Conclusion and Treatment Considerations 5. Taylor GW, Burt BA, Becker MP, et al. Severe periodontitis
Although treatment of DM and periodontal disease is cov- ^{and risk for poor glycemic control in patients with}
ered in detail in other articles in this publication, some ^{non-insulin-dependent diabetes mellitus. J Periodontol} _{1996;67:1085-1093.}
^{general considerations in the clinical management of} 6. Thorstensson H, Kuylensteirna J, Hugoson A. Medical
DM and periodontal diseases can be made based on the status and complications in relation to periodontal disease
pathophysiological interrelationships discussed in this experience in insulin-dependent diabetics. J Clin Periodontol
1996;23:194-202.
^{article. Diabetes mellitus and periodontal diseases are} 7. Saremi A, Nelson RG, Tulloch-Reid M, et al. Periodontal
chronic, treatable conditions, although neither has a cure, disease and mortality in type 2 diabetes. Diabetes Care
and each requires long-term follow-up and reinforcement ^{2005;28: 27-32.}
8. Petersen P, Ogawa H. Strengthening the prevention of
for maximum treatment results. From the medical side, _{periodontal disease: the WHO approach. J Periodontol}
all patients diagnosed with and treated for DM should be 2005;76:2187-2193.
routinely referred to a dentist to evaluate their periodon- ^{9. Albandar JM, Brunelle JA, Kingman A. Destructive}
_{tal condition as part of the overall treatment for DM. Phy-} periodontal disease in adults 30 years of age and older in _{the United States, 1988-1994. J Periodontol 1999;70:13-}
sicians should be aware of the potential impact of peri- _29.
odontal inflammation on achieving ideal glycemic con- 10. AAP Position Paper: Epidemiology of Periodontal Diseases.
trol and should concern themselves with their patients’ ^{J Periodontol 2005;76:1406-1419.}

11. Mokdad AH, Ford ES, Bowman BA, et al. The continuing ^{periodontal status. Medical providers should also educate} increase of diabetes in the U.S. Diabetes Care 2001;24:412. their DM patients about the potential role of conditions af- 12. National Center for Health Statistics, United States, 2005. fecting insulin resistance, including periodontal diseases, ^{Chartbook on Trends in the Health of Americans, Table 55.}

Hyattsville, MD. 2005.
^{and the importance of controlling such conditions.} 13. Zimmet P, Alberti KG, Shaw J. Global and societal implications
of the diabetes epidemic. Nature 2001;414:782-787.

Dentists should screen a patient’s medical history for the 14. Harris MI, Couric CC, Reiber G, et al. Diabetes in America, ^nd _{possibility of DM; order or refer the patient for appropri-} 2 ed. Washington DC: U.S. Printing Office; NIH publication _{(1995) 95-1468.} ate laboratory tests to verify glycemic status when needed; _{15. Centers for Disease Control and Prevention. National} and refer the patient to medical providers for definitive Diabetes Fact Sheet. Available at http://www.cdc.gov/ diagnosis and treatment, if indicated. Dental profession- ^{diabetes/pubs/ estimates.htm. Accessed January 16, 2005.}

166. Paster BJ, Bloches SK, Galvin JL, et al. Bacterial diversity
als should educate their DM patients that the control of _{in human subgingival plaque. J Bacteriol 2001;183:3770-}
blood glucose is important in establishing and maintain- 3783.
_{ing periodontal health and that periodontal health has} 17. Kornman KD, Page RC, Tonetti MS. The host response to
the microbial challenge in periodontitis: assembling the

the potential to enhance glycemic control. Excellent oral _{players. Periodontol 2000 1997;14:33-53.}
hygiene and consistent compliance with dental examina- 18. Gemmell E, Marshall RI, Seymour GJ. Cytokines and
tions and preventive care should be emphasized to these ^{prostaglandins in immune homeostasis and tissue}
patients as the keys to achieving overall health. destruction in periodontal disease. Periodontol 2000 _{1997;14:112-143}
19. Hujoel PP, White BA, Garcia RI, Listgarten MA. The
Finally, patients with DM and periodontal disease must dentogingival epithelial surface area revisited. J Periodontal
endeavor to educate themselves about their conditions ^{Res 2001;36:48-55.}

20. Loos BG. Systemic markers of inflammation in periodontitis.
and must work closely with their healthcare providers to _{J Periodontol 2005;76:2106-2115.}
control these chronic diseases. Patients should strive to 21. Daly CG, Mitchell DH, Highfield JE, et al. Bacteremia due
achieve maximal glycemic control through diet, exercise, ^{to periodontal probing: a clinical and microbiological}
investigation. J Periodontol 2001;72:210-214.

^{medications, and periodontal health in order to realize} 22. Geerts SO, Nys M, De Mol P, et al. Systemic release of the best possible outcomes. endotoxins induced by gentle mastication: association with periodontitis severity. J Periodontol 2002;73:73-78.

23. Loos BG, Craandijk J, Hoek FJ, Wertheim-van Dillen PME,

References van der Velden U. Elevation of systemic markers related 1. Grossi S, Genco R. Periodontal disease and diabetes mellitus: to cardiovascular diseases in the peripheral blood of

A two-way relationship. Ann Periodontol 1998;3:51-61. periodontitis patients. J Periodontol 2000;71:1528-1534.

2. Soskolne W, Klinger A. The relationship betweenperiodontal 24. Steel D, Whitehead AS. The major acute phase reactants: diseases and diabetes: An overview. Ann Periodontol C-reactive protein, serum amyloid P component and serum 2001;6:91-98. amyloid A component. Immunol Today 1994;15:81-88.

3. MealeyBL.Periodontalimplications:medicallycompromised _patients. Ann Periodontol _{1996;1:256-321.} For additional references to this article, please consult the

4. Papapanou PN. Periodontal disease: epidemiology. Ann digital version of Grand Rounds in Oral-Systemic Medicine at Periodontol _{1996;1: 1-36.} www.thesystemiclink.com.