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Current Oral Health Reports

, Volume 3, Issue 1, pp 28–35 | Cite as

Diabetes and Periodontitis—A Dental Hygienist’s Perspective

  • Casey HeinEmail author
Systemic Diseases (M Bartold, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Systemic Diseases

Abstract

Several decades of research of the interrelationships between diabetes and periodontitis have evolved into a significant body of knowledge that should be incorporated into dental practice. However, there may be a delay in implementing this important information into everyday patient care. Oral healthcare providers (i.e., dentists and dental hygienists) should be progressively engaged in changing the trajectory of the epidemics of diabetes and periodontitis. This article synthesizes the cumulative evidence on the diabetes-periodontitis link, proposes ideas for risk stratification of dental patients with diabetes and periodontitis, and builds a case for the development of a risk-prediction model that provides for the earliest identification of dental patients who have dysglycemia.

Keywords

Periodontal disease Periodontitis Diabetes-periodontal disease relationship Periodontitis and glycemic control Periodontitis and prediabetes Diabetes screening in dental office 

Notes

Compliance with Ethical Standards

Conflict of Interest

Casey Hein declares that she has 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.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Yuen HK, Mountford WK, Magruder KM, Bandyopadhyay D, Hudson PL, Summerlin LM, et al. Adequacy of oral health information for patients with diabetes. J Public Health Dent. 2009;69(2):135–41.PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Forbes K, Thomson WM, Kunzel C, Lalla E, Lamster IB. Management of patients with diabetes by general dentists in New Zealand. J Periodontol. 2008;79(8):1401–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Allen EM, Ziada HM, O’Halloran D, Clerehugh V, Allen PF. Attitudes, awareness and oral health-related quality of life in patients with diabetes. J Oral Rehabil. 2008;35(3):218–23.CrossRefPubMedGoogle Scholar
  4. 4.
    Boyd LD, Hartman-Cunningham ML. Survey of diabetes knowledge and practices of dental hygienists. J Dent Hyg. 2008;82(5):43.PubMedGoogle Scholar
  5. 5.
    Bahammam MA. Periodontal health and diabetes awareness among Saudi diabetes patients. Patient Prefer Adherence. 2015;9:225–33.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Schjetlein AL, Jorgensen ME, Lauritzen T, Pedersen ML. Periodontal status among patients with diabetes in Nuuk, Greenland. Int J Circumpolar Health. 2014;73:26093.CrossRefPubMedGoogle Scholar
  7. 7.
    Ahdi M, Teeuw WJ, Meeuwissen HG, Hoekstra JB, Gerdes VE, Loos BG, et al. Oral health information from the dentist to the diabetologist. Eur J Intern Med. 2015;26(7):498–503.CrossRefPubMedGoogle Scholar
  8. 8.
    Lin H, Zhang H, Yan Y, Liu D, Zhang R, Liu Y, et al. Knowledge, awareness, and behaviors of endocrinologists and dentists for the relationship between diabetes and periodontitis. Diabetes Res Clin Pract. 2014;106(3):428–34.CrossRefPubMedGoogle Scholar
  9. 9.
    Leite RS, Marlow NM, Fernandes JK. Oral health and type 2 diabetes. Am J Med Sci. 2013;345(4):271–3.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Löe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993;16(1):329–34.CrossRefPubMedGoogle Scholar
  11. 11.
    Strauss SM, Alfano MC, Shelley D, Fulmer T. Identifying unaddressed systemic health conditions at dental visits: patients who visited dental practices but not general health care providers in 2008. Am J Public Health. 2012;102(2):253–5.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Strauss SM, Russell S, Wheeler A, Norman R, Borrell LN, Rindskopf D. The dental office visit as a potential opportunity for diabetes screening: an analysis using NHANES 2003–2004 data. J Public Health Dent. 2010;70(2):156–62.PubMedGoogle Scholar
  13. 13.
    Herman WH, Taylor GW, Jacobson JJ, Burke R, Brown MB. Screening for prediabetes and type 2 diabetes in dental offices. J Public Health Dent. 2015;75(3):175–82.CrossRefPubMedGoogle Scholar
  14. 14.
