Diabetes mellitus and periodontal disease

Diabetes mellitus (DM) is a chronic non-transmittable disease and, alongside periodontal disease, another chronic disease, but with infectious and inflammatory etiology, that have increasing prevalence. The link between the two comorbidities is bidirectional, with common aspects such the inflammatory state, altered immune response and healing process. This link is alimented, also, by oxidative stress, an element that can initiate proinflammatory pathways in both pathologies. Moreover, periodontal disease favors the development of DM complications by a multifactorial mechanism centered on hyperglycemia, that leads to damage of the endothelial vascular cells, characteristic for microvascular complications, while the periodontal bacteria and their waste products, and inflammatory cytokines lead to an increase in systemic inflammation and damage of the vascular walls that aggravates the atherogenic process. The increase of novel cases of type 2 DM or gestational DM in patients with periodontitis has no sufficient data. Dental caries is favored by DM and not by periodontal disease. So, DM is a well-known risk factor for periodontal disease and, on the other hand, periodontitis influences the metabolic control and favors the development of DM complications, but with a link between these conditions that is not fully understood. Other comorbidities, such as missing teeth, depression, osteoporosis are, also, positively associated to higher risk of development for periodontal disease. Patients with DM should be regularly screened for periodontal disease and referred to therapy if necessary, while the patients with periodontal disease should be screened for the presence of DM.