Clinical Oral Investigations

, Volume 22, Issue 8, pp 2743–2762 | Cite as

Differences in the subgingival microbial population of chronic periodontitis in subjects with and without type 2 diabetes mellitus—a systematic review

  • Linda Sun Liu
  • Nikolaos Gkranias
  • Bruna Farias
  • Dave Spratt
  • Nikolaos DonosEmail author



The purpose of this systematic review was to evaluate the available evidence in the literature in regard to the subgingival microbial population of chronic periodontitis in subjects with type 2 diabetes mellitus (T2DM+PD) compared to non-diabetic subjects (NDM+PD).

Materials and methods

A literature search was conducted at Ovid MEDLINE and EMBASE database from 1980 to 2016, supplemented by hand searching as needed. Studies presenting with at least one of the primary outcomes (presence of any subgingival microorganisms, proportion and/or the amount of any subgingival plaque bacteria in T2DM+PD versus NDM+PD) were included. Screening, data extraction and quality assessment were conducted independently and in duplicate.


From 611 citations, 19 full-text papers were screened and 11 articles were included for critical appraisal by both reviewers. Some evidence of a difference in the microbial profile between chronic PD subjects with and without T2DM was identified. The strength of evidence is strongest in Tannerella forthysia (T .forsythia) which was reported to be less frequent in the diabetic (T2DM+PD) group in five of the studies, followed by a weaker strength of evidence for other periodontal pathogens such as Porphyromonas gingivalis (P. gingivalis) and Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), which were also found less frequent in the diabetic (T2DM+PD) group .


Only few studies have compared T2DM+PD with NDM+PD. It is therefore strongly recommended that further studies which include four distinct groups of participants (NDM+PD, T2DM+PD, NDM+NPD, T2DM+NPD) instead of using intra-subject comparisons between healthy and diseased sites of the same subjects.

Clinical relevance

Differences in bacterial populations of T2DM+PD in comparison to NDM+PD subjects may indicate the need of different protocols for the treatment of the diabetic patients with periodontal disease.


Periodontitis Diabetes mellitus Systematic review Microbiological analyses 



The work was supported by the Department of Periodontology, UCL Eastman Dental Institute, London, UK.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study, ethical approval is not required.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Periodontology UnitUCL Eastman Dental InstituteLondonUK
  2. 2.Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine & DentistryQueen Mary University of London (QMUL)LondonUK
  3. 3.Postgraduate DepartmentFederal University of PernambucoRecifeBrazil
  4. 4.Microbiology DepartmentUCL Eastman Dental InstituteLondonUK

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