Bidirectional association between periodontitis and type 2 diabetes mellitus: a literature review




Periodontitis; Type 2 Diabetes Mellitus; Glycosylated hemoglobin.


The link that periodontitis has with systemic diseases such as type 2 diabetes mellitus (T2DM) has been studied for a long time. Current evidence suggests that the mechanisms underlying this link are related to the inflammatory mediators present in both diseases and indicates that both diseases represent a mutual risk factor for developing each disease, respectively. Likewise, the impact that periodontal treatment can have on T2DM has been extensively studied, which could develop new treatment guidelines for this metabolic disease. However, this situation is currently not clear despite the clinical studies that have been carried out. It is suggested that such treatment can improve glycemic control and complications related to diabetes. The objective of this present review is to inform about the possible pathophysiological mechanisms that link T2DM with periodontitis in a bidirectional way. In the same way, to approach in a general way the effect that periodontal treatment can have on control of T2DM.


Baeza, M., Morales, A., Cisterna, C., Cavalla, F., Jara, G., Isamitt, Y., Pino, P., & Gamonal, J. (2020). Effect of periodontal treatment in patients with periodontitis and diabetes: Systematic review and meta-analysis. Journal of Applied Oral Science, 28(1), 1–13.

Barnett, M. L. (2006). The oral-systemic disease connection. An update for the practicing dentist. Journal of the American Dental Association (1939), 137, 5–6.

Borgnakke, W. S. (2015). Does Treatment of Periodontal Disease Influence Systemic Disease? Dental Clinics of North America, 59(4), 885–917.

Botero, J. E., Rodríguez, C., & Agudelo-Suarez, A. A. (2016). Periodontal treatment and glycaemic control in patients with diabetes and periodontitis: An umbrella review. Australian Dental Journal, 61(2), 134–148.

Bui, F. Q., Almeida-da-Silva, C. L. C., Huynh, B., Trinh, A., Liu, J., Woodward, J., Asadi, H., & Ojcius, D. M. (2019). Association between periodontal pathogens and systemic disease. Biomedical Journal, 42(1), 27–35.

Cao, R., Li, Q., Wu, Q., Yao, M., Chen, Y., & Zhou, H. (2019). Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: A systematic review and Bayesian network meta-analysis. BMC Oral Health, 19(1), 1–14.

Care, D., & Suppl, S. S. (2019). Classification and diagnosis of diabetes: Standards of medical care in diabetes 2019. Diabetes Care, 42(1), 13–28.

Carvajal, P. (2016). Enfermedades periodontales como un problema de salud pública: el desafío del nivel primario de atención en salud. Revista Clínica de Periodoncia, Implantología y Rehabilitación Oral, 9(2), 177–183.

Chapple, I. L. C., & Matthews, J. B. (2007). The role of reactive oxygen and antioxidant species in periodontal tissue destruction. Periodontology 2000, 43, 160–232.

Critchlow, D. (2017). Part 3: Impact of systemic conditions and medications on oral health. British Journal of Community Nursing, 22(4), 181–190.

D’Aiuto, F., Gkranias, N., Bhowruth, D., Khan, T., Orlandi, M., Suvan, J., Masi, S., Tsakos, G., Hurel, S., Hingorani, A. D., Donos, N., Deanfield, J. E., Lomax, A., Horvath, A., Zambon, R., Tay, S., Tatarakis, N., Spratt, D., Kingston, I., … Mellor, T. (2018). Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial. The Lancet Diabetes and Endocrinology, 6(12), 954–965.

Duque, A. (2016). Prevalencia de periodontitis crónica en Iberoamérica. Revista Clínica de Periodoncia, Implantología y Rehabilitación Oral, 9(2), 208–215.

Eke, P. I., Borgnakke, W. S., & Genco, R. J. (2020). Recent epidemiologic trends in periodontitis in the USA. Periodontology 2000, 82(1), 257–267.

El-Makaky, Y., & Shalaby, H. K. (2020). The effects of non-surgical periodontal therapy on glycemic control in diabetic patients: A randomized controlled trial. Oral Diseases, 26(4), 822–829.

Falcao, A., & Bullón, P. (2019). A review of the influence of periodontal treatment in systemic diseases. Periodontology 2000, 79(1), 117–128.

Gaddey, H. L. (2017). Oral manifestations of systemic disease. General Dentistry, 65(6), 23–29.

Garde, S., Akhter, R., Nguyen, M. A., Chow, C. K., & Eberhard, J. (2019). Periodontal therapy for improving lipid profiles in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. International Journal of Molecular Sciences, 20(15), 1–13.

