Diabetes-related complications tied to higher risk of periodontitis

A study presented at EASD 2024 shows that microvascular complications of diabetes, such as diabetic neuropathy and retinopathy, are independently and concomitantly associated with moderate/severe periodontitis.

“When diabetes is poorly controlled, high blood sugar levels can lead to inflammation which, over time, can affect the eyes leading to retinopathy, or the nerves in the feet causing neuropathy, or the gums, contributing to the development of severe periodontitis,” said Dr Fernando Valentim Bitencourt from Aarhus University in Denmark.

In one study, the prevalence of periodontitis in individuals with T2D ranged between 60 and 70 percent. [BMC Oral Health 2020;20:204]

In the current analysis, after adjusting for inverse probability of treatment weighting, the likelihood of having moderate/severe periodontitis was higher among those with diabetic neuropathy (odds ratio [OR], 1.36, 95 percent confidence interval [CI], 1.14–1.63) and diabetic retinopathy (OR, 1.21, 95 percent CI, 1.03–1.43) as opposed to those who did not have microvascular complications.

The likelihood was even higher among individuals who had both microvascular complications (OR, 1.51, 95 percent CI, 1.23–1.85). [EASD 2024, abstract 93]

The study also showed that dyslipidaemia further increases the risk of severe periodontitis. In the subgroup of participants with dyslipidaemia, the ORs for neuropathy, retinopathy, and both were 1.40, 1.43, and 1.47, respectively.

Biological mechanisms

Hyperglycaemia leads to local immune dysfunction, cellular stress, cytokine imbalance, and local elevation of interleukin (IL)-6, IL-1, and tumour necrosis factor levels. These, in turn, heighten bone and connective tissue destruction, which could then lead to the exacerbation of periodontitis, Bitencourt explained.

Another biological pathway that could explain the relationship between diabetes and periodontitis is the alterations in lipids that lead to oxidative stress and alteration in adipokines, which can promote local elevations in pro-inflammatory cytokines in the periodontium, he added.

Left untreated, periodontitis can lead to the destruction of the periodontal structure, subsequently leading to tooth mobility and eventual tooth loss. “This tooth loss can affect essential functions like chewing and speaking while also affecting self-esteem,” said Bitencourt.

“As a result, periodontitis can significantly [affect] a person’s quality of life, leading to difficulties with nutrition, communication, and social interactions. Understanding who is at higher risk, such as individuals with diabetes complications, is crucial for early intervention and prevention of these far-reaching effects,” Bitencourt said.

Bitencourt and colleagues evaluated data on 15,922 individuals (mean age 63.7 years) from the Health in Central Denmark cohort. Participants completed a questionnaire and underwent a comprehensive laboratory examination.

Periodontitis – not just a marker for oral health issues

“[P]eriodontitis might not only serve as a marker for oral health issues but could also help identify individuals with a higher systemic inflammatory burden who are therefore at greater risk of diabetes-associated microvascular complications,” Bitencourt noted in the EASD press release.

The results underscore a multidisciplinary treatment approach for individuals with T2D. “This study highlights the importance of including periodontitis in the prevention and management strategies for diabetes-related complications. We need to integrate general and dental care,” said Bitencourt.

“For dentists, in particular, this means recognizing that patients with T2D and moderate/severe periodontitis, especially those with dyslipidaemia, may be at a higher risk for microvascular complications … Dentists should consider recommending [screening these patients for] microvascular complications,” he said.

“By working together, healthcare providers can help ensure that patients with T2D, especially those who are at an elevated risk of diabetes complications, receive more comprehensive oral health care – potentially improving both their oral and overall health,” he added.