Research & Education

Is There a Link Between Periodontal Disease and Diabetes?

Is there a link between periodontal disease and diabetes? There might be. Emerging research suggests there may be an association between type 1 and type 2 diabetes mellitus and the two major periodontal diseases—gingivitis and periodontitis. Epidemiological studies estimate that diabetic patients are 2 to 3 times more likely to have periodontal disease than non-diabetic patients. A cross-sectional study in India concluded that more than 95% of patients with type 2 diabetes have some periodontal destruction. Human research proposes that the driver of oral complications in those with diabetes is hyperglycemia or dysregulated blood sugar.

It is understood that dysregulated blood sugar promotes inflammation and oxidative stress. Consequently, patients with diabetes and periodontal disease typically exhibit increased free radicals, reactive oxygen species (ROS), advanced glycation end products (AGEs), pro-inflammatory mediators, immune dysfunction, and impaired healing of the soft tissue and bone. Moreover, periodontal disease and diabetes share some of the same risk factors, such as alcohol consumption, obesity, smoking, stress, and dysregulated blood pressure and lipid status.

People with diabetes (especially if uncontrolled) have more tooth loss worldwide. Adolescents with diabetes have a twofold and threefold higher number of dental fillings and teeth with untreated caries, respectively. Individuals with diabetes also often experience occasional dry mouth and decreased saliva production, which may manifest as bad breath, foul taste, altered taste, difficulty with swallowing, speaking, or chewing, trouble keeping removable dentures in place, and greater incidence of oral complications.

Hyperglycemia may be associated with an oral microbial imbalance and the proliferation of Candida albicans, a commensal yeast in the oral microbiome related to candidiasis. People with diabetes may also have a greater risk of oral wounds, oral mucosal lesions, and dental plaque buildup. All of these oral complications associated with diabetes may affect a person’s quality of life.

Owing to this potential association, supporting those with periodontal disease may promote normal blood sugar regulation and vice versa. Meta-analyses and systematic reviews of randomized controlled trials reveal that patients with type 2 diabetes receiving non-surgical periodontal treatment for three months exhibited decreased glycated hemoglobin (HbA1c).

The link between periodontal disease and diabetes is still being elucidated. However, the potential association between periodontal disease and diabetes supports a transdisciplinary approach involving dental check-ups, dental hygiene, and working with a health-care practitioner to support normal blood sugar regulation.

By Danielle Moyer, MS, CNS, LDN