Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

Perio Reports

Start Discussion

Perio Reports  Vol. 24, No. 1
Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians.
Perio Reports research summaries will be included in each issue to keep you on the cutting edge
of dental hygiene science.
Why is it Called Oral-Systemic Connection?

It’s hard to avoid this topic today, with a steady stream of articles and opinion pieces focusing on the associations between oral health and systemic health. Despite links between periodontitis, diabetes and cardiovascular diseases, the dental profession has difficulty convincing other health professionals and the public of the importance of these connections.

It is a start to associate the mouth to the rest of the body. A new organization was recently formed called the American Society for Oral Systemic Health. But are we perpetuating the separation of the mouth and the rest of the body by suggesting that oral health and systemic health are still two different things? Oral health is in fact systemic health.

Two professors at the University of Manitoba in Winnipeg, Canada, suggest the terminology should be changed, to ensure that oral health is recognized as part of systemic health and not a separate entity. They suggest using the terms “oral health” and “overall health” or even “oral” and “non-oral” health rather than “oral-systemic,” which unintentionally separates the mouth from the rest of the body. As an example, they suggest a physician wouldn’t discuss diabetes, an endocrine disease of the pancreas, by referring to the patient’s pancreatic and systemic health. Since the mouth is part of the body, oral diseases with an impact on other parts of the body are in fact systemic diseases and not oral conditions with systemic influence.

Choose your words wisely when discussing oral health and overall health with patients and medical colleagues, to avoid reinforcing the separation rather than a whole-body view.

Nogueira-Filho, G., Tenenbaum, H.: So Why Do We Call It the Oral- Systemic Health Connection? J Can Dent Assoc 77: B36, 2011.
Diabetes and Dentistry

Diabetes mellitus (DM) is a relatively common metabolic disorder affecting approximately 10 percent, or 20 million Americans, with the incidence increasing. DM is a bi-directional disorder, affecting oral health and oral health affecting DM. Three primary types of DM are Type 1, Type 2 and gestational DM. Type 1 accounts for 10 percent and Type 2, 85-90 percent. Gestational DM occurs during pregnancy and in most cases resolves after childbirth.

Type 1 DM is generally diagnosed in childhood. Insulin deficiency is caused by autoimmune destruction of pancreatic beta cells. Onset and diagnosis occur rapidly, as symptoms of dehydration from hyperglycemia and ketoacidosis can lead to coma and death. Those with Type 1 DM require daily insulin injections. The body type for Type 1 DM is lean.

Type 2 DM was considered an adult disease, being diagnosed in overweight and obese adults over age 40. These traditional criteria are becoming blurred as more overweight young adults and children are being diagnosed. Insulin resistance precedes diagnosis of Type 2 DM. A confirmed diagnosis includes a defect in both the action and secretion of insulin. Diagnosis might be delayed for many years, until complications of DM are recognized. Type 2 DM is often controlled with diet and in some cases, oral medications.

Gestational DM may be a predictor of DM later in life, as 50 percent of those with gestational DM remain at risk of developing Type 2 DM later in life. Diagnosis of gestational DM provides an opportunity to initiate prevention strategies early.

Clinical Implications: Clinicians deal with the oral implications of DM now, and can also look for early signs of DM with simple screening tools.

Kidambi, S., Patel, S.: Diabetes Mellitus Considerations for Dentistry. J AM Dent Assoc 139: Suppl 5, 8S-18S, 2008.
Oral Health and Diabetes Mellitus

Periodontitis is a well-documented complication of diabetes mellitus (DM) and periodontitis might increase the risk of poor metabolic control. The subgingival microflora associated with periodontitis does not differ between those with and without DM, but those with DM have an exaggerated inflammatory response. In 1993, Dr. Löe proposed that periodontitis be considered the sixth complication of DM. The first five are: retinopathy, nephropathy, neuropathy, macrovascular disease and poor wound healing.

Those with DM have excess glucose in the blood due to a deficiency of insulin secretion or an increased cellular resistance to insulin actions. This leads to a variety of abnormalities involving fats, carbohydrates and proteins. One pathologic mechanism associated with excess glucose leads to the formation of advanced glycation end-products (AGEs). AGEs bind to receptor sites (RAGEs) on endothelial cells of the blood vessel walls and monocytes. These mechanisms are linked to the five identified complications of DM. This might also explain the link to periodontitis.

Periodontal inflammation dumps a variety of cytokines into the blood stream from oral tissues that travel to other areas and tissues of the body. These cytokines trigger an overall systemic immune response and antagonize insulin. In some cases, periodontitis is the first sign of DM. Thirty percent of those with Type 2 DM have yet to be diagnosed. Dentists and dental hygienists play an important role in the recognition of the early signs and symptoms of DM, often evident as periodontitis and poor healing following treatment.

Clinical Implications: Dentists and dental hygienists providing prevention and periodontal therapy will impact both the oral health and the general health of those with DM.

