Clinical Decision Making for Treatment of Patients with Periodontal Disease and Diabetes in a Dental Setting

Caring for patients with both diabetes and periodontitis requires careful evaluation, quantification and ongoing monitoring of existing periodontal inflammation. Consultation with the patient’s physician in regards to current levels of glycemic control and future diabetes management is an important aspect of their overall medical management. Additionally, given the large number of undiagnosed diabetic patients, dental healthcare providers must be aware of the signs and symptoms of diabetes to make appropriate referrals when indicated. Patients with diabetes may also require additional evaluations and treatment for comorbid diseases, such as obesity and cardiovascular disease.

Since conventional therapies are not always as effective in diabetic patients as on unaffected patients, adjunctive therapies should be considered. The addition of adjunctive antibiotic therapy in diabetic patients has been shown to increase the effect of periodontal therapy on glycemic control in some diabetic patients.88 Therefore, antibiotics may be considered during both active therapy and maintenance to improve results of periodontal therapy.

Figure 5. Risk Factors Associated with Diabetes and Periodontitis to Consider during Periodontal Therapy.