An extensive body of literature reports that diabetes is a risk factor for gingivitis and periodontitis, and the degree of glycemic control is a determining factor in the vulnerability to oral health complications that are three to four times higher as compared to systemically healthy individuals. Glycemic control is reasoned to be an important determinant in the immunoinflammatory response to bacteria that is not readily seen in those without diabetes. Although little difference has been found in the cultures of periodontal sites of diabetes to those without diabetes, a noteworthy difference is found in the immune defense. The diabetic patient displays impaired white blood cell functions (first line of defense), which is linked to increased periodontal destruction.26
Most evidence also indicates diabetes is associated with an increased risk of periodontitis, as well as increased disease severity and progression. It is generally thought that poorly controlled diabetes increases the risk of complications while well-controlled diabetes reduces the risk, though some studies provide mixed results where poorly controlled patients do not develop periodontitis and well-controlled patients do.26-28,40-44
Additional factors contributing to diabetes and associated periodontal risk concerns may include impaired connective tissue metabolism and bone healing, high glucose levels in gingival crevicular fluid hindering wound healing, microvascular changes, and changes in collagen synthesis and maturation.26-28,40,43,44
A 1993 review of epidemiologic studies estimated that one in three diabetics have severe periodontitis. This finding asserts aggressive periodontitis as the sixth complication of diabetes.45 The net effect of the defense alterations is an increase in periodontal inflammation, attachment loss and bone loss.46
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