Synopsis
The causal and bi-directional link between type II diabetes and periodontitis is well established. Type II diabetes is known to affect and be affected by periodontitis. Management of either disease improves the progression and outcome of the other.
Information
There is consistent evidence that periodontitis increases the risk of developing Type II diabetes (T2DM), worsens glycaemic control and complications of diabetesi. The biological mechanisms linking the diseases are plausible and bidirectional. Treatment of periodontitis improves glycaemic control and reduced complications of diabetes.
Almost 1.2 million Australians were living with T2DM and registered with the National Diabetes Services Scheme and Australasian Paediatric Endocrine Group in 2020 (AIHW)ii.
T2DM influences periodontitis by causing a hyperinflammatory response, impairing bone remodelling and through the production of advanced glycation end products (AGEs)iii. Periodontitis contributes to systemic inflammation through the elevation of IL-6, TNF and CRP levels affecting insulin resistance. The link is closely related to the severity of the diseases, with those having uncontrolled T2DM at higher risk of suffering from periodontitis and vice versai.
T2DM is preceded by inflammation, leading to pancreatic beta cell dysfunction and apoptosis as well as the development of insulin resistance. It is then logical to consider that diseases contributing to systemic inflammation impact the onset and progression of diabetesiv.
Diabetes drives the formation of AGEs that when interacting with receptors for advanced glycation end products (RAGE) on macrophages, T cells, endothelium and vascular smooth muscle leading to hyperinflammation and periodontal tissue destruction. The AGEs also contribute to impaired wound healing, enhance atherosclerosis and contribute to thickening of the basement membrane. Hyperglycaemia also increases the production of reactive oxygen species and enhances expression of cytokines. The prolonged inflammation in diabetes increases osteoclastogenesis impacting periodontitisv.
The well-established link between diabetes and periodontitis has evolved to now place periodontitis as the 6th complication of T2DM. Management of both diabetes and periodontitis will reduce the risk of complications progressingvi.
i Chapple ILC, Genco R 2013: Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases.
ii Australian Institute of Health and Welfare (2023) Diabetes: Australian facts, AIHW, Australian Government, accessed 01 May 2023.
iii Wu C, Yuan Y, Liu H, Li S, Zhang B, Chen W, An Z, Chen S, Wu Y, Han B, Li C, Li L. Epidemiologic relationship between periodontitis and type 2 diabetes mellitus. BMC Oral Health. 2020: 20; 204
iv Sanz et al 2020. Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology.
v Jiao H, Xiao E, Graves DT. Diabetes and Its Effect on Bone and Fracture Healing. Curr Osteoporos Rep. 2015 Oct;13(5):327-35.
vi Simpson TC, Clarkson JE, Worthington HV, MacDonald L, Weldon JC, Needleman I, Iheozor-Ejiofor Z, Wild SH, Qureshi A, Walker A, Patel VA, Boyers D, Twigg J. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev. 2022.