Periodontal disease and diabetes share many risk factors and risk modifiers, including obesity, hyperlipidemia, and smoking. Recent evidence may suggest that obesity, and the inflammation associated with adipose tissue, may be a modifying factor in this relationship (Figure 4).79 Obesity has also been shown to negate the effects of nonsurgical periodontal treatment on systemic CRP levels in patients with at least mild chronic periodontitis.80 The modifying affect of obesity on the relationship between periodontitis and diabetes may account for the inconsistent results of some interventional trials57,81-83 and may provide insight into the management of diabetic patients in a dental office as well as indications for dental screening recommendations for diabetic and prediabetic patients under management of a physician.
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