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The Bidirectional Relationship Between Periodontal Disease and Diabetes

Sep 14, 2023 | Periodontics

Periodontal disease, commonly known as gum disease, is a prevalent oral health condition that affects millions of people worldwide. Diabetes is also a widespread metabolic disorder but characterized by elevated blood sugar levels. While these two conditions may seem unrelated, research over the years has unveiled a complex and bidirectional relationship between periodontal disease and diabetes.

Understanding Periodontal Disease

Periodontal disease is a broad term encompassing various inflammatory conditions that affect the supporting structures of the teeth, including the gums and bone. The primary cause of periodontal disease is the accumulation of dental plaque, a sticky film of bacteria that forms on teeth. If not removed through regular brushing and flossing, this plaque can harden into tartar and lead to gum inflammation, gingivitis, and eventually, periodontitis. Periodontitis is characterized by deep pockets forming between the teeth and gums, which can result in tooth loss if left untreated.

The Diabetes Epidemic

Diabetes, on the other hand, is a chronic metabolic disorder that affects the body’s ability to regulate blood sugar (glucose) levels. There are two main types of diabetes: Type 1, an autoimmune condition typically diagnosed in childhood or adolescence, and Type 2, primarily associated with lifestyle factors and usually diagnosed in adulthood. In both types, uncontrolled diabetes can lead to a host of complications, including heart disease, kidney problems, vision impairment, and nerve damage.

The Bidirectional Relationship Between These Two Conditions

Research, such as the studies noted in the BMC Oral Health web portal in July 2020, have revealed a bidirectional relationship between periodontal disease and diabetes, where each condition can exacerbate the other. Let’s delve into this relationship:

  • Impact of Diabetes on Periodontal Disease: Poorly controlled diabetes weakens the body’s ability to fight infection, including oral infections. Consequently, individuals with diabetes are more susceptible to gum disease and tend to experience more severe forms of it. High blood sugar levels also promote the growth of harmful bacteria in the mouth, further increasing the risk of periodontal issues.
  • Weakened Immune Response: Diabetes, especially when poorly controlled, weakens the immune system’s ability to combat infections. This impaired immune response makes individuals with diabetes more susceptible to bacterial infections, including those in the mouth. When harmful bacteria in the mouth proliferate, they can contribute to gum inflammation and periodontal disease.
  • Elevated Blood Sugar Levels: Elevated blood sugar levels, a hallmark of diabetes, provide a favorable environment for harmful bacteria to thrive in the oral cavity. These bacteria feed on sugar, releasing acids and toxins that can damage gum tissue and bone, accelerating the progression of periodontal disease.
  • Impaired Wound Healing: Diabetes can impair the body’s ability to heal and repair damaged tissues, including those in the gums. This delayed healing response can make it harder for the gums to recover from the inflammation associated with periodontal disease.

The Impact of Periodontal Disease on Diabetes:

  • Inflammation and Insulin Resistance: Periodontal disease is characterized by chronic inflammation in the gums. This inflammation can trigger a systemic inflammatory response throughout the body, including insulin resistance. Insulin resistance makes it more difficult for cells to respond to insulin, leading to elevated blood sugar levels, which can worsen diabetes control.
  • Poor Blood Sugar Control: Individuals with diabetes who have untreated or poorly managed periodontal disease may find it challenging to maintain stable blood sugar levels. The ongoing inflammation and infection in the mouth can contribute to fluctuations in blood sugar, making diabetes management less effective.
  • Complicating Medication: Some medications used to manage diabetes, such as immunosuppressants or corticosteroids, can increase the risk of oral infections and exacerbate periodontal disease.

Shared Risk Factors Between Periodontal Disease and Diabetes

Several shared risk factors contribute to the close relationship between periodontal disease and diabetes:

  • Poor Oral Hygiene: Both diabetes and periodontal disease share poor oral hygiene as a risk factor. Neglecting regular dental care, including brushing, flossing, and dental check-ups, can increase the risk of both conditions.
  • Lifestyle Factors: Smoking, an unhealthy diet, and obesity are common risk factors for both diabetes and periodontal disease. These factors can contribute to the development and progression of both conditions.
  • Genetic Predisposition: Genetic factors may make some individuals more susceptible to both periodontal disease and diabetes.

Implications for Overall Health

The interplay between periodontal disease and diabetes has broader implications for overall health. Both diabetes and periodontal disease are associated with an increased risk of cardiovascular problems, including heart disease and stroke. The systemic inflammation and compromised vascular health seen in both conditions can contribute to these issues.

It has also been documented that pregnant individuals with diabetes and untreated gum disease may be at a higher risk of complications such as preterm birth and low birth weight.


Although there is an evident bidirectional relationship between type 2 diabetes mellitus (T2DM) and periodontitis, BMC says further well-designed cohort studies are needed to confirm this finding. Nonetheless, “our results suggest that both dentists and physicians need to be aware of the strong connection between periodontitis and T2DM. Controlling these two diseases might help prevent each other’s incidence.” (source)

This is supported by a research paper published in February 2023 entitled “The Bidirectional Relationship between Periodontal Disease and Diabetes Mellitus,” whcih says the proactive management of periodontal infection improves general health and leads to better control of blood glucose in patients with type 2 diabetes. “Consequently, given the significant impact of oral complications on quality of life, the prevention of oral pathology and its early management appears to be essential in the care of diabetes.” (National Institute of Health website). 

In fact, the American Academy of Periodontology advocates for collaboration between dental and medical professionals in the care of patients with diabetes. Dental professionals are encouraged to communicate with physicians to ensure that individuals with diabetes receive comprehensive care that addresses both their oral health and diabetes management.

At the Crofton, MD-based Mugford Center for Periodontics and Dental Implants, we believe the relationship between periodontal disease and diabetes is a complex one, with each condition influencing the other.  Maintaining good oral hygiene, managing blood sugar levels, and adopting a healthy lifestyle are crucial steps in reducing the risk and severity of both diseases. Regular dental check-ups and communication between dental and medical professionals are essential for individuals with diabetes. Recognizing and addressing this bidirectional relationship can have a positive impact on overall health and well-being.

“Each condition can exacerbate the other, leading to a vicious cycle where poorly controlled diabetes can contribute to gum disease, and untreated gum disease can negatively impact diabetes management,” notes Dr. David Mugford. “Recognizing and addressing this relationship is essential for healthcare professionals to provide comprehensive care to individuals with diabetes, emphasizing the importance of good oral hygiene, regular dental check-ups, and coordinated efforts between dental and medical teams to manage both conditions effectively.”

For more information this important topic or to schedule an appointment, please give us a call today to get started with an initial consultation to assess your current oral situation. Dr. Mugford or Dr. John Bruce will perform a thorough dental examination to help you understand your case and your options. Call us today to schedule your initial consultation: (410) 260-0790.

Photo credit: Photo by Marek Studzinski on Unsplash