by Bianca Garilli, ND
A diagnosis of type 2 diabetes (T2D) is typically made through the following measurements and is most commonly screened for and diagnosed by primary care providers during annual exams:
- Hemoglobin A1c (HbA1c) ≥6.5% or
- Fasting plasma glucose (FPG) ≥126 mg/dl (7.0 mmol/l) or
- 2-h plasma glucose ≥200 mg/dl (11.1 mmol/l) during an oral glucose tolerance test (OGTT) or
- In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dl (11.1 mmol/l)1
More recently, however, it has been put forward that dentists may be able to help in the identification of patients at risk for T2D through positive findings of periodontal disease. Past studies have indicated a potential link between periodontal treatment and improved glycemic control but previously there was limited evidence of a causal relationship. Recent results from a randomized controlled trial published in the Journal of Clinical Periodontology, however, has gathered data revealing that a causal relationship between periodontitis and T2D does exist.2
The study, conducted by several groups of researchers at the University of Barcelona Spain reported on a 6 month randomized clinical trial of 90 patients with an average hemoglobin A1c (HbA1C) of 7.7% and a positive diagnosis for periodontal disease. Patients were randomized to either the periodontal treatment group consisting of oral hygiene instructions, scaling and root planing or the control group who received oral hygiene instructions and supragingival removal of plaque and calculus. After six months, subjects in the treatment group were found to have a significant improvement in periodontal and metabolic parameters whereas the control group did not see such changes.2 Previous studies have found similar improvements where 3 months of effective periodontal treatment in patients with T2D was associated with reductions in HbA1C of 0.27-0.48%.3
Reasons for these findings are hypothesized to be multifactorial including links to both disease processes to the immune system, and inflammatory pathways including elevations in interleukin (IL) 1-β, tumor necrosis factor-α, IL-6, receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio, oxidative stress and toll-like receptor (TLR)2/4 expression.
This emerging evidence has prompted the European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF) to create consensus guidelines for physicians, oral healthcare professionals and patients to improve early diagnosis, prevention and co-management of diabetes and periodontitis.3
Why is this Clinically Relevant?
- Dental exams and visits should be a routine part of health checkups
- Periodontal disease should be treated appropriately by an experienced dental provider
- Signs of periodontal disease should be followed up by blood glucose testing
- Oral health should be considered a major part of the healthcare exam and viewed as a “window” into the body
1. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2010 Jan; 33(Suppl 1): S62–S69. doi: 10.2337/dc10-S062
2. Mauri-Obradors, E. et al. Benefits of non-surgical periodontal treatment in patients with type 2 diabetes mellitus and chronic periodontitis: A Randomized controlled trial. Journal of Clinical Periodontology 2018;45:345-353.
3. Sanz, M, et al. Scientific evidence on the links between periodontal diseases and diabetes: consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the international Diabetes Federation (IDF) and the European Federation of Periodontology (EFP). Journal of Clinical Periodontology 2017;45(2). DOI10.1111/jcpe.12808.