Glurich, I., & Acharya, A. (2019). Updates from the Evidence Base Examining Association between Periodontal Disease and Type 2 Diabetes Mellitus: Current Status and Clinical Relevance. Current Diabetes Reports, 19(11), 1–8.

Graves, D. T., Corrêa, J. D., & Silva, T. A. (2019). The Oral Microbiota Is Modified by Systemic Diseases. Journal of Dental Research, 98(2), 148–156.

Gurav, A. N. (2016). Management of diabolical diabetes mellitus and periodontitis nexus: Are we doing enough? World Journal of Diabetes, 7(4), 50–66.

Isola, G., Matarese, G., Ramaglia, L., Pedullà, E., Rapisarda, E., & Iorio-Siciliano, V. (2020). Association between periodontitis and glycosylated haemoglobin before diabetes onset: a cross-sectional study. Clinical Oral Investigations, 24(8), 2799–2808.

Jain, A., Gupta, J., Bansal, D., Sood, S., Gupta, S., & Jain, A. (2018). Effect of scaling and rootplaning as monotherapy on glycemic control in patients od Type 2 diabetes with chronic periodontitis: A systematic review and meta-analisis. Indian Society of Periodontology, 23(1), 303–310.

Joshipura, K. J., Muñoz-Torres, F. J., Dye, B. A., Leroux, B. G., Ramírez-Vick, M., & Pérez, C. M. (2018). Longitudinal association between periodontitis and development of diabetes. Diabetes Research and Clinical Practice, 141, 284–293.

Kinane, D. F., Stathopoulou, P. G., & Papapanou, P. N. (2017). Periodontal diseases. Nature Reviews Disease Primers, 3(17038), 1–14.

Lee, C. Y., Kuan, Y. H., Tsai, Y. F., Tai, C. J., Tsai, T. H., & Huang, K. H. (2019). Correlation between diabetes mellitus and periodontitis in Taiwan: A nationwide cohort study. Diabetes Research and Clinical Practice, 150, 245–252.

Li, X., Sun, X., Zhang, X., Mao, Y., Ji, Y., Shi, L., Cai, W., Wang, P., Wu, G., Gan, X., & Huang, S. (2018). Enhanced oxidative damage and Nrf2 downregulation contribute to the aggravation of periodontitis by diabetes mellitus. Oxidative Medicine and Cellular Longevity, 2018(1), 9421019.

Liccardo, D., Cannavo, A., Spagnuolo, G., Ferrara, N., Cittadini, A., Rengo, C., & Rengo, G. (2019). Periodontal disease: A risk factor for diabetes and cardiovascular disease. International Journal of Molecular Sciences, 20(6), 1–14.

Longo, P. L., Dabdoub, S., Kumar, P., Artese, H. P. C., Dib, S. A., Romito, G. A., & Mayer, M. P. A. (2018). Glycaemic status affects the subgingival microbiome of diabetic patients. Journal of Clinical Periodontology, 45(8), 932–940.

Mauri-Obradors, E., Estrugo-Devesa, A., Jané-Salas, E., Viñas, M., & López-López, J. (2017). Oral manifestations of diabetes mellitus. A systematic review. Medicina Oral, Patologia Oral y Cirugia Bucal, 22(5), 586–594.

Mauri‐Obradors, E., Merlos, A., Estrugo‐Devesa, A., Jané‐Salas, E., López‐López, J., & Viñas, M. (2018). Benefits of nonsurgical periodontal treatment in patients with type 2 diabetes mellitus and chronic periodontitis: a randomized controlled trial. Wiley Online Library, 45(3), 345–353.

Mizuno, H., Ekuni, D., Maruyama, T., Kataoka, K., Yoneda, T., Fukuhara, D., Sugiura, Y., Tomofuji, T., Wada, J., & Morita, M. (2017). The effects of non-surgical periodontal treatment on glycemic control, oxidative stress balance and quality of life in patients with type 2 diabetes: A randomized clinical trial. PLoS ONE, 12(11), 1–17.

O’Reilly, P. G., & Claffey, N. M. (2000). A history of oral sepsis as a cause of disease. Periodontology 2000, 23(1), 13–18.

Pérez-Losada, F. de L., Jané-Salas, E., Sabater-Recolons, M. del M., Estrugo-Devesa, A., Segura-Egea, J. J., & López-López, J. (2016). Correlation between periodontal disease management and metabolic control of type 2 diabetes mellitus. A systematic literature review. Medicina Oral Patologia Oral y Cirugia Bucal, 21(4), 440–446.

Polak, D., & Shapira, L. (2018). An update on the evidence for pathogenic mechanisms that may link periodontitis and diabetes. Journal of Clinical Periodontology, 45(2), 150–166.

