Understanding co-morbid diabetes and periodontal disease

European Federation of Periodontology

Thu. 14. November 2024

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VIENNA, Austria: On this World Diabetes Day , the European Federation of Periodontology (EFP) calls attention to the growing body of scientific evidence that underscores the critical connection between periodontal disease and diabetes. As diabetes continues to impact on millions of lives globally, understanding its effects on oral health as well as the effects of periodontal disease on diabetes is essential for improving overall health. This year’s theme, “Diabetes and well-being”, emphasises the need for accessible care and support for all individuals with diabetes—and that includes prioritising periodontal health.

The global burden of periodontitis and diabetes

Severe periodontal disease is a significant global health issue, affecting around 19% of the world’s adult population—more than one billion cases worldwide. According to the World Health Organization, oral disease affects approximately 3.5 billion people globally.¹ Diabetes is also on the rise: the International Diabetes Federation has reported that there are 537 million adults with diabetes, representing almost 10% of the adult population. Alarmingly, an estimated 240 million people have undiagnosed diabetes,² highlighting the urgent need for greater awareness and early intervention in managing both conditions.

The two-way relationship between diabetes and periodontal disease

Prof. Anton Sculean. (Image: European Federation of Periodontology)

Prof. Anton Sculean, chair of the organising committee for EuroPerio11, the 2025 edition of the periodontics congress hosted by the EFP, commented: “Recent research has shown that diabetes is not only a major risk factor for periodontitis, but that the relationship between the two conditions is bidirectional, meaning they both influence and exacerbate one another.” He continued, “Moreover, moderate to severe periodontitis is associated with an increased risk of all-cause and cardiovascular disease-related mortality in adults with diabetes.”³

People with diabetes are at a threefold higher risk of developing severe periodontal disease.⁴ The connection between these conditions is particularly evident in patients with poorly controlled blood glucose levels. The higher the level of hyperglycaemia, the more severe the periodontal disease tends to be. This is due to the impact of high blood glucose levels on the immune system, weakening the body’s ability to combat infections, including those in the gingivae. Additionally, diabetes disrupts the body’s inflammatory response, resulting in an exaggerated immune reaction in the gingivae that leads to further tissue damage.

Conversely, periodontitis can complicate diabetes management. The inflammation caused by periodontal disease is not confined to the gingivae; it can spread throughout the body, increasing systemic inflammation and, in turn, impairing insulin sensitivity. This makes it more difficult for people with periodontitis to control their blood glucose levels, contributing to a vicious cycle that complicates both conditions. Furthermore, it has been demonstrated that severe periodontitis may be an indicator of the risk of developing diabetes in patients initially normoglycemic.⁵

Emerging evidence is showing that treating periodontitis can lead to improved glycaemic control in people with diabetes, highlighting the importance of integrated care.^6–8 This finding reinforces the need for dental professionals to work closely with other healthcare providers, ensuring that patients receive comprehensive care that addresses both their oral health and diabetes management.

The EFP: A longstanding advocate of awareness

The EFP has been a leader in raising awareness about the strong link between periodontal disease and diabetes. In 2017, the EFP launched the Perio & Diabetes campaign in response to the findings of the Perio-Diabetes Workshop, held in collaboration with the International Diabetes Federation.⁹ This campaign offered essential guidelines, tools and resources for healthcare professionals, policymakers and the public to enhance understanding and effectively address the interconnection between these two conditions.

Focus on diabetes at EuroPerio11

Dr Eduardo Montero. (Image: European Federation of Periodontology)

This topic remains at the forefront of the EFP’s agenda, and it will take centre stage at the EuroPerio11 congress, which will be held in Vienna on 14–17 May 2025. On 16 May, a dedicated session will explore clinical considerations for managing patients with diabetes and periodontal disease, including screening for diabetes in dental settings. The session, to be moderated by Dr Eduardo Montero from Spain, will include expert insights from international speakers and highlight the need for collaborative care between dental and medical professionals.

“The EFP places great importance on addressing the link between diabetes and periodontal disease, as it affects not only oral health but the overall well-being of millions of people worldwide,” said Dr Montero. “Raising awareness among the public, health professionals and policymakers is essential. We need to move towards more holistic health systems that recognise the bidirectional relationship between diabetes and periodontitis and integrate oral health into global health strategies.”

This World Diabetes Day, the EFP calls on healthcare professionals, policymakers and the public to ensure that periodontal health is part of diabetes care. Together, we can improve the well-being of people with diabetes by supporting comprehensive and holistic healthcare systems that address the complex connections between oral and general health.

Scientific resources from the Perio-Diabetes Workshop and additional materials on the link between periodontitis and diabetes can be found here.

Editorial note:

More information on the EuroPerio11 session on clinical considerations for patients with diabetes can be found here. A useful infographic on the link between periodontal disease and diabetes, provided by the EFP, can be found here. A complete list of references can be found here.