The Two-way Street between Periodontal Diseases and Diabetes

Periodontitis is a chronic inflammatory disease that is initiated by the accumulation of dental biofilm, where dysbiosis leads to a chronic non-resolving condition, and destructive inflammatory response. The destruction of tissues that we clinically recognize as periodontitis (that is, destruction of the periodontal ligament, periodontal pocket formation and alveolar bone resorption) is caused mainly by the host’s inflammatory response to the bacterial challenge presented by the biofilm [38]. Periodontitis affects, in its severe forms, approximately 10% of the global population, which represents almost 750 million people worldwide[16]. The prevalence of periodontitis among all adults aged 30 years and over registered by the National Health and Nutrition Examination Survey (NHANES) in the United States is 46% [8]. In addition, periodontitis has been found to be more severe and 3 times more likely to occur in patients with diabetes mellitus (DM) compared to the general population [14,25], and the level of glycemic control is the key to determining risk, and similar to other diabetes complications, the risk of periodontitis increases with a worse glycemic index [33]. DM, a chronic non-communicable metabolic disease, occurs when blood glucose levels are increased, or because the body cannot produce any, or enough insulin, or use insulin effectively [15].