01.07.2024
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Diabetes and Periodontal Disease: Key Considerations for Optimal Care
Diabetes is a systemic condition that has been linked to a number of health issues such as heart disease, hypertension, adverse pregnancy outcomes, and periodontal disease.
Advances in clinical research have led to a greater understanding of the connection between diabetes and periodontal disease. With diabetes affecting over 422 million people in all areas of the world, it is not uncommon for dentists to have patients with this chronic disease. Understanding the correlation between diabetes and periodontal disease is important for providing optimal care.
Scientific evidence
Since individuals with diabetes require careful management of their oral health, dentists are encouraged to play a more proactive role in identifying the potential risks that these conditions can create.
Some of the latest research into the link between diabetes and periodontal disease has highlighted the following findings:
- Recent studies show evidence there is a prevalence of diabetes among patients with periodontitis. Previously it was believed that diabetic patients tended to have a high incidence and severity of periodontitis.
- A systematic review and meta-analysis of cohort studies demonstrated a bidirectional association between periodontal disease and diabetes mellitus, even after stratifying for major risk of bias.
- A more recent review of the bidirectional relationship between periodontal disease and diabetes mellitus concluded that “emphasis should be placed on oral health education and the impact that periodontitis can have on the overall inflammatory systemic burden, diabetes evolution and the risk of developing complications.”
- The European Federation for Periodontology (EFP) found that severe periodontitis adversely affects glycemic level (how much a specific food increases blood sugar levels) in both diabetic and pre-diabetic patients
- Depending on the severity of their periodontal disease, diabetic patients are more likely to have complications with their diabetes
- Emerging evidence indicates an increased risk for diabetes onset in patients with severe periodontitis.
What can dental professionals do?
The EFP has developed guidelines to aid oral health professionals in the management of periodontal diseases as they relate to systemic conditions.
The following is a summary of the EFP’s advice on the role of dentist in relation to diabetes prevention and care:
- Dentists should proactively play a role in educating patients about diabetes and periodontitis prevention.
- As a rule, dentists should screen and diagnose for periodontal disease in all diabetes patients.
- Dentists should assess patient dental and medical histories for individuals with high diabetes risk.
- Dentists should evaluate patients for signs or symptoms of poorly controlled or undiagnosed diabetes and refer to a physician for formal medical evaluation and diagnosis.
- Patients with type 1, type 2, or gestational diabetes (GDM) should receive a thorough oral examination, which includes a comprehensive periodontal examination. Even if no periodontitis is diagnosed initially, an annual periodontal review is recommended.
- Randomised clinical trials consistently demonstrate that mechanical periodontal therapy associates with approximately a 0.4% reduction in HbA1C (glycated haemoglobin which identifies average plasma glucose concentration) at 3-months, a clinical impact equivalent to adding a second drug to a pharmacological regimen for diabetes.
- Long-term assessment and management of oral health care may reflect the management of diabetes in general, and assessment of diabetes control may allow the dental care team to predict the success of oral health care.
- Diabetes patients presenting with any overt signs and symptoms of periodontitis, including loose teeth not associated with trauma, spacing or spreading of the teeth, and/or gingival abscesses or gingival suppuration, require prompt periodontal evaluation.
- Oral health education should be provided by dental professionals to all patients with diabetes.
- Patients with diabetes should be told that periodontal disease risk is increased by poorly controlled diabetes.
- Patients should be advised that if they suffer from periodontal disease, their glycaemic control may be more difficult to manage, and they are at higher risk for diabetic complications such as cardiovascular and kidney disease.
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