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A two-way street
Brian L. Mealey, DDS, MS
D an estimated 20 million
Americans, about 35 to 40
percent of whom have not
ABSTRACT
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received a diagnosis.1
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Background. The association between diabetes
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More than 9 percent of the adult
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and inflammatory periodontal diseases has been
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population has diabetes, and both studied extensively for more than 50 years. The
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the incidence and prevalence are author reviews the bidirectional relationships RT
ICLE
increasing every year. between diabetes and periodontal diseases.
The two main types of diabetes Conclusions. A large evidence base suggests that diabetes is associated
are classified primarily on the basis with an increased prevalence, extent and severity of gingivitis and peri-
of their underlying pathophys- odontitis. Furthermore, numerous mechanisms have been elucidated to
iology.2 Type 1 diabetes, which con- explain the impact of diabetes on the periodontium. While inflammation
stitutes about 5 to 10 percent of all plays an obvious role in periodontal diseases, evidence in the medical liter-
cases in the United States, results ature also supports the role of inflammation as a major component in the
from autoimmune destruction of pathogenesis of diabetes and diabetic complications. Research suggests
insulin-producing -cells in the pan- that, as an infectious process with a prominent inflammatory component,
creas, leading to total loss of insulin periodontal disease can adversely affect the metabolic control of diabetes.
secretion.3 Insulin is used by the Conversely, treatment of periodontal disease and reduction of oral inflam-
body to facilitate the transfer of glu- mation may have a positive effect on the diabetic condition, although
cose from the bloodstream into the evidence for this remains somewhat equivocal.
target tissues, such as muscle, Clinical Implications. Patients with diabetes who have periodontal
where glucose is used for energy disease have two chronic conditions, each of which may affect the other,
(Figure). Because a person with type and both of which require frequent professional evaluations, in-depth
1 diabetes no longer produces patient education and consistent educational reinforcement by health care
endogenous insulin, glucose is providers.
unable to enter target cells and Key Words. Diabetes mellitus; periodontal diseases; periodontal
remains in the bloodstream, therapy; inflammation.
resulting in sustained hyper- JADA 2006;137(10 supplement):26S-31S.
glycemia. A patient with type 1 dia-
betes must take exogenous insulin
Dr. Mealey is the graduate program director and director, Specialist Division, Department of Peri-
to remain alivehence, the former odontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San
name insulin-dependent diabetes. Antonio, Texas 78229, e-mail mealey@uthscsa.edu. Address reprint requests to Dr. Mealey.