Diabetes and periodontal disease

Epidemiological data demonstrate a clear link between periodontal disease and diabetes, and individuals with diabetes, particularly if poorly controlled, are at risk for advanced periodontitis. Diabetes is increasingly viewed as an inflammatory condition and dysregulated immune-inflammatory responses in diabetes may increase susceptibility to periodontal disease by disrupting local cytokine networks in the periodontium. Inflammatory cytokines such as interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) are important in the pathogenesis of both diseases, and together with other pro-inflammatory cytokines and adipokines, may provide a mechanistic link between the two diseases. Altered neutrophil function and deposition of advanced glycation end-products (AGEs) are also likely to be important in the increased susceptibility to periodontal disease seen in people with diabetes. Emerging data suggest that treating periodontal disease may have a beneficial effect on glycaemic control, and highlight the need to incorporate a full periodontal examination into management strategies for patients with diabetes. It is clear that the dental team must become increasingly involved in the management of patients with diabetes, and it is recommended that periodontal screening of all patients diagnosed with diabetes is undertaken as a matter of routine.