Periodontitis and diabetes mellitus influence each other

Diabetes and periodontitis are closely linked. That’s why the respective professional societies also want a specific focus to be placed on this and are calling for interdisciplinary cooperation.

Insulin injection

The two systemic diseases, periodontitis and diabetes, have a negative influence on each other. The risk of developing periodontitis is approximately 3 times higher among diabetes patients. Conversely, one of the effects of full-blown periodontitis is to increase blood glucose levels, and it therefore has a direct influence on glycemic control. Besides treatment of the diabetes, importance should therefore also be attached to dental therapy. Because this also has a positive effect on long-term blood glucose levels in diabetics. Treating periodontitis can reduce the HbA1c value by 0.4-0.8%.

On the one hand: Periodontitis influences diabetes

According to scientific studies, periodontal marker bacteria are detected significantly more frequently in subgingival samples from diabetics. Periodontitis-associated bacteria trigger the release of cytokines and other inflammatory mediators. These further weaken the already reduced effects of insulin in patients with Type 2 diabetes, thereby bringing about a reduction in glucose uptake by cells and thus leading to an increase in blood glucose levels. Diabetics with periodontal disease therefore exhibit poorer glycemic control in the long term together with a higher mortality rate as a result of diabetes complications than individuals with a healthy periodontium.

On the other hand: Diabetes predisposes to periodontitis

Increased formation of glycosylated proteins (AGE = advanced glycation end products) occurs in diabetes patients in the presence of hyperglycemia. These proteins interact with endothelial cells, fibroblasts and other immune cells, thereby bringing about the release of cytokines and other inflammatory mediators. This gives further impetus to the bone resorption and soft tissue destruction that is already increased in periodontitis patients as well as to the heightened inflammatory response.

The poor perfusion of peripheral tissue that occurs frequently in diabetics, together with the elevated blood glucose values, further promote bacterial infections. As a consequence of this, the prevalence, progression and extent of periodontal destruction is much greater in patients with diabetes than in healthy individuals. This applies mainly to diabetics with poor blood glucose control, however. Patients with well controlled glucose metabolism are not at increased risk of periodontitis.

Interdisciplinary cooperation

Generally speaking, care should be taken with diabetics to ensure that, wherever possible, dental treatment does not conflict with normal diet, insulin administration or drug regimen. In addition, interdisciplinary cooperation is very important because of the interaction between the two conditions. Where extensive therapeutic measures are planned that will interfere with the post-operative diet and drug regimen, for example, it is advisable to consult the treating doctor/diabetologist beforehand.