As we observe National Diabetes Month, it’s crucial for dental professionals to understand the profound bidirectional relationship between diabetes and oral health. This connection has evolved from a recognized association to a well-documented, clinically significant partnership that demands our attention as geriatric dentistry practitioners.
The Bidirectional Relationship: More Than Just Association
Recent evidence confirms that diabetes and periodontal disease exist in a vicious cycle of mutual influence. People with diabetes have a 2–3-fold greater risk for periodontitis compared to people without diabetes, but also a higher incidence of caries due to dry mouth. The relationship operates in both directions: dysglycemia, even slightly elevated blood sugar levels, adversely affects oral health, while any oral infection with its subsequent local and systemic inflammatory responses adversely affects blood glucose levels [1].
Research demonstrates that the prevalence of periodontal disease in diabetic populations increases significantly with age, making understanding this relationship particularly relevant for geriatric dental practice [2].
Clinical Implications: Evidence for Periodontal Intervention
The therapeutic potential of periodontal treatment in diabetes management has gained substantial scientific support. A 2025 meta-analysis demonstrated that periodontal therapy appears to significantly reduce HbA1c and CRP levels over short-term periods in diabetic patients, with significant reductions in HbA1c at three months (-0.64; CI95%=-0.96 to -0.32) and six months (-0.33; CI95%=-0.65 to -0.01). [3]
Multiple systematic reviews from 2020-2021 have consistently shown that non-surgical periodontal treatment produces meaningful improvements in glycemic control. Scaling and root planning was effective in reducing HbA1c with differences in means of 0.56 (0.36-0.75), p<0.01, while also significantly reducing C-reactive protein levels, indicating decreased systemic inflammation. [4]
Importantly, the benefit of periodontal therapy on glycemic control was much more obvious in studies with a higher baseline HbA1c level than in those with a lower baseline HbA1c level, suggesting that patients with poorer glycemic control may benefit most from periodontal intervention. [4]
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Oral Health Manifestations in Diabetes
Diabetes affects oral health through multiple pathways beyond periodontal disease. Diabetes can also slow down healing, thus interfering with the treatment of periodontal disease. Other problems diabetes can cause are dry mouth and a fungal infection called thrush that causes painful white patches intraorally. The dry mouth condition creates a cascade of problems such as soreness, ulcers, infections, and tooth decay.
Prevention and Management Strategies
These findings underscore the importance of comprehensive oral health assessment and maintenance in diabetes prevention strategies. Here are some highlights of the elements to be considered.
For Dental Professionals:
- Conduct thorough periodontal assessments in all diabetic patients [5]
- Consider HbA1c monitoring capabilities in dental settings with appropriate glucometers [5]
- Implement comprehensive periodontal therapy protocols, including scaling and root planning [4]
- Coordinate care with patients’ medical teams for optimal outcomes [5]
- Pay attention to infectious oral diseases and regular dental care with referral to other dental and medical specialists being important in preventing and managing diabetes mellitus [5]
For Patient Education:
The CDC emphasizes that regular dental exams can prevent or delay gum disease and other oral health problems. Patient education should focus on:
- The critical importance of optimal glycemic control for oral health outcomes [5]
- Daily oral hygiene as part of diabetes self-management [5]
- Recognition of oral symptoms that warrant immediate attention
- Regular brushing and flossing are critical for diabetes self-management
Looking Forward: Integrated Care Approach
The evidence strongly supports an integrated approach to diabetes and oral health care. Such interprofessional, patient centered care may contribute to improved health, wellbeing, and quality of life in people with diabetes [1]. As dental professionals, we have an opportunity to contribute meaningfully to diabetes management while simultaneously improving our patients’ oral health outcomes.
Treatment of inflammation related oral conditions, such as non-surgical periodontal treatment and extraction of infected teeth, can lead to a clinically significant decrease in blood glucose levels. This positions periodontal therapy not merely as treatment for oral disease, but as a valuable adjunctive intervention in comprehensive diabetes care.
During this National Diabetes Month, let us commit to recognizing oral health as an integral component of diabetes prevention and management, particularly in our aging population where both conditions become increasingly prevalent and interrelated.
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References
[1] Borgnakke WS. IDF Diabetes Atlas: Diabetes and oral health – A two-way relationship of clinical importance. Diabetes Res Clin Pract. 2019 Nov;157:107839. doi: 10.1016/j.diabres.2019.107839. Epub 2019 Sep 11. PMID: 31520714.
[2] Wu CZ, Yuan YH, Liu HH, Li SS, Zhang BW, Chen W, An ZJ, Chen SY, Wu YZ, Han B, Li CJ, Li LJ. Epidemiologic relationship between periodontitis and type 2 diabetes mellitus. BMC Oral Health. 2020 Jul 11;20(1):204. doi: 10.1186/s12903-020-01180-w. PMID: 32652980; PMCID: PMC7353775.
[3] Umezaki Y, Yamashita A, Nishimura F, Naito T. The role of periodontal treatment on the reduction of hemoglobinA1c, comparing with existing medication therapy: a systematic review and meta-analysis. Front Clin Diabetes Healthc. 2025 Feb 25;6:1541145. doi: 10.3389/fcdhc.2025.1541145. PMID: 40070580; PMCID: PMC11893427.
[4] Baeza M, Morales A, Cisterna C, Cavalla F, Jara G, Isamitt Y, Pino P, Gamonal J. Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis. J Appl Oral Sci. 2020 Jan 10;28:e20190248. doi: 10.1590/1678-7757-2019-0248. PMID: 31939522; PMCID: PMC6919200.
[5] Petropoulou P, Kalemikerakis I, Dokoutsidou E, Evangelou E, Konstantinidis T, Govina O. Oral Health Education in Patients with Diabetes: A Systematic Review. Healthcare (Basel). 2024 Apr 26;12(9):898. doi: 10.3390/healthcare12090898. PMID: 38727455; PMCID: PMC11083353.
