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| LETTER |
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| Year : 2012 | Volume
: 4
| Issue : 2 | Page : 173-174 |
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Periodontal therapy: A useful adjunct to improve glycemic control
Lata Goyal, ND Gupta, Afshan Bey
Department of Periodontics and Community Dentistry, Dr. Z. A. Dental College, Aligarh Muslim University, Aligarh, India
| Date of Web Publication | 10-Apr-2012 |
Correspondence Address:
Lata Goyal
Department of Periodontics and Community Dentistry, Dr. Z. A. Dental College, Aligarh Muslim University, Aligarh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0975-7406.94830
How to cite this article:
Goyal L, Gupta N D, Bey A. Periodontal therapy: A useful adjunct to improve glycemic control. J Pharm Bioall Sci 2012;4:173-4 |
Sir,
The association between oral health and systemic health is bidirectional. Fascinating research has eroded the tradition bound concept that oral infections such as periodontitis are simply local entities whose effects are limited to the oral cavity . Oral health may affect systemic health and Systemic illnesses, especially metabolic disorders, affect oral health. Many studies have been published describing the bidirectional inter-relationship exhibited by diabetes and periodontal disease. [1] Studies have provided evidence that control of periodontal infection has an impact on improvement of glycemic control evidenced by a decrease in demand for insulin and decreased hemoglobin A1c levels. [1] Several studies of diabetic subjects with periodontitis have shown improvements in glycemic control following scaling and root planing combined with adjunctive systemic doxycycline therapy. [2],[3] The magnitude of change was about 0.9-1.0% in the hemoglobin A1c test. In another study following periodontal therapy only, without systemic antibiotics, the treated subjects had a 50% reduction in the prevalence of gingival bleeding and a reduction in mean hemoglobin A1c from 7.3% to 6.5%. [4] Periodontal diseases can induce or perpetuate an elevated systemic chronic inflammatory state, as reflected in increased serum C-reactive protein, interleukin-6, and fibrinogen levels seen in many people with periodontitis. [5] Persistent systemic challenge with periodontopathic bacteria and their products may act similar to well recognized systemic infections which may also result in increased insulin resistance and poor glycemic control. Periodontal treatment designed to decrease the bacterial insult and reduce inflammation might restore insulin sensitivity over time, resulting in improved metabolic control. In individuals with type 2 diabetes, who already have significant insulin resistance, further tissue resistance to insulin produced by infection may considerably exacerbate poor glycemic control. In type I patients, normal insulin dose may be inadequate to maintain good glycemic control in the presence of infection-induced tissue resistance. Dentists must educate patients and their physicians about the interrelationships between periodontal health and glycemic control, with an emphasis on the inflammatory nature of periodontal diseases and the potential systemic effects of periodontal infection.
 References | |  |
| 1. | Southerland JH, Taylor GW, Offenbacher S. Diabetes and periodontal infection: Making the connection. Clin Diabetes 2005;4:171-8. 
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| 2. | Grossi SG, Skrepcinski FB, DeCaro T, Robertson DC, Ho AW, Dunford RG, et al. Treatment of periodontal disease in diabetics reduces glycated hemoglobin. J Periodontol 1997;68:713-19.
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| 3. | Miller LS, Manwell MA, Newbold D, Redding M, Rasheed A, Blodgett J, et al. The relationship between reduction in periodontal inflammation and diabetes control: A report of 9 cases. J Periodontol 1992;63:843-8.
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| 4. | Kiran M, Arpak N, Unsal E, Erdogan MF. The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus. J Clin Periodontol 2005;32:266-72.
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| 5. | D'Aituo F, Parkar M, Andreou G, Suvan J, Brett PM, Ready D, et al. Periodontitis and systemic inflammation: Control of the local infection is associated with a reduction in serum inflammatory markers. J Dent Res 2004;83:156-60.
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