Effects of diabetes mellitus on periodontal and peri-implant conditions: update on associations and risks.
OBJECTIVE
To review the evidence for the association between diabetes and periodontal and peri-implant conditions and the impact of periodontal therapy in subjects with diabetes.


METHODS
A search of MEDLINE-PubMed was performed up to and including December 2007. The search was limited to clinical studies published in English. Publications on animal studies were excluded. The selection criteria included all levels of available evidence.


RESULTS
Evidence on the association between diabetes and periodontitis supports the concept of increased severity but not extent of periodontitis in subjects with poorly controlled diabetes. Subjects with controlled diabetes do not show an increase in extent and severity of periodontitis. Periodontitis is associated with poor glycaemic control and diabetes-related complications. It is inconclusive that periodontal therapy with or without the use of antibiotics results in improvements of glycaemic control and of markers of systemic inflammation. Evidence is lacking to indicate that implant therapy in subjects with diabetes yields long-term outcomes comparable with those of non-diabetic subjects.


CONCLUSIONS
Poorly controlled diabetes may be considered a risk factor for increased severity of periodontitis. The effects of periodontal therapy on glycaemic control and systemic inflammation is not proven beyond doubt and need to be confirmed in large-scale randomized-controlled clinical trials.
Salvi
Giovanni E
GE
Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland. giovanni.salvi@zmk.unibe.ch
Carollo-Bittel
Barbara
B
Lang
Niklaus P
NP
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D015921:Dental Implants; D012534:Dental Scaling; D048909:Diabetes Complications / Q000097:blood / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D010510:Periodontal Diseases / Q000097:blood / Q000150:complications* / Q000628:therapy; D010518:Periodontitis / Q000097:blood / Q000150:complications / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016745:Root Planing
D000900:Anti-Bacterial Agents; D001786:Blood Glucose; D015921:Dental Implants; D018836:Inflammation Mediators