BACKGROUND: The authors conducted a systematic review of the literature to assess the relationship between diabetes mellitus and periodontitis. TYPES OF STUDIES REVIEWED: The authors conducted searches to identify published human epidemiologic studies; cross-sectional observations; and longitudinal, cohort, case-control and other studies that describe variables associated with diabetes and periodontal disease. Some animal studies are reported to support human findings and explore mechanisms of action. RESULTS: The majority of evidence demonstrates an increase in the prevalence and severity of periodontal disease in people with diabetes mellitus. Interpretation of published results is complicated by a number of factors: small sample sizes; the absence of standard reporting of the type of diabetes; the presence of diabetes complications; the lack of longitudinal studies and control groups; and inadequate control of covariates such as age, duration of diabetes and level of control of diabetes. CLINICAL IMPLICATIONS: Mechanisms underlying the accelerated periodontal disease associated with diabetes appear to reflect primarily abnormal host responses, rather than microbial shifts, resulting from diabetes. A better understanding of the mechanisms involved in the more aggressive periodontitis seen in patients with diabetes enables the practitioner to consider different therapeutic options for this growing patient population.
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