title: Epidemiology and prevention of periodontal disease in individuals with diabetes.
abstract: OBJECTIVE
  This article reviews the epidemiological evidence of the relationship between diabetes and periodontal disease, possible physiological mechanisms for the association, and effects of interventions on the occurrence and severity of periodontal disease among individuals with diabetes.
  
  
  METHODS
  A comprehensive qualitative review of published literature in the area was performed.
  
  
  RESULTS
  Much of the research in this area was found to contain methodological problems, such as failing to specify the type of diabetes, small sample sizes, and inadequate control of covariates such as age or duration of diabetes.
  
  
  CONCLUSIONS
  Trends indicate that periodontal disease is more prevalent and more severe among individuals with diabetes. This trend may be modified by factors such as oral hygiene, duration of diabetes, age, and degree of metabolic control of diabetes. Generally, poor oral hygiene, a long history of diabetes, greater age, and poor metabolic control are associated with more severe periodontal disease. The association of diabetes and periodontal disease may be due to numerous physiological phenomena found in diabetes, such as impaired resistance, vascular changes, altered oral microflora, and abnormal collagen metabolism. With some modifications, the same prevention and treatment procedures for periodontal disease recommended for the general population are appropriate for those with diabetes. People with diabetes who appear to be particularly susceptible to periodontal disease include those who do not maintain good oral hygiene or good metabolic control of their diabetes, those with diabetes of long duration or with other complications of diabetes, and teenagers and pregnant women.
authors.affiliation: Institute for Health Policy Studies, School of Medicine, University of California, San Francisco 94109.
authors.forename: P P
authors.initials: PP
authors.lastname: Katz
authors.forename: M R
authors.initials: MR
authors.lastname: Wirthlin
authors.forename: S M
authors.initials: SM
authors.lastname: Szpunar
authors.forename: J V
authors.initials: JV
authors.lastname: Selby
authors.forename: S J
authors.initials: SJ
authors.lastname: Sepe
authors.forename: J A
authors.initials: JA
authors.lastname: Showstack
mesh_terms: D048909:Diabetes Complications; D005881:Gingiva / Q000502:physiology / Q000503:physiopathology*; D006801:Humans; D008954:Models, Biological; D010510:Periodontal Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D015995:Prevalence; D012307:Risk Factors; D014481:United States