The Relationship Between Periodontitis and Glycaemic Control in Type 2 Diabetes

Periodontitis is a bacteria-related, chronic inflammation that results in destruction of the bone and connective tissue support of teeth forming periodontal pockets between the tooth and gingival soft tissue.¹ It is initiated by inadequate oral hygiene and the development of a biofilm colonised with pathogenic bacteria on the tooth surface that results in direct damage to local tissues by bacterial virulence factors (see Figures 1 and 2).² The stimulation, an inflammatory/immune response to the offending bacteria, is further associated with indirect tissue damage
Periodontitis is a bacteria-related, chronic inflammation that results in destruction of the bone and connective tissue support of teeth forming periodontal pockets between the tooth and gingival soft tissue.¹ It is initiated by inadequate oral hygiene and the development of a biofilm colonised with pathogenic bacteria on the tooth surface that results in direct damage to local tissues by bacterial virulence factors (see Figures 1 and 2).² The stimulation, an inflammatory/immune response to the offending bacteria, is further associated with indirect tissue damage^3,4 mediated by cytokines including interleukin-1 beta (IL-1β), IL-6, tumour necrosis factor-alpha (TNF-α) prostaglandins and collagenolytic enzymes.^6,7 Oxidative damage to the tissues is also a feature of the periodontitis lesion,^8,9 thought to result from hyper-reactive neutrophils generating excessive reactive oxygen species (ROS) during bacterial phagocytosis¹⁰ causing both direct damage and stimulating redox-sensitive pro-inflammatory transcription factors. Individuals vary in their susceptibility to periodontitis and the key determinant appears to be a phenotype coding for a particularly exaggerated inflammatory and immune response to pathogenic bacteria.¹¹

Within worldwide populations, periodontitis is a common condition with a prevalence of between 5 to 20 %.¹² The rate of progression varies among individuals but the most common form of the disease has a chronic, slowly progressing nature and patients may be burdened by the chronic inflammatory condition for years or decades before diagnosis and treatment.

Progression of untreated periodontitis can result in pain, aesthetic problems, functional difficulties and complete tooth loss in severe cases.¹³

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