The relationship between diabetes and periodontal health

Periodontal disease and diabetes have a two-way relationship. Studies show the two to be closed linked as the risk of periodontitis aggravated the effects of diabetes in patients with poor glycemic control and diabetes is also a significant risk factor for periodontal disease. Diabetes and chronic gum disease are both largely prevalent in the population and according to data, the the risk of periodontal disease is increased by three-fold in patients with uncontrolled glycemic control.

Periodontitis is a chronic inflammatory condition with destruction of supporting tissues around the teeth. It contains a diverse colony of bacteria which inhabits the pockets formed due to tissue breakdown and destruction. Neutrophils are the first line of defence in infection and they initiate the migration of cells, to induce chemotaxis and then phagocytosis. However, in diabetic patients, there is defective adherence of neutrophils, which dysregulates the cascade of events which needs to be followed to fight off infection. This leads to prolonged survival of microorganisms in the periodontal tissues, leading to worse cases of periodontitis. There is also an increased inflammatory cytokines load in diabetic patients which makes the disease fighting cells, i.e, monocytes and macrophages hyper responsive which causes more release of tumour necrosis factors and interleukin beta, leading to a unregulated inflammatory environment which causes increased periodontal tissue breakdown.

Does periodontal treatment helps diabetes?

Following periodontal treatment, HbA1c levels decrease significantly in diabetic patients, and the pro-inflammatory cytokines levels also reduce leading to improved glycemic control. The evidence showing the direct link between an improvement in immunological, pathological and clinical parameters and the level of glycemic control with the treatment of periodontal disease and diabetes is vast. The interplay between the two conditions highlights the need for its discussion with patients with history of either.

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