    International Diabetes Federation. IDF Diabetes Atlas Sixth Edition Poster Update 2014. Available at: http://www.idf.org/sites/default/files/Atlas-poster-2014_EN.pdf. Accessed 18 Sept 2015.
  15. 15.
    International Diabetes Federation. IDF Diabetes Atlas. 2011;5th ed.Google Scholar
  16. 16.••
    American Diabetes Association. Standards of medical care in diabetes—2015. Diabetes Care. 2015;38(Supplement 1):1–94. Dentists and dental hygienists should be familiar with the guidelines of the American Diabetes Association (ADA) and other authorities on diabetes. This position paper, that embodies the guidelines, are updated annually by the ADA.Google Scholar
  17. 17.•
    Phillips LS, Ratner RE, Buse JB, Kahn SE. We can change the natural history of type 2 diabetes. Diabetes Care. 2014;37(10):2668–76. This article provides background on the trajectory of dysglycemia to diabetes and makes the case for intervention at the earliest stage of dysglycemia.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Richards D. Review finds that severe periodontitis affects 11% of the world population. Evid Based Dent. 2014;15(3):70–1.CrossRefPubMedGoogle Scholar
  19. 19.
    Marcenes W, Kassebaum N, Bernabé E, Flaxman A, Naghavi M, Lopez A, et al. Global burden of oral conditions in 1990–2010: a systematic analysis. J Dent Res. 2013;92(7):592–7.PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ. CDC Periodontal Disease Surveillance workgroup: James Beck (University of North Carolina, Chapel Hill, USA), Gordon Douglass (Past President, American Academy of Periodontology), Roy Page (University of Washin. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012;91(10):914–20.CrossRefPubMedGoogle Scholar
  21. 21.
    Belting C, Hiniker J, Dummett C. Influence of diabetes mellitus on the severity of periodontal disease. J Periodontol. 1964;35(6):476–80.CrossRefGoogle Scholar
  22. 22.
    Salvi GE, Carollo-Bittel B, Lang NP. Effects of diabetes mellitus on periodontal and peri-implant conditions: update on associations and risks. J Clin Periodontol. 2008;35(8 Suppl):398–409.CrossRefPubMedGoogle Scholar
  23. 23.
    Chavarry NG, Vettore MV, Sansone C, Sheiham A. The relationship between diabetes mellitus and destructive periodontal disease: a meta-analysis. Oral Health Prev Dent. 2009;7(2):107–27.PubMedGoogle Scholar
  24. 24.
    Khader YS, Dauod AS, El-Qaderi SS, Alkafajei A, Batayha WQ. Periodontal status of diabetics compared with nondiabetics: a meta-analysis. J Diabet Complications. 2006;20(1):59–68.CrossRefGoogle Scholar
  25. 25.
    Tsai C, Hayes C, Taylor GW. Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population. Community Dent Oral Epidemiol. 2002;30(3):182–92.CrossRefPubMedGoogle Scholar
  26. 26.
    Mealey BL, Ocampo GL. Diabetes mellitus and periodontal disease. Periodontol 2000. 2007;44:127–53.CrossRefPubMedGoogle Scholar
  27. 27.
    Bandyopadhyay D, Marlow M, Fernandes J, Leite R. Periodontal disease progression and glycaemic control among Gullah African Americans with type-2 diabetes. J Clin Periodontol. 2010;37(6):501–9.PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Taylor GW, Burt BA, Becker MP, Genco RJ, Shlossman M. Glycemic control and alveolar bone loss progression in type 2 diabetes. Ann Periodontol. 1998;3(1):30–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Collin HL, Uusitupa M, Niskanen L, Kontturi-Narhi V, Markkanen H, Koivisto AM, et al. Periodontal findings in elderly patients with non-insulin dependent diabetes mellitus. J Periodontol. 1998;69(9):962–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Taylor G, Borgnakke W. Periodontal disease: associations with diabetes, glycemic control and complications. Oral Dis. 2008;14:191–203.CrossRefPubMedGoogle Scholar
  31. 31.
    Taylor GW, Burt BA, Becker MP, Genco RJ, Shlossman M, Knowler WC, et al. Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus. J Periodontol. 1996;67(10 Suppl):1085–93.CrossRefPubMedGoogle Scholar
  32. 32.
    Banthia R, Raje S, Banthia P, Saral SK, Singh P, Gupta S. Evaluation of the association between periodontal disease and diabetic retinopathy. Gen Dent. 2014;62(6):e28–32.PubMedGoogle Scholar
  33. 33.
