Characteristics of inflammation common to both diabetes and periodontitis: are predictive diagnosis and targeted preventive measures possible?

Abstract

Diabetes and periodontitis are chronic inflammatory disorders that contribute to each others' severity and worsen each others' prognosis. Studies have shown that patients with diabetes are at increased risk of developing periodontitis, and that diabetics with untreated periodontitis have more difficulty controlling serum glucose. Periodontal treatment that reduces gingival inflammation aids in the control of hyperglycemia. Periodontitis is accompanied by gingival bleeding and the production of an inflammatory exudate termed gingival crevicular fluid (GCF) that arises from the inflamed gingival tissues surrounding the teeth. GCF contains byproducts of connective tissue degradation, enzymes from host and bacterial cells, cytokines and other inflammatory mediators, and has been studied for screening blood glucose and for biomarkers of both diabetes and periodontitis. This review focuses on the inter-relationship between diabetes and periodontitis and the biomarkers common to both these diseases that may enable earlier detection, targeted preventive measures and individualized therapeutic intervention of these chronic conditions.

Fig. 1

Teeth surrounded by healthy periodontium

Fig. 2

Diagrammatic representation of the different components of the normal periodontium

Fig. 3

Radiograph of healthy teeth and periodontium

Fig. 4

Gingival sulcus

Fig. 5

Clinical presentation of gingivitis. Inflammation is localized to the gingiva and has not spread to the bone

Fig. 6

a. Clinical appearance of periodontitis. Note gingival inflammation, heavy deposit of dental plaque and calculus and gingival recession. b. The radiograph from the same patient shows advanced bone loss and radiographic appearance of calculus deposits

Fig. 7

Histology of periodontitis lesion. Bacterial-induced inflammation has resulted in loss of connective tissue attachment to the tooth, epithelial migration, pocket formation and loss of supporting bone

Fig. 8

Clinical presentation of periodontitis in patient with undiagnosed diabetes mellitus (type 1). History of multiple recurring periodontal abscesses

Fig. 9

Gingival crevicular fluid flow in a periodontal pocket