PERIODONTAL INFECTION AND DIABETES: MAKING THE CONNECTIONS IN TWO WAYS

Abstract

Abstract. Recent attention has been focused on our understanding of the negative influences of oral chronic inflammation on systemic health. There is growing evidence that periodontal diseases may affect general health. Periodontal diseases have powerful and multiple influences on the occurence and severity of systemic conditions and disesases, such a diabetes mellitus, cardiovascular diseases, respiratory diseases, and pregnancy complications. The relationship of periodontitis and diabetes has been supported by sufficent evidences in the past twenty years and has long been discussed with conflicting conclusions. Both'of these diseases have a relatively high incidence globally in the general population with a number of common pathways in their pathogenesis. Their relationship appears bi-directional insofar that the presence of one condition tends to promote the other, and that the appropriate management of either may assist treatment of the other. However, the converse possibility that periodontal disease either predisposes or exacerbates the diabetic condition has received little attention, and it is only less known about the impact of periodontal diseases on the diabetes-related inflammatory state. Although type 2 diabetes is a multiple risk-factor syndrome, lowered insulin sensitivity, called insulin resistance, is essential in developing the disease. Proinflammatory cytokine produced from chronic inflammation subjects as periodontitis, is known to playa predominant rolein inducinginsulinresistance. ' This review attempts to explain the immunobiological connection between periodontal disease and diabetes mellitus type 2, exploring the mechanisms through which periodontal infection can contribute to the low-grade general inflammation associated with diabetes (thus worsening insulin resistance) and discussing the impact of periodontal treatment on glycemic control in people livingwith both diabetes and periodontal disease.