    Karjalainen KM, Knuuttila ML, von Dickhoff KJ. Association of the severity of periodontal disease with organ complications in type 1 diabetic patients. J Periodontol. 1994;65(11):1067–72.CrossRefPubMedGoogle Scholar
  34. 34.
    Moore P, Weyant R, Mongelluzzo M, Myers D, Rossies K, Guggenheimer J, et al. Type 1 diabetes mellitus and oral health: assessment of tooth loss and edentulism. J Public Health Dent. 1998;58(2):135–42.CrossRefPubMedGoogle Scholar
  35. 35.
    Moore P, Weyant R, Mongelluzzo M, Myers D, Rossie K, Guggenheimer J, et al. Type 1 diabetes mellitus and oral health: assessment of periodontal disease. J Periodontol. 1999;70(4):409–17.CrossRefPubMedGoogle Scholar
  36. 36.
    Thorstensson H, Kuylenstierna J, Hugoson A. Medical status and complications in relation to periodontal disease experience in insulin-dependent diabetics. J Clin Periodontol. 1996;23(3 Pt 1):194–202.CrossRefPubMedGoogle Scholar
  37. 37.
    Shultis WA, Weil EJ, Looker HC, Curtis JM, Shlossman M, Genco RJ, et al. Effect of periodontitis on overt nephropathy and end-stage renal disease in type 2 diabetes. Diabetes Care. 2007;30(2):306–11.CrossRefPubMedGoogle Scholar
  38. 38.
    Saremi A, Nelson RG, Tulloch-Reid M, Hanson RL, Sievers ML, Taylor GW, et al. Periodontal disease and mortality in type 2 diabetes. Diabetes Care. 2005;28(1):27–32.CrossRefPubMedGoogle Scholar
  39. 39.
    Patel A, Chalmers J, Poulter N. ADVANCE: action in diabetes and vascular disease. J Hum Hypertens. 2005;19 Suppl 1:S27–32.CrossRefPubMedGoogle Scholar
  40. 40.
    Li Q, Chalmers J, Czernichow S, Neal B, Taylor BA, Zoungas S, et al. Oral disease and subsequent cardiovascular disease in people with type 2 diabetes: a prospective cohort study based on the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial. Diabetologia. 2010;53(11):2320–7.PubMedCentralCrossRefPubMedGoogle Scholar
  41. 41.••
    Demmer RT, Jacobs Jr DR, Desvarieux M. Periodontal disease and incident type 2 diabetes: results from the First National Health and Nutrition Examination Survey and its epidemiologic follow-up study. Diabetes Care. 2008;31(7):1373–9. This is the landmark study that first suggested that periodontal disease may precipitate incident diabetes. It provides the background on the inflammatory pathway that may be implicated in this association.PubMedCentralCrossRefPubMedGoogle Scholar
  42. 42.
    Wolff RE, Wolff LF, Michalowicz BS. A pilot study of glycosylated hemoglobin levels in periodontitis cases and healthy controls. J Periodontol. 2009;80(7):1057–61.CrossRefPubMedGoogle Scholar
  43. 43.
    Demmer RT, Desvarieux M, Holtfreter B, Jacobs Jr DR, Wallaschofski H, Nauck M, et al. Periodontal status and A1C change: longitudinal results from the study of health in Pomerania (SHIP). Diabetes Care. 2010;33(5):1037–43.PubMedCentralCrossRefPubMedGoogle Scholar
  44. 44.
    Santos Tunes R, Foss-Freitas MC, Nogueira-Filho GR. Impact of periodontitis on the diabetes-related inflammatory status. J Can Dent Assoc. 2010;76:a35.PubMedGoogle Scholar
  45. 45.
    Ide R, Hoshuyama T, Wilson D, Takahashi K, Higashi T. Periodontal disease and incident diabetes: a seven-year study. J Dent Res. 2011;90(1):41–6.CrossRefPubMedGoogle Scholar
  46. 46.
    Yu N, Barros S, Zhang S, Moss K, Phillips S, Offenbacher S. Insulin response genes in different stages of periodontal disease. J Dent Res. 2015;94(9 Suppl):194S–200S.CrossRefPubMedGoogle Scholar
  47. 47.•
    Borgnakke WS, Ylostalo PV, Taylor GW, Genco RJ. Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence. J Clin Periodontol. 2013;40 Suppl 14:S135–52. This systematic review of non-experimental, epidemiologic evidence on the effects of periodontal disease on diabetes control, complications and incidence, concluded that current evidence suggests that periodontal disease adversely affects diabetes outcomes, and that further longitudinal studies are warranted.PubMedGoogle Scholar
  48. 48.
    Corbella S, Francetti L, Taschieri S, De Siena F, Fabbro MD. Effect of periodontal treatment on glycemic control of patients with diabetes: a systematic review and meta-analysis. J Diabet Investig. 2013;4(5):502–9.CrossRefGoogle Scholar
  49. 49.
    Engebretson S. Periodontal disease and glycemic control in diabetics. Evid Based Dent. 2014;15(3):93–4.CrossRefPubMedGoogle Scholar
