of periodontitis on overt nephropathy and end-stage renal disease in type 2 diabetes. Diabetes Care. 2007;30(2):306–11.PubMedCrossRefGoogle Scholar
  43. 43.
    Taylor GW, Burt BA, Becker MP, Genco RJ, Shlossman M, Knowler WC, et al. Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus. J Periodontol. 1996;67(10 Suppl):1085–93.PubMedCrossRefGoogle Scholar
  44. 44.
    Ide R, Hoshuyama T, Wilson D, Takahashi K, Higashi T. Periodontal disease and incident diabetes: a seven-year study. J Dent Res. 2011;90(1):41–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Demmer RT, Jacobs DR, Desvarieux M. Periodontal disease and incident type 2 diabetes: results from the First National Health and Nutrition Examination Survey and its epidemiologic follow-up study. Diabetes Care. 2008;31(7):1373–9.PubMedCrossRefGoogle Scholar
  46. 46.
    •• Simpson TC, Needleman I, Wild SH, Moles DR, and Mills EJ. Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database Syst Rev. 2010;(5):CD004714. This is a comprehensive systematic review on the effects of periodontal treatment on glycemic control. Google Scholar
  47. 47.
    Grossi SG, Skrepcinski FB, DeCaro T, Robertson DC, Ho AW, Dunford RG, et al. Treatment of periodontal disease in diabetics reduces glycated hemoglobin. J Periodontol. 1997;68(8):713–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Katagiri S, Nitta H, Nagasawa T, Uchimura I, Izumiyama H, Inagaki K, et al. Multi-center intervention study on glycohemoglobin (HbA1c) and serum, high-sensitivity CRP (hs-CRP) after local anti-infectious periodontal treatment in type 2 diabetic patients with periodontal disease. Diabetes Res Clin Pract. 2009;83(3):308–15.PubMedCrossRefGoogle Scholar
  49. 49.
    Correa FOB, GonÃalves D, Figueredo CMS, Bastos AS, Gustafsson A, Orrico SRP. Effect of periodontal treatment on metabolic control, systemic inflammation and cytokines in patients with type 2 diabetes. J Clin Periodontol. 2010;37(1):53–8.PubMedCrossRefGoogle Scholar
  50. 50.
    O'Connell PAA, Taba M, Nomizo A, Freitas MCF, Suaid FA, Uyemura SA, et al. Effects of periodontal therapy on glycemic control and inflammatory markers. J Periodontol. 2008;79(5):774–83.PubMedCrossRefGoogle Scholar
  51. 51.
    Sun W-L, Chen L-L, Zhang S-Z, Ren YZ, Qin GM. Changes of adiponectin and inflammatory cytokines after periodontal intervention in type 2 diabetes patients with periodontitis. Arch Oral Biol. 2010;55(12):970–4.PubMedCrossRefGoogle Scholar
  52. 52.
    Makiura N, Ojima M, Kou Y, Furuta N, Okahashi N, Shizukuishi S. Relationship of Porphyromonas gingivalis with glycemic level in patients with type 2 diabetes following periodontal treatment. Oral Microbiol Immunol. 2008;23(4):348–51.PubMedCrossRefGoogle Scholar
  53. 53.
    Teeuw WJ, Gerdes VEA, Loos BG. Effect of periodontal treatment on glycemic control of diabetic patients: a systematic review and meta-analysis. Diabetes Care. 2010;33(2):421–7.PubMedCrossRefGoogle Scholar
  54. 54.
    Kiran M, Arpak N, Unsal E, Erdoğan MF. The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus. J Clin Periodontol. 2005;32(3):266–72.PubMedCrossRefGoogle Scholar
  55. 55.
    • Jones JA, Miller DR, Wehler CJ, Rich SE, Krall-Kaye EA, McCoy LC, et al. Does periodontal care improve glycemic control? The Department of Veterans Affairs Dental Diabetes Study. J Clin Periodontol. 2007;34(1):46–52. This is a short-term multi-site, single blinded RCT with two-by-two design evaluating glycemic control after a single course of periodontal therapy in patients with poorly controlled diabetes mellitus and periodontitis.PubMedCrossRefGoogle Scholar
  56. 56.
