Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology
Open accessAbstract
Background: Diabetes and periodontitis are chronic non‐communicable diseases independently associated with mortality and have a bidirectional relationship. Aims: To update the evidence for their epidemiological and mechanistic associations and re‐examine the impact of effective periodontal therapy upon metabolic control (glycated haemoglobin, HbA1C). Epidemiology: There is strong evidence that people with periodontitis have elevated risk for dysglycaemia and insulin resistance. Cohort studies among people with diabetes demonstrate significantly higher HbA1C levels in patients with periodontitis ( versus periodontally healthy patients), but there are insufficient data among people with type 1 diabetes. Periodontitis is also associated with an increased risk of incident type 2 diabetes. Mechanisms: Mechanistic links between periodontitis and diabetes involve elevations in interleukin ( IL )‐1‐β, tumour necrosis factor‐α, IL ‐6, receptor activator of nuclear factor‐kappa B ligand/osteoprotegerin ratio, oxidative stress and Toll‐like receptor ( TLR ) 2/4 expression. Interventions: Periodontal therapy is safe and effective in people with diabetes, and it is associated with reductions in HbA1C of 0.27–0.48% after 3 months, although studies involving longer‐term follow‐up are inconclusive. Conclusions: The European Federation of Periodontology ( EFP ) and the International Diabetes Federation ( IDF ) report consensus guidelines for physicians, oral healthcare professionals and patients to improve early diagnosis, prevention and comanagement of diabetes and periodontitis.
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Current evidence does not support a unique pathophysiology in patients with diabetes and periodontitis.
“Although common modifiers of periodontitis may substantially alter disease occurrence, severity, and response to treatment, current evidence does not support a unique pathophysiology in patients with diabetes and periodontitis.22”
From A new classification scheme for periodontal and peri‐implant diseases and conditions – Introduction and key changes from the 1999 classification (2018) · cites this paper as [22]
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- Authors
- Sanz, M., Ceriello, A., Buysschaert, M., Chapple, I., Demmer, R. T., Graziani, F., Herrera, D., Jepsen, S., Lione, L., Madianos, P., Mathur, M., Montanya, E., Shapira, L., Tonetti, M., & Vegh, D.
- Affiliations
- Universidad Complutense de Madrid (ES)
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (ES)
- Cliniques Universitaires Saint-Luc (BE)
- University of Birmingham (GB)
- Columbia University Irving Medical Center (US)
- University of Pisa (IT)
- University of Bonn (DE)
- Azienda Sanitaria Locale N. 2 Savonese (IT)
- National and Kapodistrian University of Athens (GR)
- Public Health Foundation of India (IN)
- Bellvitge University Hospital (ES)
- Hebrew University of Jerusalem (IL)
- Prince Philip Dental Hospital (CN)
- Department of Prosthodontics Semmelweis University Faculty of Dentistry Budapest Hungary
- Corresponding author
- Sanz, Mariano
- ORCID
- Venue
- Journal of Clinical Periodontology
- Publisher
- Wiley
- Published
- 2017-12-26
- Volume
- 45
- Issue
- 2
- Pages
- 138-149
- ISSN
- 0303-6979 (ISSN-L)
- 1600-051X
- OpenAlex
- W2745692607
- Cited by
- 738
- References
- 34
- Citations by year
- 2026: 102 · 2025: 75 · 2024: 108 · 2023: 94 · 2022: 101 · 2021: 94 · 2020: 91 · 2019: 48 · 2018: 24
- FWCI
- 61.50
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Journal Of Clinical Periodontology (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- Semmelweis University Repository (Semmelweis University) (submittedVersion)
- Funders
- Sunstar to the European Federation of Periodontology to organize the EFP/IDF Workshop
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
- Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
- Keywords
- periodontitis, diabetes mellitus, bidirectional disease association, insulin resistance, dysglycemia, HbA1c, type 2 diabetes risk, type 1 diabetes, inflammatory cytokines, oxidative stress, TLR2/4, periodontal treatment, glycemic control, co-management, consensus recommendations
- MeSH terms
- Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Insulin Resistance, Periodontal Diseases, Periodontitis
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