Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2024; 15(3): 318-325
Published online Mar 15, 2024. doi: 10.4239/wjd.v15.i3.318
Periodontitis: An often-neglected complication of diabetes
Marina G Kudiyirickal, Joseph M Pappachan
Marina G Kudiyirickal, Primary Care Dental Practice, The Smile Clinic, Preston PR1 6PZ, United Kingdom
Joseph M Pappachan, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
Joseph M Pappachan, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
Author contributions: Kudiyirickal MG wrote the initial draft of the manuscript with some help from Pappachan JM by performing literature search, interpretation of relevant scientific data, and compiling the best evidence; She also contributed to the critical revision, important intellectual content and figure preparation for the paper; Pappachan JM contributed to the conceptual design of the paper and critically supervised the whole drafting, literature review, revision and modifications of the paper including figure construction. Both authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph M Pappachan, MD, FRCP, Academic Editor, Consultant Endocrinologist, Professor, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston PR2 9HT, United Kingdom. drpappachan@yahoo.co.in
Received: December 15, 2023
Peer-review started: December 15, 2023
First decision: January 15, 2024
Revised: January 15, 2024
Accepted: February 7, 2024
Article in press: February 7, 2024
Published online: March 15, 2024
Processing time: 90 Days and 16.3 Hours
Abstract

The bidirectional association between type 2 diabetes mellitus (T2DM) and periodontitis is now well established, resulting in periodontal disease being considered as the 6th major complication of diabetes mellitus (DM) after car-diovascular disease, eye disease, neuropathy, nephropathy, and peripheral vascular disease. DM can worsen the virulence and invasiveness of pathogenic oral microbial flora aggravating the local inflammation and infection in those with periodontal disease. On the other hand, the chemical and immunological mediators released into the circulation as part of periodontal inflammation worsen the systemic insulin resistance with worsening of T2DM. Periodontitis if undiagnosed or left untreated can also result in eventual tooth loss. A study by Xu et al in the World Journal of Diabetes examined the predictive factors associated with periodontitis in Chinese patients with T2DM. The prevalence of periodontitis was found to be 75.7% in this study. Based on logistic regression analysis, the predictive factors for higher risk were low tooth brushing frequency [odds ratio (OR) = 4.3], high triglycerides (TG; OR = 3.31), high total cholesterol (TC; OR = 2.87), higher glycated hemoglobin (HbA1c; OR = 2.55), and higher age (OR = 1.05) while higher education level was protective (OR = 0.53). However, the most influential variables were HbA1c followed by age, TC, TG, low education level, brushing frequency, and sex on the random forest model (this model showed higher sensitivity for predicting the risk). A good understanding of the predictors for periodontitis in T2DM patients is important in prevention, early detection of susceptible patients, and intervention to improve periodontal health and enable long-term glycaemic control as observed by Xu et al.

Keywords: Diabetes mellitus; Periodontitis; Predictive factors; Cardiovascular disease; Glycaemic control

Core Tip: The bidirectional association between type 2 diabetes mellitus (T2DM) and periodontitis is now well established, resulting in periodontal disease being considered as the 6th major complication of diabetes mellitus (DM) after cardiovascular disease, eye disease, neuropathy, nephropathy, and peripheral vascular disease. Periodontal inflammation worsens systemic insulin resistance with worsening of DM. A higher prevalence of periodontitis is seen in patients with poor glycemic control presumably from increased level of inflammation and risk of tissue destruction in these patients. Periodontitis if undiagnosed or left untreated can result in eventual tooth loss. A study by Xu et al in the recent issue of the World Journal of Diabetes highlights the predictive factors associated with periodontitis in patients with T2DM to enable readers to have a better understanding of both diseases.