Mealey and Rose conducted and published a literature review which looked closely at the relationships between diabetes mellitus and periodontal disease, focusing specifically on common pathophysiological pathways associated with conditions such as insulin resistance and inflammation.
The authors found associations between elevated systematic inflammatory rates and enhanced risk of major cardiovascular adverse events such as stroke and myocardial infarction. There were also associations between systematic inflammatory rates and adverse events in pregnancy, and evidence indicating a relationship between impaired glycemic control and inflammation related to periodontitis. Mealey and Rose looked closely at intervention trials which demonstrated periodontal therapy can improve the condition of systemic inflammation, therefore glycemic control in diabetic patients with periodontal disease may improve as the result of an intervention. The authors emphasize the need for dentists and physicians to collaborate when treating patients with periodontitis and diabetes. For additional information on this article, please reference the full citation. Mealey BL, Rose LF. Diabetes mellitus and inflammatory periodontal disease. Compend Contin Educ Dent. 2008;29:402-408, 410, 412-413
Persson and Persson recently published an article which reviewed new literature since the European Workshop on Periodontology.
The authors also reviewed two meta-analyses which identified associations between cardiovascular diseases and periodontitis (OR: 1.1-2.2). As a result of the literature review, the authors reported “periodontitis may contribute to cardiovascular disease and stroke in susceptible subjects”, although they emphasized it is difficult to make definitive statements or conclusions regarding associations and risks between periodontitis and cardiovascular diseases due to a dearth of consistently designed epidemiologic studies on disease prevalence. The authors suggest sufficiently powered longitudinal case-control and intervention trials be conducted to determine the impact periodontitis and periodontal interventions may have on cardiovascular diseases. The authors make several recommendations for research questions associated with surrogate markers following periodontal therapy and assessment of outcomes related to periodontal therapy in cardiovascular patients. For additional information on this article, please review the following article: Persson GR, Persson RE. Cardiovascular disease and periodontitis: an update on the associations and risk. J Clin Periodontol. 2008(8 Suppl):362-79.
A systematic literature review was conducted to review the evidence-based literature for associations between periodontal and peri-implant conditions and diabetes, and the effect of periodontal therapy on outcomes in diabetic patients.
The literature review did not limit levels of evidence but focused solely on human studies. The review determined patients with periodontitis tended to have poor glycemic control and comorbid complications. The literature review found a significant association between diabetes and periodontitis in relation to severity but not extent of disease in patients whose diabetes was uncontrolled. The review lacked evidence indicating implant therapy affected long-term patient outcomes. The authors concluded “poorly controlled diabetes may be considered a risk factor for increased severity of periodontitis”; however, it was felt additional larger scale randomized controlled trials are necessary to make definitive conclusions related to the effects of periodontal therapy on glycemic control and systemic inflammation. For additional information, please review the following article: Salvi GE, Carollo-Bittel B, Lang NP. Effects of diabetes mellitus on periodontal and peri-implant conditions: update on associations and risks. J Clin Periodontol. 2008;35(8 Suppl):398-409
September 18, 2008.