Periodontal infections and diabetes mellitus: when will the puzzle be complete?
J Clin Periodontol 2007; 34: 913–916 doi: 10.1111/j.1600-051X.2007.01140.x
Division of Periodontics, Section of Oral and
Diagnostic Sciences, Columbia UniversityCollege of Dental Medicine, New York, NY,USA
Lalla E. Periodontal infections and diabetes mellitus: when will the puzzle becomplete? J Clin Periodontol 2007; 34: 913–916. doi: 10.1111/j.1600-051X.2007.01140.x.
The article in last month’s issue of the
that diabetes increases the risk for perio-
dontitis by twofold (Papapanou 1996).
the past 12 months (Engebretson et al.
including 19,245 individuals 5–78 years
similar extent of periodontal diseases in
et al. 2007, Lim et al. 2007, Jones et al.
a limitation of the latter report, acknowl-
of studies with significant heterogeneity,
i.e., very different study populations and
conditions, focuses on the topic of perio-
state with the opportunity of the January
disease duration appear to play a role in
issue Jones et al. (2007a, b) study, high-
the level of risk for periodontal diseases,
what are the effects of periodontitis and
adults reported that the level of glycae-
diabetic patients is scant, as is informa-
severity and extent of periodontitis.
ades of reports regarding the association
in several reports, although some studies
that diabetic patients are at significantly
(2001) and Mealey & Oates (2006).
r 2007 The Author. Journal compilation r 2007 Blackwell Munksgaard
might affect the diabetic state, is rather
(p 5 0.82)’’ without any further expla-
and E-selectin (Lalla et al. 2007b).
cations (i.e., cardiovascular disease and
usually have poor glycaemic control.
studying type 1 diabetes in this particu-
Saremi et al. 2005, Shultis et al. 2007).
pilot studies are of importance given the
cooperative with oral health-care habits)
has a positive systemic effect in patients
respectively, in diabetic individuals.
of other complications, this is of essence
that direct infection of the vascular wall
validated across all diabetic patients.
January issue of the journal (Jones et al.
spread of bacteria. Adjunctive antibiotic
affected individuals and this is the rea-
essential treatment strategy in both types
interested in participating patients were
of diabetes. Therefore, type of disease or
excluded. The authors adopted this strat-
egy because ‘‘it clearly left room for
quantify the effects of periodontal ther-
(i.e., the overall host burden). The treat-
range of poor control’’. Indeed, baseline
ment strategy in type 2 patients is argu-
456 patients, from 10 longitudinal perio-
further substantiates the concept that in
both disease types, the potential effects
À 1.5, 0.7). A larger, but still not statis-
requirements, lipid levels/profile, serum
authors reported that ‘‘the type of con-
r 2007 The Author. Journal compilation r 2007 Blackwell Munksgaard
Periodontal infections and diabetes mellitus
support for the concept that periodontitis
Bakhshandeh, S., Murtomaa, H., Mofid, R.,
Vehkalahti, M. M. & Suomalainen, K.
although statistical significance was not
Bodenheimer, T., Wagner, E. H. & Grumbach,
Davila-Perez, C., Amano, A., Alpuche-Solis, A.
G., Patino-Marin, N., Pontigo-Loyola, A. P.,
the untreated subjects received increases
Hamada, S. & Loyola-Rodriguez, J. P. (2007)
in insulin during the 4-month period.
to real changes in clinical practice.
Distribution of genotypes of Porphyromonas
gingivalis in type 2 diabetic patients with
periodontitis in Mexico. Journal of Clinical
Engebretson, S., Chertog, R., Nichols, A., Hey-
Hadavi, J., Celenti, R. & Grbic, J. (2007)
Plasma levels of tumour necrosis factor-alpha
al. 2005, 2006). Dentists tend to inquire,
in patients with chronic periodontitis and
Engebretson, S. P., Vossughi, F., Hey-Hadavi,
J., Emingil, G. & Grbic, J. T. (2006) The
influence of diabetes on gingival crevicular
effect size achieved in the current study
fluid beta-glucuronidase and interleukin-8.
patient relations are significant predic-
Iwamoto, Y., Nishimura, F., Nakagawa, M.,
include the fact that periodontal destruc-
tors for general dentists (Kunzel et al.
deep sites were still present at 4 months.
microbial periodontal treatment on circulat-
ing tumor necrosis factor-alpha and glycated
reveal improved periodontal healing.
