Bone Disorders, Diabetes
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Periodontitis in Patients with Diabetes— A Complication that Impacts on Metabolic Control

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Published Online: May 14th 2012 US Endocrinology, 2012;8(1):35-9 DOI:
Authors: Corneliu Sima, Michael Glogauer
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Diabetes and periodontal diseases (PDs) exhibit a bidirectional relationship centered on an enhanced inflammatory response that manifests both locally and systemically. Diabetes is an established risk factor for PD, whereas the treatment of the latter has been shown to improve glycemic control in diabetic patients. Although compelling evidence from in vitro and animal studies supports a plausible biological explanation for the relationship between the two conditions centered on systemic low-grade inflammation, the limited number of comparable large randomized clinical trials is reflected in the limited specific guidelines offered by the international organizations for diabetes and periodontitis regarding the management of the two diseases in an individual. Further understanding of the biological phenomena underlying PDs and diabetes is critical for individual therapeutic approaches to patients with both conditions by endocrinologists and periodontists.


Diabetes, periodontal diseases, inflammation, glycemic control


Diabetes is a multifactorial, life-threatening chronic disease characterized by a dysregulation of the endocrine and metabolic pathways involved in the control of blood glucose levels resulting in hyperglycemia. Uncontrolled diabetes gradually impacts on the nervous and circulatory systems, resulting in irreversible long-term complications.

Diabetes is a multifactorial, life-threatening chronic disease characterized by a dysregulation of the endocrine and metabolic pathways involved in the control of blood glucose levels resulting in hyperglycemia. Uncontrolled diabetes gradually impacts on the nervous and circulatory systems, resulting in irreversible long-term complications. In 2010, approximately 8.3 % of the US population—or 25.8 million people—had diabetes either diagnosed (18.8 million) or undiagnosed (7.0 million) and a further 79 million people were estimated to have pre-diabetes according to the Centers for Disease Control and Prevention.1 Chronic hyperglycemia is a hallmark of diabetes regardless of the pathophysiological mechanism of the disease and is regarded as a central player in the development of acute complications—such as hypoglycemic coma, ketoacidotic coma, hyperosmolar non-ketonic coma, myocardial infarction (MI), and stroke—and chronic complications—such as diabetic nephropathy, retinopathy, neuropathy, cardiovascular diseases, peripheral vascular diseases, and periodontal diseases (PDs).

PDs are chronic, microbially induced inflammatory disorders of the tooth-supporting tissues (periodontium) characterized by the progressive destruction of those tissues and ultimately resulting in tooth loss. PDs are the most common inflammatory and bone lytic diseases of humans. Up to 75 % of North American adults experience the morbidity and decreased oral function associated with alveolar bone destruction and subsequent edentulism during their lifetime. Oral bone loss takes on additional importance because of recent evidence linking PDs with systemic health conditions including diabetes, cardiovascular disease, and cancer as well as with giving birth to premature children.

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The authors have no conflicts of interest to declare.


Michael Glogauer, DDS, PhD, Associate Professor, Faculty of Dentistry and Faculty of Medicine, University of Toronto, Room 221, Fitzgerald Building, 150 College Street, Toronto, Ontario, M5S 3E2, Canada. E:




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