Periodontal disease and diabetes. A two-way street.

BACKGROUND The association between diabetes and inflammatory periodontal diseases has been studied extensively for more than 50 years. The author reviews the bidirectional relationships between diabetes and periodontal diseases. CONCLUSIONS A large evidence base suggests that diabetes is associated with an increased prevalence, extent and severity of gingivitis and periodontitis. Furthermore, numerous mechanisms have been elucidated to explain the impact of diabetes on the periodontium. While inflammation plays an obvious role in periodontal diseases, evidence in the medical literature also supports the role of inflammation as a major component in the pathogenesis of diabetes and diabetic complications. Research suggests that, as an infectious process with a prominent inflammatory component, periodontal disease can adversely affect the metabolic control of diabetes. Conversely, treatment of periodontal disease and reduction of oral inflammation may have a positive effect on the diabetic condition, although evidence for this remains somewhat equivocal. CLINICAL IMPLICATIONS Patients with diabetes who have periodontal disease have two chronic conditions, each of which may affect the other, and both of which require frequent professional evaluations, in-depth patient education and consistent educational reinforcement by health care providers.