The periodontal host response with diabetes.

In the past decade, periodontal disease has been recognized as not merely a local infectious disease, but as chronic, subclinical, inflammatory disease for the host. Diabetic subjects appear to respond to bacterial challenge in an exaggerated manner as compared with non-diabetic subjects through several possible mechanisms, and develop more severe forms of inflammatory periodontal disease. Severe periodontal disease in such subjects, in turn, acts to reduce insulin sensitivity known as insulin resistance, thereby contributing to the induction of hyperglycemia as well as hyperinsulinemia, important risk factors for diabetic vascular complications. Additionally, recent studies suggested that such subclinical inflammatory states promote renal dysfunction and diabetic dyslipidemia, both of which are important risk factors for atherosclerosis. Finally, all such conditions act to increase the risk for coronary heart diseases, the leading cause of mortality and morbidity in diabetic subjects. Thus, it appears that exaggerated host responses in diabetic subjects ultimately accelerate diabetic vascular disorders, at least partially via periodontal inflammation in subjects with severe periodontitis. The purpose of this review article is to summarize current knowledge on the bidirectional relationship between diabetes and periodontal disease as well as its complications, and to provide future strategies for prevention and treatment of periodontal disease in diabetic subjects.