  50. 50.
    Gurav A. Periodontal therapy—an adjuvant for glycemic control. Diabet Metab Syndr. 2012;6(4):218–23.CrossRefGoogle Scholar
  51. 51.
    Li Q, Hao S, Fang J, Xie J, Kong XH, Yang JX. Effect of non-surgical periodontal treatment on glycemic control of patients with diabetes: a meta-analysis of randomized controlled trials. Trials. 2015;16:291. doi: 10.1186/s13063-015-0810-2.PubMedCentralCrossRefPubMedGoogle Scholar
  52. 52.
    Wang X, Han X, Guo X, Luo X, Wang D. The effect of periodontal treatment on hemoglobin a1c levels of diabetic patients: a systematic review and meta-analysis. PLoS One. 2014;9(9), e108412.PubMedCentralCrossRefPubMedGoogle Scholar
  53. 53.
    Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, et al. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012;55(1):21–31.PubMedCentralCrossRefPubMedGoogle Scholar
  54. 54.
    Mauri-Obradors E, Jané-Salas E, Sabater-Recolons M, Vinas M, López-López J. Effect of nonsurgical periodontal treatment on glycosylated hemoglobin in diabetic patients: a systematic review. Odontology. 2015;103(3):301–13.CrossRefPubMedGoogle Scholar
  55. 55.
    Wang TF, Jen IA, Chou C, Lei YP. Effects of periodontal therapy on metabolic control in patients with type 2 diabetes mellitus and periodontal disease: a meta-analysis. Medicine (Baltimore). 2014;93(28), e292.CrossRefGoogle Scholar
  56. 56.
    Jones J, Miller D, Wehler C, Rich S, Krall-Kaye E, McCoy L, et al. Does periodontal care improve glycemic control? The Department of Veterans Affairs Dental Diabetes Study. J Clin Periodontol. 2007;34(1):46–52.CrossRefPubMedGoogle Scholar
  57. 57.
    Darre L, Vergnes J, Gourdy P, Sixou M. Efficacy of periodontal treatment on glycaemic control in diabetic patients: a meta-analysis of interventional studies. Diabet Metab. 2008;34(5):497–506.CrossRefGoogle Scholar
  58. 58.•
    Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, et al. Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev. 2015;11, CD004714. This review updates the previous version published in 2010, regarding the effect periodontal treatment may have on glycaemic control. The review included 35 studies (including seven from the previous version of the review), which included 2565 participants in total. The conclusion was that there is low quality evidence that the treatment of periodontal disease by SRP does improve glycaemic control in people with diabetes, with a mean percentage reduction in HbA1c of 0.29 % at 3–4 months; however, there is insufficient evidence to demonstrate that this is maintained after 4 months.PubMedGoogle Scholar
  59. 59.
    Lamster I, Cheng B, Burkett S, Lalla E. Periodontal findings in individuals with newly identified pre-diabetes or diabetes mellitus. J Clin Periodontol. 2014;41(11):1055–60.CrossRefPubMedGoogle Scholar
  60. 60.
    Saito T, Shimazaki Y, Kiyohara Y, Kato I, Kubo M, Iida M, et al. The severity of periodontal disease is associated with the development of glucose intolerance in non-diabetics: the Hisayama study. J Dent Res. 2004;83(6):485–90.CrossRefPubMedGoogle Scholar
  61. 61.
    Islam SA, Seo M, Lee YS, Moon SS. Association of periodontitis with insulin resistance, beta-cell function, and impaired fasting glucose before onset of diabetes. Endocr J. 2015;62(11):981–9.CrossRefPubMedGoogle Scholar
  62. 62.
    Timonen P, Saxlin T, Knuuttila M, Suominen AL, Jula A, Tervonen T, et al. Role of insulin sensitivity and beta cell function in the development of periodontal disease in adults without diabetes. J Clin Periodontol. 2013;40(12):1079–86.CrossRefPubMedGoogle Scholar
  63. 63.•
    Arora N, Papapanou P, Rosenbaum M, Jacobs D, Desvarieux M, Demmer R. Periodontal infection, impaired fasting glucose and impaired glucose tolerance: results from the Continuous National Health and Nutrition Examination Survey 2009–2010. J Clin Periodontol. 2014;41(7):643–52. Investigators studied the relationship between periodontal disease, a clinical manifestation of periodontal infection, and pre-diabetes in a in a cross-sectional study among a nationally representative sample of diabetes-free adults who received a full-mouth periodontal examination and an oral glucose tolerance test, and then classified according to periodontal status. Periodontal infection was positively associated with prevalent impaired glucose tolerance.PubMedCentralCrossRefPubMedGoogle Scholar
