Diabetes

Diabetes mellitus refers to metabolic disorders that interfere with the regulation of glucose. This can occur through insufficient production of insulin by the pancreas or when glucose-dependent cells become resistant to insulin.37 As the number of Americans diagnosed with diabetes approaches 10% of the population and many more remain undiagnosed,38 it will be even more important for dental professionals to recognize the screening opportunities that exist within the dental office. For instance, capillary glucose can be measured in the dental office without requiring a finger prick.39 It is also possible to utilize other diabetic screening tools in addition to a chairside HbA1c screening that assess the patient’s history of conditions, such as hypertension and dyslipidemia, as well as an evaluation of periodontal condition and/or missing teeth as an indicator of dysglycemia.39

Diabetes and periodontitis are two chronic conditions that have been considered to be linked biologically.40 It has been established that diabetic patients are at greater risk for developing periodontal disease29 and that type 2 diabetics have higher prevalence of the disease.41 In addition, poor glycemic control is often related to more severe periodontal conditions.41 This could be due to the chronic inflammatory-immune response that accompanies a hyperglycemic environment. Excessive systemic inflammatory mediators travel to the periodontium, which can result in attachment loss, pocket formation and destruction of alveolar bone.30 Diabetic patients with active periodontal disease may have more difficulty controlling it due to increased inflammation and insulin resistance along with reduced ability to regulate glucose.42 There is also a strong microbial component that makes management more difficult.29 For instance, a study that utilized 16S rRNA gene sequencing noted significant differences between subgingival microbiota in patients with Type 2 diabetes and those without diabetes.29

It is thought that periodontal patients who adhere to a strict maintenance program are better able to manage their blood glucose levels and A1c readings. However, research results are mixed. According to a multicenter, randomized controlled trial conducted in 2016, periodontal therapy had no effect on hemoglobin A1c (HbA1c) or other measures indicating glycemic control in diabetic patients.41 The potential benefit of periodontal therapy is the reduction of local and systemic inflammation, which aids in glycemic control and helps reduce the risk and impact of the disease.37 Specifically, periodontal therapy helps inhibit the secretion of lipopolysaccharides (LPS) from pathogens, such as porphyromonas gingivalis, which improves the ability of certain cytokine proteins to regulate insulin activity.30 This suggests that the management of oral disease can positively affect diabetes and vice versa. Additionally, it is worth noting that when diabetic patients receive periodontal treatment and are well-maintained, there is a significant reduction in medical costs and number of hospitalizations observed.26