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PERIO-DIABETES PROJECT

Physician Area

INDEX

Project Connexus was created to prevent diabetes, cardiovascular diseases and periodontitis, because they are serious diseases that are closely correlated to one another.

Type II Diabetes [T2D] and Periodontitis [PD] are amongst the most prevalent non-communicable (chronic inflammatory) diseases in the world. They compromise the quality of life of millions of people. Between 1980 and 2014, T2D global prevalence went from 110 Million to 420 Million. The projection for the next 20 years will be of 700 million people suffering from T2D.
A metanalysis from 2009 revealed that T2D patients had double the risk of developing PD compared to patients without T2D, and almost all patients with T2D suffered from PD too.
We all know that patients affected by T2D have metabolic hyperglycemia, and that, eventually, they will develop cardiovascular complications, diabetic retinopathy, neuropathy and nephropathy in the medium-long period.
These said complications should bring all medical categories that are involved in prevention to provide efficient protocols to reduce the incidence of this pathology.
The bidirectionality between Diabetic and Periodontal pathology is well documented in international literature: Diabetic Patients are highly susceptible to severe periodontitis, which increases the risk of developing chronic hyperglycemia.
The effects that Periodontitis has on diabetes are correlated to the penetration of mouth bacteria or their degradation products in the circulation. These events produce, through the increase in inflammatory chemical mediators, an increase in the systemic inflammation, which facilitates the incidence of insulin-resistance. The prolonged exposure to hyperglycemia leads to proteins and lipid glycation (AGE), a phenomenon that explains the typical microcirculation complications in T2D patients. We also know that the typical glycation in T2D patients is the same as HbA1c glycation.
The link between AGE and Monocyte Receptors causes the production of inflammatory cytokines IL-1, IL-6, TNF-alpha and PDGF, and the increase in inflammatory markers like CRP, which is an independent predictor of cardiovascular diseases.
Strong scientific evidences (especially systematic revisions with metanalysis) show that Periodontitis treatment improves glucose metabolic function, decreasing the levels of serum HbA1c and CRP, leading to the decrease of general inflammation.
The results show a 35% reduction of T2D-related cardiovascular complications for each HbA1 percentage point reduction.

The improvement in inflammation parameters in patients who suffer from T2D following Periodontitis therapy brings up important considerations on the necessity to include Periodontal treatment in the treatment of these patients; This will positively influence, to a great degree, the atero-cardio-vascular complications. A revision published in 2020 by Wu et al. on the epidemiologic relationship between T2D and PD has shown the following results:

Include, in the therapy of these patients, periodontal treatment that will positively affect especially the well-known athero-cardio-vascular complications

  1. Cross-sectional studies support a strong correlation between T2D and PD.
  2. Prospective studies highlight the reciprocal influence of the two pathologies; The more serious the TD2 and PD manifestations, the stronger their association is.
  3. Cohort studies show an increase in the incidence of PD in T2D patients and an increase of T2D in PD patients.
  4. Patients with poor glycemic control show an increased susceptibility to PD.
  5. Patients who suffer from severe PD showed an increased incidence in T2D compared to patients with moderate PD.

Strong scientific evidences on the bidirectional correlation between PD-T2D should:

  • Prompt dentists that spot PD in a patient to encourage him to verify an unknown hyperglycemia or T2D.
  • Prompt General Practitioners, Diabetologists, internists, Endocrinologists to encourage T2D patients to get a dental screening to rule out PD or to get proper treatment in case PD is present.
  • Prompt all involved medical categories to raise patients’ awareness about T2D and PD being reciprocal risk factors.

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We invite all physicians: Diabetologists, Cardiologists, Internists, General Practitioners

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An extreme summary of bibliographical references

  1. World Health Organization. Global report on diabetes. 2016: http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf. Accessed September 9, 2017.
  2. Loe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993; 16:329–334.
  3. Tsai C, Hayes C, Taylor GW. Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population. Community Dent Oral Epidemiol. 2002; 30:182–192.
  4. Mealey BL, Ocampo GL. Diabetes mellitus and periodontal disease. Periodontol 2000. 2007; 44:127–153.
  5. Emrich LJ, Shlossman M, Genco RJ. Periodontal disease in non-insulin dependent diabetes mellitus. J Periodontol. 1991; 62:123–131.
  6. Cianciola LJ, Park PH, Bruck E, Mosovich L, Genco RJ. Prevalence of periodontal disease in insulin-dependent mellitus (juvenile diabetes). J Am Dent Assoc. 1982; 104:653–660.
  7. Lalla E, Cheng B, Lal S et al. Diabetes mellitus promotes periodontal destruction in children. J Clin Periodontol. 2007; 34:294–298.
  8. Julia Stöhr, Janett Barbaresko, Manuela Neuenschwander & Sabrina Schlesinger Bidirectional association between periodontal disease and Diabetes mellitus: asystematic review and meta-analysis of Cohort studies. Scientific Reports. 2021; 11:13686. www.nature.com/scientificreports
  9. Myllymaki, V. et al. Association between periodontal condition and the Development of type 2 diabetes mellitus. results from a 15-years follow-up study. J clin. Periodotology. 2018; 45: 1276-1286.
  10. Bascones-Martinez A, Muñoz-Corcuera M, Bascones-Ilundain J. Diabetes and periodontitis: a bidirectional relationship. Med Clin (Barc). 2015; 145:31-5.
  11. Taylor G, Burt B, Becker M, Genco R, Shlossman M, Knowler W, et al. Severe periodontitis and risk for poor glycemic control in patients with non-insulin- dependent diabetes mellitus. Periodontol. 1996. 67 Suppl 10S:1085-93.
  12. Acharya A, Thakur S, Muddapur M, Kulkarni R. Systemic cytokine in type 2 diabetes mellitus and chronic periodontitis. Curr Diabetes Rev. 2018; 14:182-8.
  13. Mesia R, Gholami F, Huang H, Clare-Salzler M, Aukhil I, Wallet S, et al. Systemic inflammatory responses in patients with type 2 diabetes with chronic periodontitis. BMJ Open Diabetes Res Care. 2016; 4: e000260
  14. Quintero AJ, Chaparro A, Quirynen M, Ramirez V, Prieto D, Morales H, et al. Effect of two periodontal treatment modalities in patients with uncontrolled type 2 diabetes mellitus: a randomized clinical trial. J Clin Periodontol. 2018; 45:1098-106.
  15. Chen-zhou Wu, Yi-hang Yuan, Hang-hang Liu, Shen-sui Li, Bo-wen Zhang, Wen Chen, Zi-jian An, Si-yu Chen, Yong-zhi Wu, Bo Han, Chun-jie Li and Long-jiang Li. Epidemiologic relationship between periodontitis and type 2 diabetes mellitus. BMC Oral HealtH. 2020; 20:204.
  16. Grossi S, Skrepcinski F, DeCaro T, Robertson D, Ho A, Dunford R, et al. Treatment of periodontal disease in diabetics reduces glycated hemoglobin. J Periodontol. 1997; 68:713