Even if you trained as a dentist more than 20 years ago, the link between periodontitis and diabetes was something that was widely established. Over the last 20 years experts have identified mechanisms for this link, and established an overall better understanding.

Diabetes is known to be an inflammatory disease, as is periodontitis. It is now well documented that the oral inflammation from active periodontitis contributes to an elevation in inflammatory markers in the bloodstream, which in turn can trigger inflammation elsewhere, including pancreatic function for example, which is part of diabetic pathogenesis. In fact the European Federation of Periodontology (EFP) and American Academy of Periodontology (AAP) teamed up last year in a global workshop, reviewing all the literature on this very topic, and have made a stance about this systemic link. Once they established and supported the strong link between Periodontitis and Diabetes, and how each seems to be a risk factor for the other, the next step needed was intervention studies – so actually looking to see if periodontal treatment could help to improve diabetic control.

A recent study by Engebretson et al (JAMA 2013, Dec 18;310(23):2523-32), looked at 514 patients with both type II diabetes and untreated chronic periodontitis. Half underwent non-surgical periodontal therapy consisting of scaling and root planing, followed by supportive periodontal therapy up to 6 months, compared to the control group who received no dental treatment for 6 months. The glycated haemoglobin levels were measured and compared from baseline to 6 months. Interestingly, this study found no significant improvement in the glycemic control (so no significant reduction in HBA1c) despite improved periodontal markers, their conclusions being that non surgical periodontal treatment in patients with diabetes was not helpful in lowering levels of HbA1c.

However, what we mustn’t forget is that non-surgical periodontal treatment still helped improve the periodontal health and retain the patients’ teeth. It may also have reduced their systemic inflammation and possibly their risk to other inflammatory diseases such as heart disease – this wasn’t within the remit of this study. The American Academy of Periodontology has reported in their position paper how treatment of advanced periodontal therapy has been found to improve diabetic control in certain groups of patients –so like with all studies – part of the conclusions are inevitably that more studies are needed.

So where do we go from here? One thing to be aware of is that diabetes is often diagnosed late, and it is thought that over 40% of patients may have had the disease for some time prior to diagnosis. Perhaps we need to be making our patients more aware of this link? If they have Chronic Periodontitis, or you notice that their periodontal stability seems be taking a turn for the worse, with no other obvious reasons such as poor oral hygiene, be suspicious of an underlying systemic link. Don’t be shy about writing to the GP to ask for blood tests looking at the immune system (white blood cells) and testing for diabetes. You could save a life, even if the perio treatment itself doesn’t!

Dr Rana Al-Falaki

This post was written by Dr Rana Al-Falaki. Dr Al-Falaki is a specialist at the specialist periodontal practice, the Al-FaPerio clinic in Buckhurst Hill, Essex. After qualifying from St Barts and The London School of Medicine and Dentistry in 1997 Rana went on to attain her MClinDent in Periodontics in 2002 with distinction. She was entered into the GDC Specialist List in 2003 after obtaining her exit specialist qualification of Membership in Restorative Dentistry from The Royal College of Surgeons (England).