    Rocha M, Nava LE, Vázquez dela Torre C, Sánchez-Márin F, Garay-Sevilla ME, Malacara JM. Clinical and radiological improvement of periodontal disease in patients with type 2 diabetes mellitus treated with alendronate: a randomized, placebo-controlled trial. J Periodontol. 2001;7(2):204–9.CrossRefGoogle Scholar
  57. 57.
    Al-Mubarak S, Ciancio S, Aljada A, Ross C, Dandona P. Comparative evaluation of adjunctive oral irrigation in diabetics. J Clin Periodontol. 2002;29(4):295–300.PubMedCrossRefGoogle Scholar
  58. 58.
    Rodrigues DC, Taba MJ, Novaes ABJ, Souza SLS, Grisi MFM. Effect of non-surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus. J Periodontol. 2003;74(9):1361–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Stewart JE, 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(4):306–10.PubMedCrossRefGoogle Scholar
  60. 60.
    Promsudthi A, Pimapansri S, Deerochanawong C, Kanchanavasita W. The effect of periodontal therapy on uncontrolled type 2 diabetes mellitus in older subjects. Oral Dis. 2005;11(5):293–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Darré L, Vergnes J-N, Gourdy P, Sixou M. Efficacy of periodontal treatment on glycaemic control in diabetic patients: A meta-analysis of interventional studies. Diabetes Metab. 2008;34(5):497–506.PubMedCrossRefGoogle Scholar
  62. 62.
    Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405–12.PubMedCrossRefGoogle Scholar
  63. 63.
    Khaw K-T, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med. 2004;141(6):413–20.PubMedCrossRefGoogle Scholar
  64. 64.
    Mealey BL, Rose LF. Diabetes mellitus and inflammatory periodontal diseases. Curr Opin Endocrinol, Diabetes Obes. 2008;15(2):135–41.CrossRefGoogle Scholar
  65. 65.
    Mealey BL, Oates TW, American Academy of Periodontology. Diabetes mellitus and periodontal diseases. J Periodontol. 2006;77(8):1289–303.PubMedCrossRefGoogle Scholar
  66. 66.
    Manouchehr-Pour M, Spagnuolo PJ, Rodman HM, Bissada NF. Impaired neutrophil chemotaxis in diabetic patients with severe periodontitis. J Dent Res. 1981;60(3):729–30.PubMedCrossRefGoogle Scholar
  67. 67.
    McMullen JA, Van Dyke TE, Horoszewicz HU, Genco RJ. Neutrophil chemotaxis in individuals with advanced periodontal disease and a genetic predisposition to diabetes mellitus. J Periodontol. 1981;52(4):167–73.PubMedCrossRefGoogle Scholar
  68. 68.
    Graves DT, Liu R, Alikhani M, Al-Mashat H, Trackman PC. Diabetes-enhanced inflammation and apoptosis–impact on periodontal pathology. J Dent Res. 2005;85(1):15–21.Google Scholar
  69. 69.
    Salvi GE, Collins JG, Yalda B, et al. Monocytic TNF alpha secretion patterns in IDDM patients with periodontal diseases. J Clin Periodontol. 1997;24(1):8–16.PubMedCrossRefGoogle Scholar
  70. 70.
    Kjersem H, Hilsted J, Madsbad S, Arnold RR, Lang NP, Offenbacher S. Polymorphonuclear leucocyte dysfunction during short term metabolic changes from normo- to hyperglycemia in type 1 (insulin dependent) diabetic patients. Infection. 1988;16(4):215–21.PubMedCrossRefGoogle Scholar
  71. 71.
    Gustke CJ, Stein SH, Hart TC, Hoffman WH, Hanes PJ, Russell CM, et al. HLA-DR alleles are associated with IDDM, but not with impaired neutrophil chemotaxis in IDDM. J Dent Res. 1998;77(7):1497–503.PubMedCrossRefGoogle Scholar
  72. 72.
