We thank Dr. Varon (1) for his interest in the relationship between periodontitis and kidney disease in type 2 diabetes, but we disagree with most of his statements and conclusions.

First, although our analysis (2) excluded individuals with kidney disease (macroalbuminuria or low glomerular filtration rate) at baseline, we did not exclude individuals with known risk factors for …

https://care.diabetesjournals.org/content/diacare/30/12/e139.full.pdf

Effect of Periodontitis on Overt Nephropathy and End-Stage Renal Disease in Type 2 Diabetes Response to Varon

Opinions on the interdependence between diabetes mellitus and oral periodontal disease are controversial. Experimental and clinical investigations carried out so far have not brought unique results. General objective of our research is to investigate on the strictly defined group of subjects aged 35-44 with diabetes mellitus type I the influence of metabolic control HbA1C on changes of periodontium and other organs. According to duration of diabetes mellitus the patients are divided into subdecade and postdecade groups. This group consists of 56 patients out of which 33 patients are with subdecade and 23 with postdecade insulin-dependent diabetes mellitus. In this group periodontal pocket depths, gingival index, number of extracted teeth and the volume of nonstimulated saliva are measured in comparison with a control group. The incidence of oral diseases and complications in other organs of insulin-dependent patients in subdecade and postdecade period are also examined and recorded. Periodontal diabetic disease is verified by pathohistological findings. Values of HbA1C in either subdecade or postdecade group with diabetes mellitus are above normal values. Values of periodontal pocket depths as well as the values of gingival index are substantially greater at insulin-dependent diabetes mellitus patients compared to the control group.

Diabetes mellitus and periodontal diseases

Bacteremia Associated with Toothbrushing and Dental Extraction

This article aims to narrate the various oral complications in individuals suffering from diabetes mellitus. Google search for "diabetes mellitus and oral complications" was done. The search was also carried out for "diabetes mellitus" and its oral complications individually. Diabetes mellitus is a chronic metabolic disorder that is a global epidemic and a common cause of morbidity and mortality in the world today. Currently, there are about 422 million cases of diabetes mellitus worldwide. Diabetic patients can develop different complications in the body such as retinopathy, neuropathy, nephropathy, cardiovascular disease. Complications in the oral cavity have been observed in individuals suffering from diabetes mellitus. A study noted that more than 90% of diabetic patients suffered from oral complications. Another research has shown a greater prevalence of oral mucosal disorders in patients with diabetes mellitus than non-diabetic population: 45-88% in patients with type 2 diabetes compared to 38.3-45% in non-diabetic subjects and 44.7% in type 1 diabetic individuals compared to 25% in the non-diabetic population. Oral complications in people with diabetes are periodontal disease, dental caries, oral infections, salivary dysfunction, taste dysfunction, delayed wound healing, tongue abnormalities, halitosis, and lichen planus. The high glucose level in saliva, poor neutrophil function, neuropathy, and small vessel damage contribute to oral complications in individuals with uncontrolled diabetes. Good oral health is imperative for healthy living. Oral complications cause deterioration to the quality of life in diabetic patients. Complications like periodontal disease having a bidirectional relationship with diabetes mellitus even contribute to increased blood glucose levels in people with diabetes. This article intends to promote awareness regarding the oral health of diabetics and to stress the importance of maintaining proper oral hygiene, taking preventive measures, early detection, and appropriate management of oral complications of these patients through a multidisciplinary approach.

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Oral Health Messiers: Diabetes Mellitus Relevance.

This Perspective provides a brief summary of the scientific evidence for the often two-way links between hyperglycemia, including manifest diabetes mellitus (DM) and oral health. It delivers in a nutshell examples of current scientific evidence for the following oral manifestations of hyperglycemia, along with any available evidence for effect in the opposite direction: periodontitis, caries, periapical periodontitis, peri-implantitis, dry mouth (xerostomia/hyposalivation), dysbiosis in the oral microbiome, candidiasis, taste disturbances, burning mouth syndrome, cancer, traumatic ulcers, infections of oral wounds, delayed wound healing, melanin pigmentation, ﬁssured tongue, benign migratory glossitis (geographic tongue), temporomandibular disorders, and osteonecrosis of the jaw. Evidence for effects on quality of life will also be reported. This condensed overview delivers the rationale and sets the stage for the urgent need for delivery of oral and general health care in patient-centered transdisciplinary collaboration for early detection and management of both hyperglycemia and oral diseases to improve the quality of life.

/pdf/diabetes-and-oral-health-summary-of-current-scientific-1rh8vhhpxa.pdf

Diabetes and Oral Health: Summary of Current Scientific Evidence for Why Transdisciplinary Collaboration Is Needed

There is a huge body of literature suggesting an association and a bidirectional relationship between periodontal disease and diabetes. Diabetes and periodontal diseases are both chronic diseases with a high prevalence. Dentists/periodontists, in their daily clinical practice, very often attend to diabetes patients with diverse oral health conditions and cater to their dental treatment needs. Safe and effective periodontal therapy in this population requires a broad understanding of diabetes, medical management of diabetes, and essential modifications to dental/periodontal therapy that may be required. This paper describes a joint statement put forth by the Indian Society of Periodontology and the Research Society for the Study of Diabetes in India aiming to provide expert consensus and evidence-based guidelines for optimal clinical management of periodontal conditions in diabetes patients or patients at risk for diabetes. Although this paper is not envisioned to be a comprehensive review of this topic, it intends to provide the guidelines for dental professionals and periodontists.

Management of periodontal disease in patients with diabetes- good clinical practice guidelines: A joint statement by Indian Society of Periodontology and Research Society for the Study of Diabetes in India

Purvi M. Chawla

Papers

Management of periodontal disease in patients with diabetes- good clinical practice guidelines: A joint statement by Indian Society of Periodontology and Research Society for the Study of Diabetes in India