Diabetes mellitus and periodontal disease: education, collaboration and information sharing between doctors, dentists and patients
DOI:
https://doi.org/10.15277/bjd.2023.403Keywords:
diabetes, periodontitis, risk identification, educationAbstract
People living with diabetes (DM) are at higher risk of developing periodontal disease than those without diabetes. This observation was first recorded in 1928. It is now believed that the risk is 3-4 times greater than for people without DM, and more for smokers. However, many doctors are not aware of this.
DM and periodontal disease are bi-directionally linked, the one affecting the other and vice versa, although the mechanism is not fully understood. Periodontal disease has an adverse effect on glycaemic control. That improves when periodontitis is successfully treated.
Doctors should consider periodontal disease when their patients have persistently high glycated haemoglobin (HbA1c) levels, and dentists should consider diabetes or pre-diabetes when they have patients with unstable periodontitis.
Doctors and dentists, and their teams, need to share results. This paper considers what that shared information should be. A system of red, amber and green for both medical and dental risks is proposed. Until there are reliable methods of information exchanges and a paradigm shift in inter-professional working, patients should obtain their medical and dental results and share them with their respective advisors.
Those patients who do not attend for dental care should be advised by their doctor about the potential benefits of dental screening for periodontitis.
References
Stöhr J. Bidirectional association between periodontal disease and diabetes mellitus: a systematic review with meta-analysis of cohort studies. Sci Rep 2021;11:13686. https://doi.org/10.1038/s41598-021-93062-6
Tsaic C, Hayes C, Taylor GW. Glycaemic control of type II diabetes and severe periodontal disease in the US adult population. Community Dent Oral Epidemiol 2002;30:182-92. https://doi.org/10.1034/j.1600-0528.2002.300304.x
Genco RJ, Borgnakke WS. Risk factors for periodontal disease. Periodontol 2000 2013;62:59-94. https://doi.org/10.1111/j.1600-0757.2012.00457.x
Battancs E, Gheorghita D, Nyiraty S, et al. Periodontal disease in diabetes mellitus: a case-control study in smokers and non-smokers. Diabetes Ther 2020;11:2715-28. https://doi.org/10.1007/S13300-020-0093-8 EPub 2020 Sep 25
Gianos E, Jackson EA, Tejpal A, et al. Oral health and atherosclerotic cardiovascular disease: A review. Am J Prev Cardiol 2021;7:100179. https://doi.org/10.1016/j.ajpc.2021.100179
Khumaedi AI, Purnamasari D, Wijaya P, Soeroso Y. The relationship of diabetes, periodontitis and cardiovascular disease. Diabetes Metab Syndr 2019;13:1675-8. https://doi.org/10.1016/j.dsx.2019.03.023
Mahajan S, Bhaskar N, Kaur RK, Jain A. A comparison of oral health status in diabetic and non-diabetic patients receiving haemodialysis – a systematic review and meta-analysis. Diabetes Metab Syndr 2021;15:102256. https://doi.org/10.1016/j.dsx.2021.102256
Preshaw PM, Alba AL, Herrera D, et al. Periodontitis and diabetes: a two- way relationship. Diabetologia 2012;55:21-31. https://doi.org/10.1007.s00125-011-2342 Epub 2011 Nov 6.
Yoshioka M, Okamoto Y, Murata M, et al. Association between oral health status and diabetic nephropathy-related indices in Japanese middle-aged men. J Diabetes Res 2020;2020:Article ID 4042129. https://doi.org/10.1155/2020/4042129
Borgnakke WS, Anderson PF, Shannon C, Jivanescu A. Is there a relationship between oral health and diabetic neuropathy? Curr Diab Rep 2015;11:93. https://doi.org/10.1007/s11892-015-0673-7
Moore PA,Weyant RJ, Mongelluzzo MB, et al. Type 1 diabetes, xerostomia and salivary flow rates. Oral Medicine 2001;92:281-91. https://doi.org/10.1067/moe.2001.117815
Tandon A, Kamath YS, Gopalkrishna P, et al. The association between diabetic retinopathy and periodontal disease. Saudi J Ophthalmol 2021; 34:167-70. https://doi.org/10.4103/1319-4534.310412
Nguyen ATM, Akhtar R, Garde S, et al. The association of periodontal disease with the complications of diabetes mellitus. A systematic review. Diabetes Res Clin Prac 2020;165:108244. https://doi.org/10.1016/j.diabres.2020.108244
Southerland JH, Taylor GW, Offenbacher S. Diabetes and periodontal infection: making the connection. Clinical Diabetes 2009;23:171. https://doi.org.10.2337/diaclin.23.4.171
Liu R, Bal HS, Desta T, et al. Tumor necrosis factor-alpha mediates diabetes- enhanced apoptosis of matrix-producing cells and impairs diabetic healing. Am J Pathol 2006;168:757-64. https://doi.org/10.2353/ajpath.2006.050907