Preshaw, P. M., & Bissett, S. M. (2019). Periodontitis and diabetes. British Dental Journal, 227(7), 577–584.

Sabharwal, A., Gomes-Filho, I. S., Stellrecht, E., & Scannapieco, F. A. (2018). Role of periodontal therapy in management of common complex systemic diseases and conditions: An update. Periodontology 2000, 78(1), 212–226.

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. (2018). 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. Journal of Clinical Periodontology, 45(2), 138–149.

Scully, C., & Ettinger, R. L. (2007). The influence of systemic diseases on oral health care in older adults. Journal of the American Dental Association, 138(9), 7–14.

Shi, B., Lux, R., Klokkevold, P., Chang, M., Barnard, E., Haake, S., & Li, H. (2020). The subgingival microbiome associated with periodontitis in type 2 diabetes mellitus. The ISME Journal, 14(2), 519–530.

Stratton, I. M., Adler, A. I., Neil, H. A., Matthews, D. R., Manley, S. E., Cull, C. A., Hadden, D., Turner, R. C., & Holman, R. R. (2000). Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ (Clinical Research Ed.), 321(7258), 405–412.

Taboza, Z. A., Costa, K. L., Silveira, V. R., Furlaneto, F. A., Montenegro, R., Russell, S., Dasanayake, A., & Rego, R. O. (2018). Periodontitis, edentulism and glycemic control in patients with type 2 diabetes: A cross-sectional study. BMJ Open Diabetes Research and Care, 6(1), 1–7.

Taylor, J. J., Preshaw, P. M., & Lalla, E. (2013). A review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes. Journal of Periodontology, 84(4), 113–134.

Tonetti, M. S., Greenwell, H., & Kornman, K. S. (2018). Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Journal of Periodontology, 89(1), 159–172.

Tsobgny-Tsague, N. F., Lontchi-Yimagou, E., Nana, A. R. N., Tankeu, A. T., Katte, J. C., Dehayem, M. Y., Bengondo, C. M., & Sobngwi, E. (2018). Effects of nonsurgical periodontal treatment on glycated haemoglobin on type 2 diabetes patients (PARODIA 1 study): A randomized controlled trial in a sub-Saharan Africa population. BMC Oral Health, 18(1), 1–8.

Vadakkekuttical, R. J., Kaushik, P. C., Mammen, J., & George, J. M. (2017). Does periodontal inflammation affect glycosylated haemoglobin level in otherwise systemically healthy individuals? - A hospital based study. Singapore Dental Journal, 38, 55–61.

Van Dyke, T. E., & Winkelhoff, A. J. van. (2013). Infection and inflammatory mechanisms. Journal of Periodontology, 84(4), 1–7.

Vieira, C. L. Z., & Caramelli, B. (2009). The history of dentistry and medicine relationship: could the mouth finally return to the body? Oral Diseases, 15(8), 538–546.

Wang, S., Liu, J., Zhang, J., Lin, J., Yang, S., Yao, J., & Du, M. (2017). Glycemic control and adipokines after periodontal therapy in patients with Type 2 diabetes and chronic periodontitis. Brazilian Oral Research, 31, 90–99.

Winning, L., Patterson, C. C., Neville, C. E., Kee, F., & Linden, G. J. (2017). Periodontitis and incident type 2 diabetes: a prospective cohort study. Journal of Clinical Periodontology, 44(3), 266–274.

Xiao, E., Mattos, M., Vieira, G. H. A., Chen, S., Corrêa, J. D., Wu, Y., Albiero, M. L., Bittinger, K., & Graves, D. T. (2017). Diabetes Enhances IL-17 Expression and Alters the Oral Microbiome to Increase Its Pathogenicity. Cell Host and Microbe, 22(1), 120–128.

Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology, 14(2), 88–98.

Ziukaite, L., Slot, D. E., Cobb, C. M., Coucke, W., & Van der Weijden, G. A. (2018) Prevalence of diabetes among patients diagnosed with periodontitis: A retrospective cross-sectional study. International Journal of Dental Hygiene, 16(2), 305–311.



How to Cite

JIMÉNEZ PALACIOS, M. A.; ALEJANDRO CUMBICUS, J. M.; ROMERO ESPINOZA, K. A. Bidirectional association between periodontitis and type 2 diabetes mellitus: a literature review. Research, Society and Development, [S. l.], v. 10, n. 1, p. e42310111822, 2021. DOI: 10.33448/rsd-v10i1.11822. Disponível em: Acesso em: 7 mar. 2021.



Health Sciences