Correspondence
Infections Associated with Diabetes Mellitus
N Engl J Med 2000; 342:895-896March 23, 2000
- Article
To the Editor:
In their review article, Joshi et al. (Dec. 16 issue)1 do not mention an extremely common infection seen in patients with diabetes: chronic periodontitis. Periodontitis is associated with substantial morbidity in the form of tooth loss, which directly affects nutritional sta-tus and the quality of life. In addition, this form of chronic infection often adversely affects glycemic control. Although periodontitis rarely causes death, it can lead to more serious infections such as Ludwig's angina and is a major factor in bacteremia. The relation between diabetes and periodontitis has been well established2-6 and is gaining widespread attention.
6 ReferencesJames W. Curtis, Jr., D.M.D.
Palmetto Richland Memorial Hospital, Columbia, SC 292031
Joshi N ,Caputo GM ,Weitekamp MR ,Karchmer AW . Infections in patients with diabetes mellitus. N Engl J Med 1999;341:1906-1912
Full Text | Web of Science | Medline2
Hugoson A ,Thorstensson H ,Falk H ,Kuylenstierna J . Periodontal conditions in insulin-dependent diabetics. J Clin Periodontol 1989;16:215-223
CrossRef | Web of Science | Medline3
Safkan-Seppala B ,Ainamo J . Periodontal conditions in insulin-dependent diabetes mellitus. J Clin Periodontol 1992;19:24-29
CrossRef | Web of Science | Medline4
Oliver RC ,Tervonen T . Periodontitis and tooth loss: comparing diabetics with the general population. J Am Dent Assoc 1993;124:71-76
Web of Science | Medline5
Seppala B ,Seppala M ,Ainamo J . A longitudinal study on insulin-dependent diabetes mellitus and periodontal disease. J Clin Periodontol 1993;20:161-165
CrossRef | Web of Science | Medline6
Oliver RC ,Tervonen T . Diabetes -- a risk factor for periodontitis in adults? J Periodontol 1994;65:Suppl:530-538
Web of Science | Medline
To the Editor:
In their review, Joshi et al. fail to mention that oral infections occur commonly in patients with diabetes and are referred to as the sixth major complication of diabetes.1 The risk of oral infections, particularly periodontitis, among patients with uncontrolled or poorly controlled diabetes is generally two to four times the risk among patients with well-controlled diabetes or healthy persons.2-4 Periodontitis is a chronic inflammatory bacterial disease of the tissues that surround and support the teeth. The disease results in loss of attachment of ligament fibers and supporting alveolar bone, which if left untreated can increase the mobility of a tooth and necessitate extraction. Diabetes may complicate the pathogenesis of periodontitis by causing abnormalities in the vasculature of the gingival tissues, deregulating the normal production of cytokines and growth factors, decreasing the synthesis and cross-linking of collagen, increasing collagenase levels, and depressing immune responses.
Aggressive and difficult-to-treat forms of periodontitis develop in approximately 30 to 45 percent of adult patients with diabetes, as compared with about 10 to 15 percent of the healthy population without diabetes. The incidence of periodontitis among patients with type 1 diabetes increases after puberty and with aging. Periodontal health may decline more rapidly in patients with poorly controlled diabetes than in those in whom it is well controlled. The prevalence of periodontal diseases among patients with well-controlled diabetes is no higher than that in healthy control subjects, which suggests that tight metabolic control of blood glucose levels can block the onset of periodontal complications associated with diabetes.
Recent reports suggest that there is an association between periodontitis and the destabilization of metabolic balance in patients with diabetes.2,4 These findings suggest that prevention of and therapy for periodontitis and possibly other oral infections must be part of the overall treatment plan for patients with diabetes mellitus.
4 ReferencesDennis Mangan, Ph.D.
Robert H. Selwitz, D.D.S., M.P.H.
National Institutes of Health, Bethesda, MD 20892-6402Robert Genco, D.D.S., Ph.D.
State University of New York at Buffalo, Buffalo, NY 142141
Loe H . The sixth complication of diabetes mellitus. Diabetes Care 1993;16:329-334
Web of Science | Medline2
Collin HL ,Uusitupa M ,Niskanen L , et al. Periodontal findings in elderly patients with non-insulin dependent diabetes mellitus. J Periodontol 1998;69:962-966
Web of Science | Medline3
Oliver RC ,Tervonen T . Periodontitis and tooth loss: comparing diabetics with the general population. J Am Dent Assoc 1993;124:71-76
Web of Science | Medline4
Grossi SG ,Genco RJ . Periodontal disease and diabetes mellitus: a two-way relationship. Ann Periodontol 1998;3:51-61
CrossRef | Medline
Author/Editor Response
The authors reply:
To the Editor: We thank Dr. Curtis and Dr. Mangan et al. for highlighting the importance of periodontal infections in patients with diabetes mellitus. Although space constraints did not allow us to address every infection that is seen in patients with diabetes, we agree that periodontal disease may cause substantial morbidity in such patients. Therefore, primary care clinicians should be aware of this condition.
Nirmal Joshi, M.D.
Gregory M. Caputo, M.D.
Milton S. Hershey Medical Center, Hershey, PA 17033- Citing Articles (3)
Citing Articles
1
Bashutski, Jill D., Eber, Robert M., Kinney, Janet S., Benavides, Erika, Maitra, Samopriyo, Braun, Thomas M., Giannobile, William V., McCauley, Laurie K., . (2010) Teriparatide and Osseous Regeneration in the Oral Cavity. New England Journal of Medicine 363:25, 2396-2405
Full Text2
Sok-Ja Janket, Judith A. Jones, Jukka H. Meurman, Alison E. Baird, Thomas E. Van Dyke. (2008) Oral infection, hyperglycemia, and endothelial dysfunction. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 105:2, 173-179
CrossRef3
S. Bjelland, P. Bray, N. Gupta, R. Hirsch. (2002) Dentists, Diabetes and Periodontitis. Australian Dental Journal 47:3, 202-207
CrossRef
