Short Communication

Combined Medical Problems of Diabetes (DM) and Periodontitis Disease (PD) for Future Adequate Management

Hiroshi Bando

Medical Research Japan Low Carbohydrate Diet Promotion Association (JLCDPA) Tokushima University, Tokushima, Japan
Received Date: May 04, 2021; Published Date: May 30, 2021;

*Corresponding author: Hiroshi Bando, Medical Research Japan Low Carbohydrate Diet Promotion  Association (JLCDPA) Tokushima University, Tokushima, Japan.

How to cite this article: Hiroshi Bando (2021) “Combined Medical Problems of Diabetes (DM) and Periodontitis Disease (PD) for Future Adequate Management.” Sis Med Psy Neuro J 1(1): 06-10.

Short Communication
Healthy Congratulations for the inaugural issue of “Sisla Medical Psychiatry & Neurology Journal” [1]. When looking back the long history of medical practice, common diseases have been changed for infectious diseases such as tuberculosis to non-communicable diseases (NCDs) such as diabetes. Nowadays, common medical problems include metabolic syndrome, locomotive syndrome, diseases of psychiatry/neurology, and others. In the light of actual clinical practice, this journal will be expected to contribute much for the development of academic medical world [2].

Keywords: Sisla Medical Journal; Diabetes Mellitus (DM); Periodontal Disease (PD); Low Carbohydrate Diet (LCD)

Across the world, diabetes mellitus (DM) and periodontal disease (PD) have been highly increasing and prevalent [3]. Their combination has been pointed out for years, and PD is now recognized as one of diabetic complications [4]. Actually, several medical and health problems are found in diabetic patients with PD [5]. Then, adequate clinical management for them has been required for internal medicine and dental departments [6]. In this article, the importance of clinical management of PD and DM would be described from several points of view.

Concerning DM and PD, several guidelines were observed so far. One of them was presented by the Consensus report and guidelines on PD and DM [7,8]. It was made in the Perio-Diabetes workshop, that was organized by both of International Diabetes Federation (IDF) and the European Federation of periodontology (EFP). The contents were proposed for physician and dentist. Among them, some adequate items were from the viewpoints of psychiatry, neurology and psychology, such as i) informing the patients of both links, ii) taking the advantage of screening questionnaire and iii) continuing regular PD monitoring.

This article describes some viewpoints in the following: i) DM, ii) PD, iii) impressive case, iv) patient-oriented medicine.

Firstly, DM has been one of the well-predicted risk factors for PD. Conversely, PD can influence general systemic inflammatory glucose metabolism, insulin resistance and lipid metabolism [9,10]. As DM is chronic metabolic disease, its pathophysiology is either decreased insulin secretion or increased insulin resistance. PD may affect both function of glucose and insulin.

The mutual directional relationship of DM and PD has been recently in discussion across the world [11]. Lots of investigations have showed two-way association between them. From epidemiological evaluation, increased prevalence and incidence of PD has been observed in adults patients with type 2 DM (T2DM) [12]. The decreased value of HbA1c was shown to be significant for effective treatment of T2DM [13]. Further, every 1 % decrease of HbA1c may bring 35% risk reduction of complications, including PD [14].

The relationship among PD, retinopathy and nephropathy was investigated for T2DM patients [15]. Meta-analysis was conducted from 8 articles with 3987 cases. PD was found with overall microvascular complications (OR 1.96). All results revealed that PD was found with retinopathy (OR 3.77) and nephropathy (OR 1.55). In conclusion, PD exist with retinopathy, diabetic nephropathy among T2DM cases and further evaluation will be expected with larger clinical trials.

From mentioned above, adequate treatment for PD can result in the HbA1c reduction. Diabetic patients will have the benefit by receiving periodontal therapy. In the case of hospitalized diabetic case, dental check has to be taken that was not usually conducted routinely [16]. Consequently, any diabetic case will receive routine oral examination and periodontal treatment if needed in also outclinic practice.

Secondly, periodontal pathogens cause cytokine production and oxidative stress which will bring the impaired sensitivity and function of insulin [17]. The treatment of periodontal disease associated with improvement of diabetes control would be beneficial. For recent compared study about these aspects, patients with chronic PD and DM were followed by HbA1c, scaling root planing (SRP) and full-mouth scaling. As a result, significant improvement of HbA1c and periodontal status were found for 3 months [17].

According to recent study, the correlation between glucose variability and PD were investigated for T2DM [18]. The cases were 182 T2DM cases associated with generalized PD. The markers included clinical attachment level (CAL), probing depth (PD), bleeding on probing (BoP), presence of suppuration (SUP), number of remaining teeth, HbA1c and fasting glucose. The results showed that the severity of PD was higher in poor controlled T2DM in comparison with better controlled cases [18].

On the other hand, periodontitis means a chronic inflammatory situation of gum around the teeth. It has been observed due to biofilm accumulation from the improper oral hygiene. As regard to the biofilm, it consists of more than 1000 kinds of species of microorganisms. They are involved in the trigger factors and perpetuation of periodontitis such as Tannerella forsythia and Porphyromonas gingivalis  [19,20]. Periodontitis may bring to form the pockets between gums and teeth, decreased support of periodontal tissue and bone. It means clinical attachment loss, which may cause teeth mobility and future necessity for removal of the tooth.

Thirdly, Author and collaborators have continued medical practice and research on T2DM, PD and low carbohydrate diet (LCD) for years. Among them, one case was 57-year-old men who suffered from PD, DM, obesity. He was treated by brushing of the teeth, removal of calculus on the gingival margin, extraction of non-storable teeth, temporary splinting under supportive periodontal therapy (SPT) and LCD. He was on super-LCD with 12% of carbohydrate ratio, and showed the reduction of HbA1c and weight reduction for 3 months as 7.8%-5.4% and 100kg-90kg, respectively.

