What came first; perio or diabetes?

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The study shows a temporal association between perio and diabetes.

A new study has shown periodontal disease to be an independent predictor of type 2 diabetes, adding a new twist to the association between oral and systemic health.

American researchers found that among nearly 9,300 American adults who were followed for 17 years, those who began the study with periodontal disease were more likely to develop diabetes later on.

Men and women with moderate levels of disease had twice the risk of diabetes as those with healthy gums. Substantial tooth loss was linked to a 70% higher risk of developing the disease. The association persisted regardless of periodontal disease definition, according to the study.

The findings, published in the journal Diabetes Care, do not prove that periodontal disease causes diabetes in some people.

But the study is the first to show such a temporal association between the two conditions; the relationship between diabetes and gum disease is well-known, but it has traditionally been assumed that gum disease is solely a consequence of diabetes.

"The pertinent finding was our observation that periodontal disease can precede the onset of overt type 2 diabetes," said lead researcher Dr Ryan T. Demmer, of Columbia University in New York.

More studies are needed both to prove that periodontal disease directly contributes to type 2 diabetes, and that treating the dental problem can prevent diabetes, he said.

"It would be inappropriate, based on our findings, to definitively say that better oral health will reduce an individual's risk of diabetes development.

"[However], individuals who had periodontal disease at baseline were more likely to develop type 2 diabetes later in life."

Still, the findings are in line with research suggesting that gum disease is a risk factor for heart disease and strokes. Periodontal disease arises from bacterial infection, and it is thought that chronic, systemic inflammation in response to the bacteria may be a contributing factor in the development of cardiovascular disease.

In theory, this could also explain the link to diabetes. Demmer noted that inflammatory molecules could, for instance, affect the body's ability to maintain glycemic control.

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