    Gyurko R, Siqueira CC, Caldon N, Caldon N, Gao L, Kantarci A, et al. Chronic hyperglycemia predisposes to exaggerated inflammatory response and leukocyte dysfunction in Akita mice. J Immunol (Baltimore, Md: 1950). 2006;177(10):7250–6.Google Scholar
  73. 73.
    Sima C, Rhourida K, Van Dyke TE, Gyurko R. Type 1 diabetes predisposes to enhanced gingival leukocyte margination and macromolecule extravasation in vivo. J Periodont Res. 2010;45(6):748–56.PubMedCrossRefGoogle Scholar
  74. 74.
    Beam HA, Parsons JR, Lin SS. The effects of blood glucose control upon fracture healing in the BB Wistar rat with diabetes mellitus. J Orthop Res. 2002;20(6):1210–6.PubMedCrossRefGoogle Scholar
  75. 75.
    He H, Liu R, Desta T, Leone C, Gerstenfeld LC, Graves DT. Diabetes causes decreased osteoclastogenesis, reduced bone formation, and enhanced apoptosis of osteoblastic cells in bacteria stimulated bone loss. Endocrinology. 2004;145(1):447–52.PubMedCrossRefGoogle Scholar
  76. 76.
    Liu R, Bal HS, Desta T, Krothapalli N, Alyassi M, Luan Q, et al. Diabetes enhances periodontal bone loss through enhanced resorption and diminished bone formation. J Dent Res. 2006;85(6):510–4.PubMedCrossRefGoogle Scholar
  77. 77.
    Lalla E, Lamster IB, Feit M, Huang L, Spessot A, Qu W, et al. Blockade of RAGE suppresses periodontitis-associated bone loss in diabetic mice. J Clin Investig. 2000;105(8):1117–24.PubMedCrossRefGoogle Scholar
  78. 78.
    Takeda M, Ojima M, Yoshioka H, Inaba H, Kogo M, Shizukuishi S, et al. Relationship of serum advanced glycation end products with deterioration of periodontitis in type 2 diabetes patients. J Periodontol. 2005;77(1):15–20.CrossRefGoogle Scholar
  79. 79.
    Zizzi A, Tirabassi G, Aspriello SD, Piemontese M, Rubini C, Lucarini G. Gingival advanced glycation end-products in diabetes mellitus-associated chronic periodontitis: an immunohistochemical study. J Periodont Res. doi: 10.1111/jre.12007.
  80. 80.
    Murillo J, Wang Y, Xu X, Klebe RJ, Chen Z, Zardeneta G, et al. Advanced glycation of type I collagen and fibronectin modifies periodontal cell behavior. J Periodontol. 2008;79(11):2190–9.PubMedCrossRefGoogle Scholar
  81. 81.
    Lalla E, Kaplan S, Yang J, Yang J, Roth GA, Papapanou PN, et al. Effects of periodontal therapy on serum C-reactive protein, sE-selectin, and tumor necrosis factor-α secretion by peripheral blood-derived macrophages in diabetes. J Periodont Res. 2007;42(3):274–82.PubMedCrossRefGoogle Scholar
  82. 82.
    • Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M, et al. Treatment of periodontitis and endothelial function. N Engl J Med. 2007;356(9):911–20. This is a single blinded RCT that evaluated the effects of non-surgical periodontal treatment on markers of endothelial dysfunction in patients with periodontits.PubMedCrossRefGoogle Scholar
  83. 83.
    Engebretson S, Chertog R, Nichols A, Hey-Hadavi J, Celenti R, Grbic J. Plasma levels of tumour necrosis factor-alpha in patients with chronic periodontitis and type 2 diabetes. J Clin Periodontol. 2007;34(1):18–24.PubMedCrossRefGoogle Scholar
  84. 84.
    Davé S, Van Dyke T. The link between periodontal disease and cardiovascular disease is probably inflammation. Oral Dis. 2008;14(2):95–101.PubMedCrossRefGoogle Scholar
  85. 85.
    Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol. 1996;67(10 Suppl):1123–37.PubMedGoogle Scholar
  86. 86.
    Friedewald VE, Kornman KS, Beck JD, Genco R, Goldfine A, Libby P, et al. The American Journal of Cardiology and Journal of Periodontology editors' consensus: periodontitis and atherosclerotic cardiovascular disease. J Periodontol. 2009;80(7):1021–32.PubMedCrossRefGoogle Scholar
  87. 87.
    Loos BG. Systemic markers of inflammation in periodontitis. J Periodontol. 2005;76(11 Suppl):2106–15.PubMedCrossRefGoogle Scholar
  88. 88.
    Noack B, Genco RJ, Trevisan M, Grossi S, Zambon JJ, De Nardin E. Periodontal infections contribute to elevated systemic C-reactive protein level. J Periodontol. 2001;72(9):1221–7.PubMedCrossRefGoogle Scholar
  89. 89.
    Okabe K, Nakagawa K, Yamamoto E. Factors affecting the occurrence of bacteremia associated with tooth extraction. Int J Oral Maxillofac Surg. 1995;24(3):239–42.PubMedCrossRefGoogle Scholar
  90. 90.
    Yoshii S, Tsuboi S, Morita I, Takami Y, Adachi K, Inukai J, et al. Temporal association of elevated C-reactive protein and periodontal disease in men. J Periodontol. 2009;80(5):734–9.PubMedCrossRefGoogle Scholar
  91. 91.
    Nakano K, Nemoto H, Nomura R, Inaba H, Yoshioka H, Taniguchi K, et al. Detection of oral bacteria in cardiovascular specimens. Oral Microbiol Immunol. 2009;24(1):64–8.PubMedCrossRefGoogle Scholar
  92. 92.
    Koren O, Spor A, Felin J, Fåk F, Stombaugh J, Tremaroli V, et al. Human oral, gut, and plaque microbiota in patients with atherosclerosis. Proc Natl Acad Sci. 2011;108 Suppl 1:4592–8.PubMedCrossRefGoogle Scholar
  93. 93.
    Haraszthy VI, Zambon JJ, Trevisan M, Zeid M, Genco RJ. Identification of periodontal pathogens in atheromatous plaques. J Periodontol. 2000;71(10):1554–60.PubMedCrossRefGoogle Scholar
  94. 94.
    Toyofuku T, Inoue Y, Kurihara N, Kudo T, Jibiki M, Sugano N, et al. Differential detection rate of periodontopathic bacteria in atherosclerosis. Surg Today. 2011;41(10):1395–400.PubMedCrossRefGoogle Scholar
  95. 95.
    • Desvarieux M. Periodontal microbiota and carotid intima-media thickness: the oral Infections and Vascular Disease Epidemiology Study (INVEST). Circulation. 2005;111(5):576–82. INVEST is randomly sampled population-based cohort study investigating the relationship between oral infections, carotid atherosclerosis, and stroke. The present study demonstrates a direct relationship between periodontal microbiology and subclinical atherosclerosis.PubMedCrossRefGoogle Scholar
  96. 96.
    • Desvarieux M, Demmer RT, Jacobs DR, Rundek T, Boden-Albala B, Sacco RL, et al. Periodontal bacteria and hypertension: the oral infections and vascular disease epidemiology study (INVEST). J Hypertens. 2010;28(7):1413–21. INVEST is randomly sampled population-based cohort study investigating the relationship between oral infections, carotid atherosclerosis, and stroke. The present study demonstrates a direct relationship between levels of subgingival bacterial levels and systolic, diastolic blood pressure and prevalence of hypertension.PubMedCrossRefGoogle Scholar
  97. 97.
    Sima C, Glogauer M. Periodontitis in patients with diabetes - a complication that impacts on metabolic control. US Endocrinol. 2012;8:35–9.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Matrix Dynamics GroupTorontoCanada
  2. 2.University of TorontoTorontoCanada

Personalised recommendations