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Do the results of this study have a major impact on the field of endocrinology?
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Results challenge the notion that diabetes leads to a high incidence of periodontal disease.
This is a very interesting study challenging the long held idea that diabetes results in a higher incidence of periodontal disease. Endocrinologists as a group have advocated for good oral hygiene practices in people with diabetes because of the association of diabetes and periodontal problems and have encouraged regular professional examinations and dental care for our patients. This study makes one pause and wonder whether in the future dentists might be referring patients for medical evaluation when they are found to have periodontal disease in the absence of a diagnosis of diabetes or cardiovascular disease.
 Linda Hansen |
There is emerging evidence that systemic inflammation may predict type 2 diabetes. Periodontal disease is also associated with systemic inflammation, and has been suggested to be a risk factor for CVD. Type 2 diabetes and atherosclerotic CVD share many of the same risk factors, and it is an interesting hypothesis that an often diagnosed condition like periodontal disease may serve as a predictor for other serious diseases that are potentially life-threatening. If this association is validated, this may allow earlier detection of these diseases and earlier intervention. Given the prevalence of type 2 diabetes and CVD, this association could have significant public health implications.
Every endocrinologist should be in the habit of asking his/her patients about their dental care and emphasizing regular dental visits, in much the same way that we all strive to make sure that patients are getting regular dilated ophthalmologic exams. It is important that this emerging literature be published in dental journals as well, to make sure that as medical and dental providers, we are giving patients consistent messages about the importance of dental care.
Linda Hansen, MD, is an Endocrinologist at Wheaton Franciscan Medical Group in Racine, Wis.
Relationship is known, but these results are intriguing.
We have known of an association between periodontal disease and diabetes for some time. It is recommended that patients with diabetes have regular dental exams. It is intriguing that the paper found periodontal disease to be an independent risk factor.
 Jerald Marifke |
The study reports doing a good job of trying to control confounding risk factors; however, the cause and effect hypothesis is not clearly proven by this study. We have shown that diabetes mellitus is the end result of a continuum of glucose intolerance. There has been evidence presented showing that factors other than hyperglycemia result in the complications that develop with diabetes including heart disease. The disease is often present at least five to 10 years if not longer before a clinical diagnosis is made. Therefore the fact that the subjects in this study did not have a diagnosis of diabetes prior to the onset of periodontal disease does not mean that something else from the continuum of glucose intolerance did not cause the periodontal disease. Further study to evaluate this hypothesis would include trying to prevent or treat the periodontal disease aggressively and see if this would decrease the incidence of the development of diabetes.
It is a part of my routine practice to advise my patients with diabetes to take their oral health seriously and have a routine dental exam every six months or per the recommendation of their dental health professional. This includes edentulous patients. It is still important to have healthy gums.
Jerald Marifke, MD, is an Endocrinologist at Froedtert Hospital Milwaukee, Wis. and an Assistant Professor of Medicine in the Department of Medicine, Division of Endocrinology, Metabolism, and Clinical Nutrition at Medical College of Wisconsin.