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Alan J. Moritz, DDS, MS† and Brian L. Mealey, DDS, MS‡
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Abstract
This review examines the unique relationships between periodontal diseases and diabetes mellitus (DM). Scientific literature related to possible mechanisms of interaction, with a focus on potential common pathophysiologic pathways, including those associated with inflammation, altered host responses, and insulin resistance, is reviewed. Current evidence suggests that insulin resistance may be a major shared metabolic abnormality linking the interaction of periodontal disease and type 2 DM. As insulin resistance in type 1 patients is less prominent, this relationship may be most significant for type 2 patients. A model is proposed by which chronic inflammation resulting from periodontal disease may contribute to increased insulin resistance in type 2 DM, thus worsening glycemic control. Subsequently, a reduction in periodontal inflammation through treatment may possibly result in enhanced insulin sensitivity and better glycemic control. Understanding these processes will allow health care providers to gain further insight into additional features these diseases share: both conditions are ultimately treatable and in many ways preventable.
Citation: Moritz A, Mealey B. Periodontal disease, insulin resistance, and diabetes mellitus: a review and clinical implications.
Grand Rounds Oral-Sys Med. 2006;2:13-20. (Digital version Grand Rounds Oral-Sys Med. 2006;2:13-20c.)
(A complimentary copy of this article may be downloaded at www.thesystemiclink.com.)
Key Words: Periodontal disease, diabetes mellitus, inflammation, insulin resistance, obesity
Introduction
Periodontal disease and diabetes mellitus (DM) are chronic disorders that rely on a major inflammatory component to affect host tissue damage. Both conditions have major impacts on the health and well-being of millions of individuals worldwide. Because these diseases are both ubiquitous and insidious, it is important that health care professionals fully understand the risks that these conditions pose to patients and are able to provide the most relevant, up-to-date treatments grounded in the scientific literature. Although associations between a variety of oral health conditions and chronic systemic diseases have been observed in recent years, an interaction between periodontal disease and DM has been documented most consistently.1,2 Current evidence suggests that DM is associated with an increased prevalence and severity of gingivitis (inflammation of the gingiva around the teeth) and periodontitis (inflammation and destruction of the tooth-supporting structures of the periodontal ligament and bone).3,4 Conversely, periodontitis may increase the risk for worsening glycemic control in diabetic patients,5 as well as increasing the risk for diabetic complications.6,7
Epidemiology of Periodontal Disease and Diabetes Mellitus Advanced periodontal disease with deep pockets and de- † struction of periodontal ligaments and alveolar bone afflicts approximately 10%-15% of adults worldwide.8 In the United States, approximately 13% of adults have severe peri- ‡ odontitis, and 35% of those over age 30 have some form of periodontitis.9 The prevalence of periodontitis in the U.S. is
Director, Department of Periodontics, 52nd Dental Squadron, United States Air Force, Spangdahlem Air Base, Germany
Associate Professor, Department of Periodontics, Effective June 2006: Head, Specialist Division and Graduate Program Director, University of Texas Health Science Center at San Antonio, TX
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