Diabetes and Periodontal Disease: A Bidirectional Relationship
Diabetes and Periodontal Disease: A Bidirectional Relationship
Diabetes and Periodontal Disease: A Bidirectional Relationship
Subdirection of Public Health Research at the National Institute of Perinatology (Instituto Nacional de Perinatología)
Mexico City, Mexico
E-mail: dra_diazromero@yahoo.com.mx
Summary. Periodontal disease (PD) and diabetes mellitus (DM) hold a consistent relationship. DM not only
increases the risk of having PD and with that its prevalence, but it also augments the progression of more aggressive
and quickly defining signs. There is a bidirectional relationship between DM and PD. The treatment of periodontitis
in diabetic patients favors a reduction in mediators responsible for the destruction of periodontal tissue and decreases
with it, a resistance to insulin. PD is characterized by low grade chronic inflammation that may remain silent in
diabetics causing damage that is not locally limited but may extend systemically.
Key words: Periodontal disease, loss of glycemic control, low grade chronic inflammation
response to the Porphyromonas gingivalis antigens The above explains why periodontitis can increase
compared to the monocytes of non-diabetic patients the risk of poor glycemic control and how this improves
(11). The level of inflammatory cytokines in the crevi- with periodontal treatment (24).
cular fluid is also related to glycemic control. Egebret-
son (12) reported that diabetic patients with periodoni-
tis, whose HbA1c levels were over 8%, had approxi-
mately twice the amount of interleukin-1β (IL-1β) in
their crevicular fluid in comparison to patients with in-
dexes below 8%. The net effect of these changes in the
immune response of diabetics is an increase in perio-
dontal inflammation, a loss of epithelial insertion and
alveolar bone.
The gingival sulcus (13) is a labile site for the body to
present a hermetic closure to the external environment. In
this space, the crevicular fluid increases in the presence of
inflammation. The increase in the loss of periodontal in-
sertion and the alveolar bone (14) in diabetic patients is
associated with changes in the metabolism of connective
tissue where there is a lack of response in resorption and
formation. The effect of the hyperglycemic state includes
the inhibition of osteoblastic proliferation (15) and colla-
gen production resulting in a reduction in the formation
and decrease in mechanical properties of the newly
formed bone (16-17).
The changes mentioned above may contribute to the
pathogenicity of periodontal disease and changes in
healing since collagen is the predominating structural
protein in the gums. In addition, collagen is susceptible
to degradation due to the action of MMPs as colla-
genases found to be in high amounts in tissues of dia-
betics, including the periodontal tissue.
Periodontal disease is a silent condition. Diabetics Table 1. Signs of Alarm related to Periodontal Disease
need to be aware of the signs of PD (Table 1). Bleeding
of the gums is the first sign of subgingival infection. • Gum bleeding
This is when all the personnel involved in the care of • Gingival inflammation
diabetic patients should take active participation and • Halitosis
therefore opportunely refer patients to the dentist. • Sensitive denture
• Dental movement
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DIABETES AND PERIODONTAL DISEASE: A BIDIRECTIONAL RELATIONSHIP 9
Departman za istraživanje javnog zdravlja, Nacionalni institut za perinatologiju, Meksiko Siti, Meksiko
E-mail: dra_diazromero@yahoo.com.mx
Kratak sadržaj: Periodontalna bolest (PB) i diabetes mellitus (DM) su u doslednoj vezi. DM ne samo da povećava rizik od
pojave PB, a samim tim i njegovu učestalost, nego i povećava progresiju znakova koji su agresivniji i koji se brže određuju.
Postoji dvosmerna veza između DM i PB. Tretiranjem periodontitisa kod pacijenata sa dijabetesom, smanjuju se posrednici
odgovorni za razaranje periodontalnog tkiva a samim tim smanjuje se i rezistentnost na insulin. PB karakteriše hronična
upala niskog inteziteta koja može ostati prikrivena kod dijabetičara, uzrokujući štetu koja nije lokalno ograničena već može
sistematično da se širi.
Ključne reči: Periodontalna bolest, gubitak glikemičke kontrole, upala niskog inteziteta