Janket, S. J., Wightman, A., Baird, A. E., Van
Dyke, T. E. & Jones, J. A. (2005) Does
periodontal treatment improve glycemic con-
trol in diabetic patients? A meta-analysis of
Jones, J. A., Miller, D. R., Wehler, C. J., Rich,
S., Krall, E., Christiansen, C. L., Rothendler,
J. A. & Garcia, R. I. (2007a) Study design,
recruitment, and baseline characteristics: the
department of veterans affairs dental diabetes
study. Journal of Clinical Periodontology 34,
clinical trial. As a final point, the Jones
et al. study represents a major effort and
Jones, J. A., Miller, D. R., Wehler, C. J., Rich,
Christiansen, C. L., Rothendler, J. A. &
inducing a positive effect on the diabetic
Garcia, R. I. (2007b) Does periodontal care
state and offers valuable information for
the design of future multi-centre clinical
infections–diabetes relationship is large,
of veterans affairs dental diabetes study.
Journal of Clinical Periodontology 34, 46–52.
Khader, Y. S., Dauod, A. S., El-Qaderi, S. S.,
results from large, multi-centre clinical
Alkafajei, A. & Batayha, W. Q. (2006)
trials with multiple treatment modalities
with nondiabetics: a meta-analysis. Journal
of Diabetes Complications 20, 59–68.
r 2007 The Author. Journal compilation r 2007 Blackwell Munksgaard
Kunzel, C., Lalla, E., Albert, D. A., Yin, H. &
Effect of periodontitis on overt nephropathy
Lamster, I. B. (2005) On the primary care
pilot study. Journal of Periodontal Research
and end-stage renal disease in type 2 diabetes.
frontlines: the role of the general practitioner
in smoking-cessation activities and diabetes
Lim, L. P., Tay, F. B., Sum, C. F. & Thai, A. C.
Taylor, G. (2001) Bi-directional interrelation-
ships between diabetes and periodontal dis-
Dental Associations 136, 1144–1153; quiz
metabolic control and inflammation on sever-
eases: an epidemiologic perspective. Annals
Kunzel, C., Lalla, E. & Lamster, I. (2007)
with diabetes mellitus. Journal of Clinical
Taylor, G. W., Burt, B. A., Becker, M. P.,
Dentists’ management of the diabetic patient:
Genco, R. J., Shlossman, M., Knowler, W.
contrasting generalists and specialists. Amer-
Mealey, B. L. & Oates, T. W. (2006) Diabetes
C. & Pettitt, D. J. (1996) Severe periodontitis
ican Journal of Public Health 97, 725–730.
mellitus and periodontal diseases. Journal of
and risk for poor glycemic control in patients
Kunzel, C., Lalla, E. & Lamster, I. B. (2006)
with non-insulin-dependent diabetes mellitus.
Navarro-Sanchez, A. B., Faria-Almeida, R. &
Journal of Periodontology 67, 1085–1093.
the diabetic patient in the dental office.
Bascones-Martinez, A. (2007). Effect of non-
Journal of Periodontology 77, 331–340.
Hugoson, A. (1996) Medical status and com-
Lalla, E., Cheng, B., Lal, S., Kaplan, S., Soft-
plications in relation to periodontal disease
ness, B., Greenberg, E., Goland, R. S. &
experience in insulin-dependent diabetics.
moderate periodontitis. Journal of Clinical
promotes periodontal destruction in children.
Journal of Clinical Periodontology 34, 294–
Papapanou, P. N. (1996) Periodontal diseases:
epidemiology. Annals of Periodontology 1,
Lalla, E., Kaplan, S., Chang, S. M., Roth, G. A.,
Celenti, R., Hinckley, K., Greenberg, E. &
Saremi, A., Nelson, R. G., Tulloch-Reid, M.,
Papapanou, P. N. (2006) Periodontal infec-
Hanson, R. L., Sievers, M. L., Taylor, G. W.,
tion profiles in type 1 diabetes. Journal of
Shlossman, M., Bennett, P. H., Genco, R. &
Clinical Periodontology 33, 855–862.
Knowler, W. C. (2005) Periodontal disease
Lalla, E., Kaplan, S., Yang, J., Roth, G. A.,
and mortality in type 2 diabetes. Diabetes
Papapanou, P. N. & Greenberg, S. (2007b)
Effects of periodontal therapy on serum C-
Shultis, W. A., Weil, E. J., Looker, H. C.,
reactive protein, sE-selectin and tumor necro-
Curtis, J. M., Shlossman, M., Genco, R. J.,
Knowler, W. C. & Nelson, R. G. (2007)
r 2007 The Author. Journal compilation r 2007 Blackwell Munksgaard
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