Background: Diabetes and periodontitis are chronic non-communicable diseases independently associated with mortality and have a bidirectional relationship. Aims: To update the evidence for their epidemiological and mechanistic associations and re-examine the impact of effective periodontal therapy upon metabolic control (glycated haemoglobin, HbA1C). Epidemiology: There is strong evidence that people with periodontitis have elevated risk for dysglycaemia and insulin resistance. Cohort studies among people with diabetes demonstrate significantly higher HbA1C levels in patients with periodontitis (versus periodontally healthy patients), but there are insufficient data among people with type 1 diabetes. Periodontitis is also associated with an increased risk of incident type 2 diabetes. Mechanisms: Mechanistic links between periodontitis and diabetes involve elevations in interleukin (IL)-1-β, tumour necrosis factor-α, IL-6, receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio, oxidative stress and Toll-like receptor (TLR) 2/4 expression. Interventions: Periodontal therapy is safe and effective in people with diabetes, and it is associated with reductions in HbA1C of 0.27–0.48% after 3 months, although studies involving longer-term follow-up are inconclusive. Conclusions: The European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF) report consensus guidelines for physicians, oral healthcare professionals and patients to improve early diagnosis, prevention and comanagement of diabetes and periodontitis.
Bibliographical noteFunding Information:
Funded through an unrestricted grant from Sunstar to the European Federation of Periodontology to organize the EFP/IDF Workshop
Funding for this workshop was provided by the European Federation of Periodontology in part through unrestricted educational grants from Sunstar. Workshop participants filed detailed disclosures of potential conflict of interests relevant to the workshop topics, and these are kept on file. Declared potential dual commitments included having received research funding, consultant fees and speaker’s fee from Colgate-Palmolive, Procter & Gamble, Johnson & Johnson, Sunstar and Dentaid.
© 2017 John Wiley & Sons A/S and Elsevier B.V.
- chronic kidney disease
- diabetes mellitus
- gestational diabetes
- periodontal disease
- type 1 diabetes
- type 2 diabetes