Impact of diabetes on periodontal disease

Abstract

Diabetes mellitus is characterized by high blood glucose levels and elevated levels of cytokines such as tumor necrosis factor (TNF), increased generation of reactive oxygen species (ROS) and the formation of advanced glycation end products that contribute to diabetic complications. Periodontitis is triggered by invasion of gingival connective tissue by bacteria or their products, which initiate a host response that leads to inflammation and loss of supporting structure of the tooth. The inflammation also interferes with the repair process so that uncoupling occurs and osteolysis is not reversed by the formation of new bone. Individuals with diabetes mellitus have greater risk of developing periodontitis as well as increased severity. Animal models have provided insight into the mechanisms by which diabetes increases periodontal bone loss by affecting critical cell types including inflammatory cells, osteoclasts, and osteoblasts. The loss of bone that is increased by hyperglycemia can be reversed by inhibition of cytokines and advanced glycation end products.