  64. 64.
    Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.CrossRefGoogle Scholar
  65. 65.
    Hein C. Proceedings and consensus opinion from the global oral and systemic health summit: Present evidence and future directions. Grand Rounds in Oral-Sys Med 2007 February; Grand Rounds Supplement:1–23.Google Scholar
  66. 66.
    American Academy of Periodontology. Position paper: periodontal maintenance. J Periodontol. 2003;74:1395–401.CrossRefGoogle Scholar
  67. 67.
    Tervonen T, Karjalainen K. Periodontal disease related to diabetic status. A pilot study of the response to periodontal therapy in type 1 diabetes. J Clin Periodontol. 1997;24(7):505–10.CrossRefPubMedGoogle Scholar
  68. 68.
    Mealey BL, Oates TW. AAP-commissioned review. Diabetes and periodontal diseases. J Periodontol. 2006;77:1289–303.CrossRefPubMedGoogle Scholar
  69. 69.
    American Academy of Periodontology. Parameter on systemic conditions affected by periodontal diseases. J Periodontol. 2000;71:880–3.CrossRefGoogle Scholar
  70. 70.
    Borrell LN, Kunzel C, Lamster I, Lalla E. Diabetes in the dental office: using NHANES III to estimate the probability of undiagnosed disease. J Periodontal Res. 2007;42(6):559–65.CrossRefPubMedGoogle Scholar
  71. 71.•
    Hein C, Batista H. Obesity and cumulative inflammatory burden: a valuable risk assessment parameter in caring for dental patients. J Evid Based Dent Pract. 2014;14(Suppl):17–26. This article provides a well synthesized summary of the relationship between obesity, periodontal disease, and Metabolic Syndrome and suggests a new model of risk assessment that recognizes cumulative inflammatory burden associated with periodontal disease and obesity.CrossRefPubMedGoogle Scholar
  72. 72.
    Javed F, Thafeed Alghamdi AS, Mikami T, Mehmood A, Ahmed HB, Samaranayake LP, et al. Effect of glycemic control on self-perceived oral health, periodontal parameters, and alveolar bone loss among patients with prediabetes. J Periodontol. 2014;85(2):234–41.CrossRefPubMedGoogle Scholar
  73. 73.
    Rao MV, Reddy MV, Sunder SS, Kolasani B, Kiranmai G, Kumar KR. In-dental office screening for diabetes mellitus using gingival crevicular blood. J Int Soc Prev Community Dent. 2014;4 Suppl 3:S161–5.PubMedCentralCrossRefPubMedGoogle Scholar
  74. 74.
    Koneru S, Tanikonda R. Reliability of gingival blood sample to screen diabetes in dental hospital. Int J Prev Med. 2015;6:23. doi: 10.4103/2008-7802.153538. eCollection 2015.PubMedCentralCrossRefPubMedGoogle Scholar
  75. 75.
    Tabak AG, Jokela M, Akbaraly TN, Brunner EJ, Kivimaki M, Witte DR. Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. Lancet. 2009;373(9682):2215–21.PubMedCentralCrossRefPubMedGoogle Scholar
  76. 76.
    Tabák A, Herder C, Rathmann W, Brunner E, Kivimäki M. Prediabetes: a high-risk state for diabetes development. Lancet. 2012;379(9833):2279–90.PubMedCentralCrossRefPubMedGoogle Scholar
  77. 77.
    Ferrannini E, Nannipieri M, Williams K, Gonzales C, Haffner S, Stern M. Mode of onset of type 2 diabetes from normal or impaired glucose tolerance. Diabetes. 2004;53(1):160–5.CrossRefPubMedGoogle Scholar
  78. 78.
    Laspa E, Christen A, Efstathiadou Z, Johnston D, Godsland I. Long-term changes and variability in diabetes risk factors prior to the development of impaired glucose homeostasis. Diabet Med. 2007;24(11):1269–78.CrossRefPubMedGoogle Scholar
  79. 79.
    Sattar N, McConnachie A, Ford I, Gaw A, Cleland SJ, Forouhi NG, et al. Serial metabolic measurements and conversion to type 2 diabetes in the west of Scotland coronary prevention study: specific elevations in alanine aminotransferase and triglycerides suggest hepatic fat accumulation as a potential contributing factor. Diabetes. 2007;56(4):984–91.CrossRefPubMedGoogle Scholar

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© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.College of DentistryUniversity of ManitobaWinnipegCanada
  2. 2.EvergreenUSA

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