Johnson DR, O’Connor JC, Satpathy A, Freund GG. Cytokines in type II diabetes. Vitam Horm 2006;74:405-41. https://doi.org/10.1016/S0083-6729(06)74017-1
Lappin DF, Robertson D, Hodge P, et al. The influence of glycated haemoglobin on the cross-susceptibility between type I diabetes and periodontal disease. J Periodont 2015;86:1249. https://doi.org/10.1902/jop.2015.150149
Wu YY, Xioa E, Graves DT. Diabetes mellitus related bone metabolism and periodontal disease. Int J Oral Sci 2015;7:63-72. https://doi.org/10.1038/ijos.2015.2
Krakauer JC, McKenna MJ, Buderer NF, et al. Bone loss and bone turnover in diabetes. Diabetes 1995;44:775-82. https://doi.org/10.2337/diab.44.7.775
Löe H, Theilade E, Jensen SB. Experimental gingivitis in man. Periodontol 1965;36:177-87. https://doi.org/10.1092/jop.1965.36.3.177
Cekici A, Kantarci A, Hasturk H, Van Dyke TE. Inflammatory and immune pathways in the pathogenesis of periodontal disease. Periodontol 2000 2014;64:57-80. https://doi.org/10.1111/prd.12002
Genco RJ, Graziani F, Hasturk H. Effects of periodontal disease on glycaemic control, complications and incidence of diabetes mellitus. Periodontol 2000 2020;83:59-65. https://doi.org/10.1111/prd.12271
Kumar A, Sharma DS, Verma M, et al. Association between periodontal disease and gestational diabetes mellitus: a prospective cohort study. J Clin Periodontol 2018;45:920-31. https://doi.org/10.1111/jcpe.12902.
Taylor GW. Bidirectional interrelationships between diabetes and periodontal disease: an epidemiological perspective. Ann Periodontol 2001;1:99-112. https://doi.org/10.1902/annals.2001.6.1.99
Costa KI, Taboza ZA, Angelino GB, Siveira V, et al. Influence of periodontal disease on changes of glycated haemoglobin levels in patients with type 2 diabetes mellitus: a retrospective cohort study. J Periodontol 2017;88:17-25. https://doi.org/10.1092/jop.2016.160140
Wang TF, Jen IA, Chou C, Lei P. Effects of periodontal therapy on metabolic control in patients with type 2 diabetes and periodontal disease: a meta- analysis. Medicine (Baltimore) 2014;93:e292. https://doi.org/10.1097/MD0000000000292
Löe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 1999;16:329-34.
Tse SY. Diabetes mellitus and periodontal disease: awareness and practice among doctors working in public general outpatient clinics in Kowloon West Cluster of Hong Kong. BMC Fam Prac 2028;19:199. https://doi.org/10.1186/s12875-018-0887-2
NICE.org.uk/guidance/NG17/chapter/recommendations NICE (2015). Recommendations | Type 1 diabetes in adults: diagnosis and management | Guidance | NICE. [online] www.nice.org.uk. Available at: https://www.nice.org.uk/guidance/ng17/chapter/Recommendations NICE.org.uk/guidance/NG28/chapter/recommendations NICE (2015). Recommendations | Type 2 Diabetes in adults: Management | Guidance | NICE. [online] www.nice.org.uk. Available at: https://www.nice.org.uk/guidance/ng28/chapter/Recommendations
Siddiqi A, Zafar S, Sharma A, Quaranta A. Diabetes mellitus and periodontal disease. The call for interprofessional education and interprofessional collaborative care. A systematic review of the literature. J Interprof Care 2020;10:1. https://doi.org/10.1080/13561820.2020.1825354
Turner C. Diabetes mellitus and dental health: a review. Geriatric Med J, 16 November 2021. https://www.gmjournal.co.uk/diabetes-and-dental-health-areview
King R, Chasma F. Diabetes and periodontal disease. Faculty Dent Journal 2022;13:78-81. https://doi.org/10.1308/rcsfdj.2022.18
Strain WD, Down S, Brown P, Puttanna A, Sinclair A. Diabetes and frailty: an expert consensus statement on the management of older adults with type 2 diabetes. Diabetes Ther 2021;12:1227-47. https://doi.org/10.1007/s13300-021-01035-9
Barmes D. CPITN – a WHO initiative. Int Dent J 1994;44:523-5. Available at: https://pubmed.ncbi.nih.gov/7836006/
Williams J. Diabetic periodontoclasia. J Amer Dent Assoc 1928;15:523-9.
Turner CH. Implant maintenance. The Dentist 2011, 62.
Simpson TC, Clarkson JE, Worthington HV, et al. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database of Systematic Reviews 2022 CD004714. https://doi.org/10.1002/14651858.CD004714.pub4
Turner C. Diabetes mellitus and periodontal disease; the profession’s choices. Brit Dent J 2022;233:537-8. https://doi.org/10.1038/s41415-022-5029-5
Published
Issue
Section
License
Publish & Transfer of Copyright Agreement
For the mutual benefit and protection of the Author and the Journal Owner/Publisher it is necessary that the Author provides formal written Consent to Publish and Transfer of Copyright before publication of the Work.