Fourthly, regarding patient-oriented medicine, a recommended proposal may be present concerning the medical and health problem of DM and PD. It is ‘Healthy Japan 21’ by Japan’s Ministry of Health, Labor and Welfare. It includes several important tasks life style-related diseases, such as dental health and DM. As concrete measures, regular medical and dental checkup, cessation of smoking, moderation in drink, self-care, tooth brushing, plaque control and suppression of sugar intake.

In summary, recent trend concerning DM and PD was described. The common pathophysiological situation will be understood broadly by medical staffs and patients. This article would be hopefully a reference for future clinical practice and research.


  1. Kato M, Bando H, Matsuzaki S, Waka S (2020) Recent Topics on Various Clinical Problems Related with Diabetic Neuropathy. J Clin Neurol Neurosci 1: 01.
  2. American Diabetes Association. 11. Microvascular complications and foot care: Standards of Medical Care in Diabetesd 2021. Diabetes Care 44.
  3. Nguyen ATM, Akhter R, Garde S, Scott C, Twigg SM (2020) The association of periodontal disease with the complications of diabetes mellitus. A systematic review. Diabetes Res Clin Pract 165: 108244.
  4. Sakamoto D, Bando H, Iwatsuki N, Sakamoto K, Okada M, et al. (2020) Remarkable Improvement of Periodontal Diseases (PD) and Diabetic State with Weight Reduction by Super Low Carbohydrate Diet (LCD). J Oral Dent Health Res 2: 114.
  5. Bando H (2018) Diabetes Mellitus (DM) and Periodontal Disease (PD) with Mutual Vicious Cycle. International Journal of Research Studies in Medical and Health Sciences 3: 37-39.
  6. Bissett SM, Presseau J, Rapley T, Preshaw PM (2019) Uptake of best practice recommendations in the management of patients with diabetes and periodontitis: a cross-sectional survey of dental clinicians. BDJ 226: 131-137.
  7. Sanz M, Ceriello A, Buysschaert M, Iain C, RyanTD, Fillippo G, et al. (2018) Scientific evidence on the links between periodontal diseases and diabetes: consensus report and guidelines of the Joint EFP/IDF Workshop on Periodontal Diseases and Diabetes. J Clin Periodontol 45: 138-149.
  8. Singh M, Bains VK, Jhingran R, Srivastava R, Madan R, Maurya SC, et al. (2019) Prevalence of periodontal disease in type 2 diabetes mellitus patients: A cross sectional study. Contemp Clin Dent 10: 349-357.
  9. Vesa CM, Popa L, Popa AR, Rus M, Zaha AA, Bungau S, et al. (2020) Current data regarding the relationship between type 2 diabetes mellitus and cardiovascular risk factors. Diagnostics 10: 314.
  10. Joshipura KJ, Muñoz Torres FJ, Dye BA, Leroux BG, Ramírez Vick M, et al. (2018) Longitudinal association between periodontitis and development of diabetes. Diabetes Res Clin Pract 141: 284-293.
  11. Mealey BL and Oates TW (2006) Diabetes mellitus and periodontal diseases. J Periodontol 77: 1289-1303.
  12. Botero JE, Rodríguez C, Agudelo Suarez AA (2016) Periodontal treatment and glycaemic control in patients with diabetes and periodontitis: An umbrella review. Aust Dent J 61: 134-148.
  13. Genuth S, Eastman R, Kahn R, Klein R, Lachin J, Lebovitz H, et al. (2003) American Diabetes Association: Implications of the United Kingdom prospective diabetes study. Diabetes Care 26: S28-S32.
  14. Wu HQ, Wei X, Yao JY, Qi JY, Xie HM, Sang AM, et al. (2021) Association between retinopathy, nephropathy, and periodontitis in type 2 diabetic patients: a Meta-analysis. Int J Ophthalmol 14: 141-147.
  15. Singh M, Bains VK, Jhingran R, Srivastava R, Madan R, Maurya SC, et al. (2019) Prevalence of periodontal disease in type 2 diabetes mellitus patients: A cross-sectional study. Contemporary Clinical Dentistry 10: 349
  16. Prasad R, Raj A, Khan SF, Agarwal S, Shalini B, Chandini HS (2021) Effect of non-surgical periodontal therapy on glycemic control of patients with chronic periodontitis and type 2 diabetes mellitus: A 3 month follow-up intervention study. Internat J Applied Dental Sci 7: 05-08.
  17. Stoicescu M, Calniceanu H, Țig I, Nemeth S, Tent A, Popa A, et al. (2021) Significant aspects and correlation between glycemic control and generalized chronic periodontitis in type 2 diabetes mellitus patients. Experiment Therapeut Med 22: 671-675.
  18. Zaha DC, Bungau S, Aleya S, Tit DM, Vesa CM, Popa AR, et al. (2019) What antibiotics for what pathogens? The sensitivity spectrum of isolated strains in an intensive care unit. Sci Total Environ 687: 118-127.
  19. Zaha DC, Bungau S, Uivarosan D, Tit DM, Maghiar TA, Maghiar O, et al. (2020) Antibiotic consumption and microbiological epidemiology in surgery departments: Results from a single study center. Antibiotics Basel 9: 81.
  20. Sakamoto D, Bando H, Iwatsuki N, Sakamoto K, Okada M, Ogawa T (2020) Remarkable Improvement of Periodontal Diseases (PD) and Diabetic State with Weight Reduction by Super Low Carbohydrate Diet (LCD). J Oral Dent Health Res 2: 114.