The association of sever periodontitis and diabetes mellitus is very strong and complex.
The periodontitis is a chronic inflammatory disease characterized by the destruction of supporting structures of the teeth, the periodontal fibers and alveolar bone. It is a highly prevalent disease. Severe periodontitis is prevalent in 10-15% of the population. It affects the quality of life adversely.
Epidemiological studies have shown that Diabetes is a major risk factor for periodontitis. Susceptibility to develop periodontitis increases approximately three folds if a person becomes diabetic.
It has been proved that there is a direct correlation between the severity of hyperglycemia and the severity of the periodontitis. The mechanism that plays role in this interaction has not been fully deciphered. It has been shown through few experiments that the defective neutrophil function, immunologic malfunctions and cytokines do play their roles. Emerging evidences show that the diabetes does have a role in the increase in the severity of periodontitis; and the inflammatory process of periodontitis makes the glycemic control difficult. Therefore, it is a two way relationship.
Not only the diabetes makes the periodontitis worst, but it becomes friend with the periodontitis when it comes to damage the other body organs. The incidence of end stage renal disease and macro albumin urea increases three times and two times respectively in diabetic individuals with severe periodontitis than those diabetic patients without severe periodontitis. Furthermore, the risk of having cardio-renal mortality (like ischemic heart disease and diabetic nephropathy combined) increases three folds in diabetics with sever periodontitis than diabetics without severe periodontitis.
Studies have shown that the treatment of periodontitis results in approximately 0.4% reduction in the level of HbA1C. The oral and periodontal health promotion should be made the integral part of the diabetes management.