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JADA Continuing Education

Background. The authors conducted a systematic review of the literature to assess the relationship between diabetes mellitus and periodontitis.

Types of Studies Reviewed. The authors conducted searches to identify published human epidemiologic studies; cross-sectional observations; and longitudinal, cohort, case-control and other studies that describe variables associated with diabetes and periodontal disease. Some animal studies are reported to support human findings and explore mechanisms of action.

Results. The majority of evidence demonstrates an increase in the prevalence and severity of periodontal disease in people with diabetes mellitus. Interpretation of published results is complicated by a number of factors: small sample sizes; the absence of standard reporting of the type of diabetes; the presence of diabetes complications; the lack of longitudinal studies and control groups; and inadequate control of covariates such as age, duration of diabetes and level of control of diabetes.

Clinical Implications. Mechanisms underlying the accelerated periodontal disease associated with diabetes appear to reflect primarily abnormal host responses, rather than microbial shifts, resulting from diabetes. A better understanding of the mechanisms involved in the more aggressive periodontitis seen in patients with diabetes enables the practitioner to consider different therapeutic options for this growing patient population.

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