Periodontal Disease and Diabetes: Interconnections and Clinical Implications

Periodontal disease (PD), a chronic inflammatory condition affecting the supporting structures of teeth, has a well-established bidirectional relationship with diabetes mellitus (DM) (Hallmon & Mealey, 1992; Kudiyirickal & Pappachan, 2024). Diabetes predisposes individuals to PD by compromising immune function, promoting microbial dysbiosis, and increasing oxidative stress (Gowdar & Almuhaiza, 2016; Buczko et al., 2015). Conversely, periodontal inflammation exacerbates systemic insulin resistance and impairs glycemic control, mediated by pro-inflammatory cytokines such as TNF-α and IL-6 (Nishimura & Murayama, 2001; Kumari et al., 2020). Clinical studies consistently show that diabetic patients exhibit deeper periodontal pockets, increased clinical attachment loss, higher plaque accumulation, and greater tooth loss compared to non-diabetic individuals (Kripal et al., 2011; Ahamed et al., 2020; Khatri et al., 2022). Hyperglycemia further intensifies periodontal tissue destruction and fosters growth of virulent oral pathogens like Porphyromonas gingivalis (Kudiyirickal & Pappachan, 2024; Zheng et al., 2021).

Despite the high prevalence of periodontal complications among diabetic patients, awareness of oral–systemic links remains limited (Islam et al., 2021; Kaur et al., 2023; Alhazmi et al., 2022). This knowledge gap underscores the importance of patient education, regular dental check-ups, and interdisciplinary collaboration between dentists and endocrinologists (Lifshitz et al., 2016; Townsend, 2004). Interventions, including non-surgical periodontal therapy, adjunctive systemic or topical treatments, and lifestyle modifications, have demonstrated improvements in local periodontal health, inflammatory biomarkers, and, in some cases, glycemic control (Vergnes et al., 2018; Rapone et al., 2021; PhD et al., 2022).

Salivary biomarkers such as total antioxidant capacity and C-reactive protein offer non-invasive tools to monitor oxidative stress and inflammation in both PD and DM, providing opportunities for early detection and risk stratification (Zambon et al., 2018; Buczko et al., 2015; Segawa et al., 2019). Additionally, pediatric and pregnant populations warrant special attention, as early-onset periodontal inflammation and maternal periodontal disease can exacerbate metabolic and systemic complications, including gestational diabetes (Gowdar & Almuhaiza, 2016; Zambon et al., 2018; Percy, 2008).

Overall, managing PD in diabetic patients requires a multifactorial approach addressing microbial, immunologic, metabolic, and behavioral determinants. Integrating oral health care into routine diabetes management can mitigate systemic inflammation, reduce tooth loss, and potentially improve glycemic outcomes, highlighting the critical role of periodontal medicine in holistic patient care (Schallhorn, 2016; Almeida et al., 2013; Kudiyirickal & Pappachan, 2024).

References (For extensive references list- click here)

Hallmon, W.W., & Mealey, B.L. (1992). The Diabetes Educator, 18(4).

Kudiyirickal, M.G., & Pappachan, J.M. (2024). World Journal of Diabetes, 15(3), 318.

Nishimura, F., & Murayama, Y. (2001). J Dent Res, 80(8).

Kripal, K., Kumari, S.J., & Prasanna. (2011). Biomedicine, 31(2).

Zambon, M., et al. (2018). Reprod Sci, 25.

Vergnes, J.N., et al. (2018). J Clin Periodontol, 45(10).

Rapone, B., et al. (2021). Int J Environ Res Public Health, 18(6).

Islam, S.A., et al. (2021). Pak Oral & Dent J, 41(2).

Buczko, P., Zalewska, A., & Szarmach, I. (2015). J Physiol Pharmacol, 66(1).

Ahamed, S.T., Rajasekar, A., & Mathew, M.G. (2020). Int J Res Pharm Sci, 11(Spl3).