Over the last decade there have been numerous studies providing compelling evidence that periodontal therapy can improve metabolic control in diabetes, reduce pre-term birth in high risk pregnant females, and reduce pneumonia in patients in intensive care units. In contrast, and despite the strong data confirming the relationship between diabetes and periodontitis, many practitioners in both medicine and dentistry have failed to convert these findings into clinical actions. There is no doubt that poor glycemic control, as assessed by glycated hemoglobin levels (HbA1c), increases the risk for developing the long-term complications of diabetes, including periodontitis. This article presents 4 case studies that demonstrate the importance of achieving and sustaining optimal oral care in the diabetic patient and offers scientifically supported recommendations for treatment of periodontal disease, and strategies for progressive disease management to achieve metabolic control of diabetes and decrease risk for diabetic complications.
Citation: Ryan M, Carnu O, Tenzler R. The impact of periodontitis on metabolic control and risk for diabetic complications. Grand
Rounds Oral-Sys Med. 2006;2:24-34. (Digital version Grand Rounds Oral-Sys Med. 2006;2:24-34a.)
(A complimentary copy of this article may be downloaded at
www.thesystemiclink.com.)
The bridge between systemic disease and oral inflammation, primarily the role of periodontal disease, has been the focus of a multitude of publications in both medical and dental journals. The strongest data supporting an oral-systemic link exists for diabetes and periodontitis with reports of this connection traced back to the 1920s1 and 1930s. 2 In addition, an uncontrolled oral infection such as periodontitis will increase the risk for poor metabolic control and certain long-term complications of diabetes, particularly nephropathy3 and cardiovascular disease (CVD). 4 Recent research has shown that improving oral health is important to optimizing metabolic control of diabetes; 5-7 therefore, the treatment of periodontal diseases should not be considered optional or elective, but instead a standard of care integral to diabetes management.
In 1993 Dr. Harold Löe, former director of the National Institute for Dental and Craniofacial Research, 8 identified periodontitis as the sixth long-term complication of diabetes. Today, adults with diabetes have heart disease death rates about 2 to 4 times higher than those without diabetes; and the risk for stroke is 2 to 4 times higher among diabetic people. Despite these dismal statistics, evidence of a bi-directional relationship between diabetes and periodontal disease, and the potential of unattended periodontal infection to increase diabetic complications, there still exists a practice gap in dentistry and medicine in the recognition and/or proactive management of diabetic patients with periodontal disease. A recent survey of general dentists and periodontists revealed † Director of Clinical Research; School of Dental Medicine, that dental practitioners’ rates of proactive management of dia- State University of New York at Stony Brook betic patients, e.g., willingness to change/adjust treatment plans, ‡ Graduate Student; School of Dental Medicine, State
University of New York at Stony Brook
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