Diabetes Mellitus (DM)

      Basis of Current Understanding: Numerous Prospective and Cross-Sectional Studies

                                  Studies on Biochemical Relationships

                                  Studies on Periodontal Treatment Effects on Diabetes

      Strength of Statistical Evidence: Relationship - Strong

      Studies Link Periodontal Treatment to Reduction of Disease: Yes

      Reported Risk: 30-198%                                                  

      The relationship between gum disease and Diabetes Mellitus is the most well established of all of the links between Periodontal Disease and other diseases. Many studies have shown  statistically significant relationships when they have examined Diabetes influencing the chances of Periodontal Disease or Periodontal Disease increasing the risk of Diabetes.  The two diseases are also synergistic – when both are present, they have a greater effect on other organ systems than if their individual effects were simply added. 

      Recent studies have begun to delve into the nature of the relationship between the two diseases. For example, investigators have found that the bacteria that cause gum disease is related to increased blood sugar levels.  Going in the opposite direction, they have found that the level of bleeding and tissue inflammation in Periodontal Disease can be predicted by the level of proteins altered by high blood sugar levels.

      Diabetes influences the course and severity of gum disease by altering the body’s ability to respond to infection.  In particular, white blood cells are less capable of eliminating bacteria and instead can cause surrounding healthy gum tissues to become inflamed.  At the same time, Diabetes can change the equilibrium between the cells that create and remove bone.  This makes it more likely that the alveolar bone surrounding the teeth will be destroyed by the periodontal disease process.

      Gum disease affects Diabetes by creating cytokines – messengers created by infections and inflammatory disease.  Cytokines affect many organs throughout the body.  For instance, Tumor Necrosis Factor-α (TNF-α) has been shown to disrupt the lining of large blood vessel, making them more predisposed to atherosclerosis.  Other cyctokines make cells more insulin resistant, raising blood sugar levels and making it more difficult for cells to get the energy they need to function optimally.

      A number of studies have attempted to discover if periodontal treatment can affect blood sugar levels in type 2 diabetics.  While the results have been complicated by the definition of gum disease used in the various studies, the majority have shown a modest level of average blood sugar reduction after scaling and root planing.  Two studies published in 2007 and 2008 have shown nearly identical average HbA1c reductions of about 0.6%.  Individual results in all of the studies vary widely.  Some participants had no reduction in blood sugar levels while a few showed HbA1c reductions of more than 3%.

For a more detailed discussion of the link between Periodontal Disease and Diabetes, including a list of reference, please see our article “The Connection Between Periodontal Disease and Diabetes”.  For information on how we tailor dental care for our diabetic patients, please see Periodontal Management of the Diabetic Patient.