Lamster, I., Lalla, E., Borgnakke, W., Taylor, G.: The Relationship Between Oral Health and Diabetes Mellitus. J Am Dent Assoc 139: Suppl 5, 19S-24S, 2008.
Inflammation – the Link Between Perio and Diabetes

Type 2 DM is a broad activation of the innate immune response, causing chronic low-grade inflammation throughout the body. Type 2 DM is commonly seen in overweight and obese people who have elevated levels of circulating fatty acids that inhibit glucose uptake, glycogen synthesis and glycolysis. This triggers the innate immune response. Often, insulin resistance is countered by an increase in insulin production. However, in 30 percent of Type 2 DM cases, pancreatic cells are reduced by programmed cell death called apoptosis, leading to inadequate insulin production.

Cytokines are released by white blood cells in the periodontal tissues in response to subgingival bacteria. These cytokines eventually make their way into the blood stream and to distant organs and tissues. Cytokines circulating in the blood stream activate an acute phase response with a cascade of immune responses.

The risk for periodontitis in those with DM is two- to five-times higher compared to those without DM. Changes in the blood vessels in those with DM influence the initiation and progression of gingivitis and periodontitis. Both DM and periodontal disease experience cytokine-induced acute phase immune response reactions. Compromised immune response leads to both progression of periodontal disease and reduced metabolic control in DM.

Some, but not all clinical trials demonstrate improved glycemic control following periodontal therapy. Study outcomes are similar for both oral diabetes drugs and periodontal treatment when measuring glycemic control.

Clinical Implications: Active periodontal therapy, as well as maintenance care is important for both oral health and overall health. Dentists and hygienists provide valuable care for those with both periodontitis and DM.

Tunes, R., Foss-Freitas, M., Nogueira-Filho, G.: Impact of Periodontitis on the Diabetes-Related Inflammatory Status. J Can Dent Assoc 76: 1-7, 2010.
Awareness of Diabetes’ Impact on Other Diseases

The incidence of diabetes is on the rise worldwide. Chronic systemic manifestations of diabetes are primarily seen in the vascular system, with specific issues related to the microvasculature including retinopathy, nephropathy and neuropathy. Oral complications of diabetes include gingivitis, periodontitis, xerostomia and consequently, caries. Diabetes is bi-directional, with uncontrolled diabetes leading to periodontitis and severe periodontitis impacting glycemic control.

A researcher at the University of Sharjah in the United Arab Emirates, used a written questionnaire to evaluate the attitudes and awareness of patients with diabetes. The 200 subjects were seeking care at the largest diabetic clinic in Benghazi, Libya. The questions related to oral health and oral care.

The majority of subjects, 71 percent, had Type 2 diabetes, with 18 percent reporting Type 1 and 11 percent unsure which type they had. Subjects ranged in age from 17 to 78 years and had diabetes from one week to 40 years.

Dry mouth was experienced by 84 percent of the group. Smokers accounted for 42 percent of the group. The majority had teeth, but 31 percent were edentulous with only 44 percent of them wearing full dentures. Only 17 percent brushed twice daily and only 12 percent reported daily flossing. The dentist was the primary source of information about oral complications of diabetes and oral care. Those reporting oral infections also had high glycemic control scores. Less than 50 percent were aware that dental diseases are complications of diabetes.

Clinical Implications: Education is needed from both dental and medical professionals addressing the oral complications associated with diabetes and the importance of good oral hygiene and regular dental care.

Eldarrat, A.: Awareness and Attitude of Diabetic Patients about Their Increased Risk for Oral Diseases. Oral Health Prev Dent 9: 235-241, 2011.
Diabetes Part of Multiple Risk Factor Syndrome

Periodontal disease is the sixth-most-common complication of diabetes. The primary cause of death for those with diabetes is cardiovascular disease with risk being three-times higher in people with Type 2 diabetes mellitus (DM). A recent study showed a one percent increase in hemoglobin A1c (HbA1c) level associated with an 18 percent increased risk of cardiovascular disease.

This case report follows the diagnosis and treatment of a 62-year-old Japanese woman presenting with severe periodontitis and diabetes. She was diagnosed 10 years earlier with DM, was receiving daily insulin injections and had no other complications of diabetes besides periodontitis. She was also a smoker and took oral medications for high blood pressure and high cholesterol.

Clinically, several teeth were missing, anterior teeth were flared and severe bone loss was evident around some teeth with severe mobility. Plaque and calculus levels were high throughout the mouth. Periodontal treatment was provided including surgery and oral hygiene instructions. Following treatment her HbA1c level, cholesterol levels and blood pressure improved. The patient was then followed and remained stable for four years while receiving periodontal maintenance therapy. She then developed myocardial infarction. During this time she showed continuous deterioration of her HbA1c level and also increased periodontitis. Following coronary bypass surgery and re-establishment of periodontal maintenance therapy, systemic markers improved. The long-term clustering of these risk factors is associated with development of heart problems.

Clinical Implications: Dental and medical clinicians will provide coordinated treatments for general health and periodontal health in the management of patients with multiple risk factor syndrome.

Shimoe, M, Yamamoto, T., Iwamoto, Y., Shiomi, N., Maeda, H., Nishimura, F., Takashib, S.: Chronic Periodontitis with Multiple Risk Factor Syndrome: A Case Report. J Int Acad Periodontol 13: 40-47, 2011.
Dentaltown Magazine
September 2025
Dentaltown Magazine September 2025 Read Current Issue Read Archived Issues
Sponsors
Townie Perks
Townie® Poll
Who or what do you turn to for most financial advice regarding your practice?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds Dental News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2025 Dentaltown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450