Current evidence suggests diabetes is a risk factor for gingivitis and periodontitis and that the level of glycemic control is an important determinant in this relationship.36-38 Diabetes has been associated with an increased risk of periodontitis in children,39 in populations with high incidence of diabetes mellitus,40-43 and in adult populations.44,45 In a multivariate risk analysis, subjects with diabetes demonstrated an approximately 3-fold increased odds of having periodontitis compared to healthy subjects after adjusting for confounding factors including age, gender, and oral hygiene.38,41,42 Additionally, diabetic subjects with poor glycemic control demonstrated greater progressive bone loss as compared with subjects with diabetes who are well-controlled.43,46,47 Periodontitis has been referred to as the “sixth complication of diabetes”48 indicating that much like the classic complications of diabetes, periodontitis may be a result of the extended hyperglycemia on the periodontal tissues.
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