Updates from the Evidence Base Examining Association between Periodontal Disease and Type 2 Diabetes Mellitus: Current Status and Clinical Relevance
Purpose of the Review
Epidemiological surveillance documents an escalating epidemic prevalence of both type 2 diabetes (T2DM) and periodontal disease (PD). The principal goals of this review are to: 1) re-examine the clinical significance of associations between PD and T2DM, based on strength of collective evidence as determined by systematic review and meta-analysis, and 2) review findings of the systematic reviews and meta-analyses in light of the current understanding of PD-associated pathophysiology and intersection with T2DM pathophysiology.
Tooth loss predicts risk for chronic disease and mortality. PD is significantly associated with complications of diabetes, including retinopathy. Based on systematic reviews and meta-analyses, the adjunctive use of certain antibiotics enhances non-surgical periodontal treatment (NSPT) in patients with T2DM. Systematic reviews and meta-analyses support NSPT efficacy in achieving metabolic control.
Systematic reviews and meta-analyses support the association between PD and T2DM, albeit the effect size may be modest. PD-T2DM interactions have important clinical implications.
KeywordsPeriodontal disease Diabetes mellitus, type 2 Systematic reviews as topic Meta-analysis as topic Tooth loss Delivery of healthcare, Integrated
This review was supported by grant funding from Delta Dental of Wisconsin.
Compliance with Ethical Standards
Conflict of Interest
Ingrid Glurich and Amit Acharya declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 7.Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci (Qassim). 2017;1:72–80.Google Scholar
- 8.• Eke PI, Thornton-Evans GO, Wei L, et al. Periodontitis in US Adults: National Health and Nutrition Examination Survey 2009–2014. J Am Dent Assoc. 2018;149:576–588.e6. https://doi.org/10.1016/j.adaj.2018.04.023. Latest update of periodontal disease surveillance, methodological approach, and prevalence estimates in the USA.CrossRefPubMedGoogle Scholar
- 11.World Health Organization. Cardiovascular disease https://www.who.int/cardiovascular_diseases/en/ (accessed 5-30-2019).
- 13.• Sanz M, Ceriello A, Buysschaert M, Chapple I, Demmer RT, Graziani F, et al. Scientific evidence on the links between periodontal disease and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology. Diab Res Clin Prac. 2018;137:231–41. https://doi.org/10.1111/jcpe.12808, https://www.ncbi.nlm.nih.gov/pubmed/29208508. Most recent expert joint consensus report and clinical practice guideline on PD and diabetes management informed by scientific evidence review issued by the IDF and EFP.CrossRefGoogle Scholar
- 14.• Graziani F, Gennal S, Solini A, Oetrini M. A systematic review and meta-analysis of epidemiologic observational evidence on the effect of periodontal disease on diabetes: an update of the review of the EFP-AAP workshop. J Clin Periodontol. 2018;45:167–87. https://doi.org/10.1111/jcpe.12837 https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.12837. Results of a systematic review and meta-analysis by an international workgroup of experts from the European Federation of Periodontology and American Association of Periodontology of observational studies examining effect of PD on T2DM.CrossRefPubMedGoogle Scholar
- 15.Song SJ, Han K, Lee S, Park JB. Association between the number of natural teeth and diabetic retinopathy among type 2 diabetes mellitus: The Korea national health and nutrition examination survey. Medicine (Baltimore). 2017;96:479e8694. https://doi.org/10.1097/MD.0000000000008694.CrossRefGoogle Scholar
- 16.Horikawa Y, Suzuki A, Enya M, Hashimoto K, Nishida S, Kobayashi R, et al. Periodontal disease may be associated with the occurrence of diabetic retinopathy: a subgroup analysis of the survey of the diabetes coordination notebook in Gifu. Exp Clin Endocrinol Diabetes. 2019. https://doi.org/10.1055/a-0879-1890.
- 23.Hasuike A, Iguchi S, Suzuki D, Kawano E, Sato S. Systematic review and assessment of systematic reviews examining the effect of periodontal treatment on glycemic control in patients with diabetes. Med Oral Patol Oral Cir Bucal. 2017;22(2):e167–76. https://doi.org/10.4317/medoral.21555.CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2017. https://www.cdc.gov/diabetes/data/statistics/statistics-report.html (accessed 5-29-2019)Google Scholar