Knowledge In Action
Focus: Impact of Diabetes Control on Periodontal Treatment Outcomes
Welcome to the latest installment of our Knowledge in Action series — your source for evidence-based insights in dental hygiene.
Key Findings
Understanding the Link Between Diabetes and Oral Health
This month, we explore the relationship between diabetes mellitus (DM) and periodontal disease. Persons with diabetes have a 2-3-fold greater risk for periodontitis compared to persons without diabetes, but also a higher incidence of caries due to dry mouth and increased levels of salivary lactate. A recent systematic review and network meta-analysis confirms the bidirectional relationship between diabetes and oral health. Periodontal inflammation affects insulin sensitivity or action, while poor glycemic control leads to the deterioration of periodontal health. Half to 80% of individuals with Type 2 diabetes mellitus (DM2) have a form of periodontal disease (severe gingivitis or periodontitis), particularly when diabetes is poorly controlled, yet the majority are unaware of the connection between diabetes and their oral health.
Key Takeaways:
· Diabetes Status Matters: Periodontal inflammation is involved in the pathogenesis of DM2 and leads to poor glycemic control. The presence of diabetes, regardless of glycemic control, can pose significant oral health complications. There is a direct relationship between good oral health and the control of DM – oral health education and periodontal treatment can improve glycemic control, by restricting inflammation.
· Glycemic Control Impact: Conservative periodontal treatment has been shown to reduce HbA1c percentage in persons with DM2 and periodontitis. Non-surgical periodontal therapy (NSPT) should therefore be included as part of overall diabetes management for persons with DM2.
· Dental Hygiene Implications: NSPT appears to be effective in combination with oral hygiene education in controlling both diabetes and periodontitis. The presence of diabetes, regardless of glycemic control, can affect periodontal treatment outcomes. This underscores the need for health promotion and management strategies for both of these chronic diseases as part of person centered and holistic dental hygiene care. Patients with diabetes would benefit from integrated and systematic medical and oral health care for the long-term control of diabetes. Increased understanding of genetic factors and salivary biomarkers may further inform etiological theory and clinical management in the future.
