Insight into Molecular Mechanisms and Pathways Related to the Association of Periodontal Disease and Type 2 Diabetes Mellitus

Abstract

Introduction: Periodontal disease is a condition that damages the supporting tissues, potentially resulting in tooth extraction, while type 2 diabetes is a condition that involves insulin resistance, leading to hyperglycaemia and systemic inflammation.

Methods: A broad literature search was conducted in PubMed, Scopus, Web of Science, Google Scholar, and ProQuest. Search terms included combinations of keywords related to periodontal disease, type 2 diabetes, bone metabolism, genetics/epigenetics, inflammation, and oxidative stress, refined using Boolean operators. Titles and abstracts were screened, and eligible full-text articles were reviewed for relevant data.

Results: This review found that periodontal disease, a major cause of tooth loss in adults, is strongly influenced by the bidirectional relationship with type 2 diabetes. Hyperglycaemia in poorly controlled diabetes exacerbates periodontal inflammation by enhancing the formation of advanced glycation end-products, triggering pro-inflammatory pathways such as the activation of Nuclear Factor kappa-light-chain-enhancer of activated B cells and cytokine release (e.g., Tumour Necrosis Factor-α, Interleukin [IL]-6, IL-18). Concurrent dysbiosis of the oral microbiome disrupts immunoregulation, while an imbalance in the receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG) system promotes osteoclastogenesis, collectively leading to accelerated tissue destruction, impaired healing, and an increased risk of complications.

Conclusion: This review clarifies the molecular mechanisms of the triad axis of oral microbiota- inflammatory factors-bone metabolism markers in the bidirectional association between periodontal disease and type 2 diabetes. Understanding the underlying mechanisms of this bidirectional relationship can provide valuable information for researchers to identify potential targets for effective management strategies for periodontal disease in patients with type 2 diabetes.

Keywords: Periodontal disease; gingivitis; insulin resistance.; periodontitis; type 2 diabetes.