Association of periodontal disease with diabetes and chronic kidney disease -Basic and clinical research-

Abstract

Periodontitis is closely associated with diabetes mellitus and has a diabetic complication-like appearance. In an in-vivo study performed using obese rodents, we first found that insulin resistance in the gingiva, in addition to that in the retina and glomeruli of the kidney, was induced via vascular inflammation even prior to diabetes mellitus. Furthermore, inflammation caused by oxidative stress was observed in the vascular endothelial cells of the gingiva. Oxidative stress caused by elevated production of reactive oxygen species (ROS) in the periodontal tissues is associated with impaired cellular functions, delayed gingival wound healing, impaired periodontal tissue regeneration, and compromised implant osseointegration.

Clinical studies have shown that patients with type 2 diabetes mellitus have a significantly higher frequency of morphological abnormalities in the gingival capillaries. The glycemia control status was found to be correlated with the periodontal inflammatory surface area (PISA) even after adjusting for the full-mouth plaque control level. Intensive diabetes care resulted in a significant reduction in the severity of periodontal inflammation and of the probing pocket depth. These clinical findings provide evidence for a bidirectional relationship between diabetes mellitus and periodontal disease.

Chronic kidney disease is associated with the major complications of diabetes mellitus. Further research is needed to better understand the association between periodontal disease and chronic kidney disease. Available evidence to date suggests that a correlation may exist between the oral health of patients with end-stage renal failure and their systemic condition, including survivability. A 3-year longitudinal study found insufficient oral hygiene as a significant risk factor for mortality, and involvement of periodontal disease in the development of the malnutrition-inflammation-atherosclerosis (MIA) syndrome, which is a significant risk factor for survival in patients undergoing dialysis. The findings suggest that dental interventions, such as instructions for maintaining oral hygiene and periodontal therapy, may potentially improve the overall prognosis of patients undergoing hemodialysis.

Future research in the field of periodontal medicine should consider how dental professionals could potentially contribute to the promotion of overall health by controlling periodontal disease.