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The Relationship Between Diabetes and Periodontal Disease: Debora C. Matthews, DDS, Dip Perio, MSC
The Relationship Between Diabetes and Periodontal Disease: Debora C. Matthews, DDS, Dip Perio, MSC
A b s t r a c t
There is good evidence to support the claim that periodontitis may be more prevalent among diabetic patients than
nondiabetic people. Similarly, studies have shown that periodontal therapy influences glycemic control in people with
diabetes mellitus. Given that nearly 10% of Canadians are affected by either type 1 or type 2 diabetes (including those
in whom the disease is undiagnosed), all dentists will encounter patients with diabetes. Dental practitioners must be
aware of the implications of this relationship and manage their patients’ periodontal care accordingly.
B
y the year 2010, it is expected that 3 million due to a disturbance in the autoimmune process. The onset
Canadians will be afflicted with diabetes mellitus.1 of the disease is often abrupt, and patients with this type of
It has been reported that for every person known to diabetes are more prone to ketoacidosis and wide fluctua-
have diabetes, there is someone else in whom the disease tions in plasma glucose levels. If untreated, these patients
remains undiagnosed.2 In other words, up to 10% of are likely to manifest the classic signs and symptoms of
Canadian adults may currently have diabetes. This means diabetes: polyuria (excessive urine output), polydipsia
that dentists will regularly encounter diabetic patients. This (excessive thirst) and polyphagia (excessive appetite), as well
paper discusses the possible impact of diabetes on the peri- as pruritis, weakness and fatigue. These patients are more
odontal patient and the ways in which untreated periodon- likely to suffer severe systemic complications as a result of
titis may influence the course of diabetes. the disease.
The causes of type 2 diabetes mellitus range from
What Is Diabetes? insulin resistance with relative insulin deficiency to a
Diabetes mellitus is a metabolic disorder characterized predominantly secretory defect accompanied by insulin
by hyperglycemia due to defective secretion or activity of resistance. The onset is generally more gradual than for
insulin.1 In the current classification of this condition, the type 1, and this condition is often associated with obesity.
terms “insulin-dependent diabetes mellitus” and “non- In addition, the risk of type 2 diabetes increases with age
insulin-dependent diabetes mellitus” are not used, in part and lack of physical activity, and this form of diabetes is
because they relate to treatment rather than to the diagno- more prevalent among people with hypertension or
sis. A conclusive diagnosis of diabetes mellitus is made by dyslipidemia. Type 2 diabetes has a strong genetic compo-
assessing glycated hemoglobin levels; in those people with nent, with the disease being more common in North
diabetes, sequential fasting plasma glucose levels will be Americans of African descent, Hispanics and Aboriginal
7 mmol/L or more. people. People with type 2 diabetes constitute 90% of the
Diabetes mellitus can be classified into 1 of 4 broad cate- diabetic population.
gories according to signs and symptoms. Gestational diabetes mellitus (GDM) is glucose intoler-
Type 1 diabetes mellitus encompasses diabetes resulting ance that begins during pregnancy. The children of moth-
primarily from destruction of the beta-cells in the islets of ers with GDM are at greater risk of experiencing obesity
Langerhans of the pancreas. This condition often leads to and diabetes as young adults.3 As well, there is a greater risk
absolute insulin deficiency. The cause may be idiopathic or to the mother of developing type 2 diabetes in the future.
Journal of the Canadian Dental Association March 2002, Vol. 68, No. 3 161
Matthews
162 March 2002, Vol. 68, No. 3 Journal of the Canadian Dental Association
The Relationship Between Diabetes and Periodontal Disease
Table 3 Risk factors for diabetesa Dr. Matthews is head, division of periodontics, faculty of dentistry,
Dalhousie University, Halifax, Nova Scotia.
Family history of diabetes mellitus
Previous gestational diabetes Correspondence to: Dr. Debora C. Matthews, Division of
Dyslipidemia Periodontics, Faculty of Dentistry, Dalhousie University, Halifax,
NS B3H 3J5. E-mail: debora.matthews@dal.ca.
Infertility, hirsutism
Obesity The views expressed are those of the author and do not necessarily reflect
Smoking the opinions or official policies of the Canadian Dental Association.
aAdapted from Meltzer and others.3
References
1. Tan M, Daneman D, Lau D, and others. Diabetes in Canada: strate-
frequently, especially if periodontal disease is already gies towards 2000. In: Canadian Diabetes Advisory Board; 1997;
present. Patients with well-controlled diabetes who have Toronto; 1997. p. 3.
good oral hygiene and who are on a regular periodontal 2. Tan MH, MacLean DR. Epidemiology of diabetes mellitus in Canada.
Clin Invest Med 1995; 18(4):240-6.
maintenance schedule have the same risk of severe peri- 3. Meltzer S, Leiter L, Daneman D, Gerstein HC, Lau D, Ludwig S, and
odontitis as nondiabetic subjects. C others. 1998 clinical practice guidelines for the management of diabetes
Journal of the Canadian Dental Association March 2002, Vol. 68, No. 3 163
Matthews
164 March 2002, Vol. 68, No. 3 Journal of the Canadian Dental Association