The relationship between periodontitis and diabetes has similarly been explained by dysfunctions of the immune response.12-14 Diabetics, especially those with severe periodontitis, have been found to have dysfunctions in immune cell activity, which can increase tissue damage and inflammation.
Different forms of diabetes, such as type 1 and type 2 diabetes, as well as gestational diabetes, affect the risk and progression of periodontitis differently. People with type 2 diabetes have a higher risk of developing periodontitis, and good glycemic control is a key factor in managing this risk. Type 1 diabetics also have a higher risk of periodontitis, and gestational diabetes can affect both the health of the mother and the fetus.
According to research, periodontitis can even double the risk of developing gestational diabetes. However, the mechanism by which periodontitis affects gestational diabetes is not fully understood.15,16
Professor Sorsa says that increased levels of inflammatory mediators including aMMP-8 in the bloodstream due to gum inflammation, combined with gestational diabetes, may serve as a basis for systemic, chronic inflammation.
The active matrix metalloproteinase-8 oral rinse test (aMMP-8 POCT), developed by a team of scientists led by Professor Sorsa, has shown a positive correlation with glycated hemoglobin (HbA1c) values and may even aid in primary care referrals .
HbA1c values reflect average blood sugar levels over the past two to three months. This test measures the percentage of hemoglobin with glucose attached to it, providing insight into blood sugar control over time. It is commonly used to diagnose diabetes and monitor blood sugar levels in people with diabetes.
Oral health status revealed within minutes
Traditional diagnostic methods are not always sufficient to identify the risk of periodontitis and diabetes. Therefore, new rapid biomarker-based tests have been developed to help identify the risk of these diseases at an early stage.3-11
The aMMP-8 immunoassays (PerioSafe and ImplantSafe/ORALyzer) are based on measuring the concentration of active MMP in the oral solution. Professor Sorsa says studies have shown that elevated levels of aMMP-8 can indicate both periodontitis and diabetes.
The rapid aMMP-8 test can be performed in the dental office and results are obtained immediately. This allows early intervention in the development of periodontitis and diabetes risk assessment. In addition, the test provides patients with important information about their oral health and diabetes risk, which encourages better self-care and adherence to healthy lifestyles.
Professor Sorsa says, “The test allows detection of periodontitis signs even before symptoms appear, which provides an opportunity for early treatment and prevention of complications.” The test has been shown to be useful in screening patients with type 1, type 2 and gestational diabetes.
“General health starts with a healthy mouth”
Maintaining good oral hygiene and scheduling regular dental checkups is imperative for people with diabetes. Dr. Pätilä notes, “Overall health starts with a healthy mouth. Therefore, it is important to regularly clean the mouth thoroughly.” (Note: Dr. Pätilä is one of the Finnish scientists behind the development of Lumoral’s new light-activated oral health enhancing method. Lumoral is not currently available in the US.)
Because 95% of dental disease is caused by bacteria in dental plaque, regular plaque removal improves dental hygiene and prevents and treats periodontal disease.
“If we want to improve the results of dental care treatments, we need to focus on removing the plaque left on the teeth after brushing,” says Professor Sorsa.
Dr. Pätilä adds, “Regular and thorough brushing and flossing is key to maintaining oral health. The use of a light-activated antibacterial method as an adjunctive therapy in the treatment of dental and gum diseases significantly enhances the effectiveness of the treatment.”
Editor’s Note: This article first appeared on Clinical Insights newsletter, a publication of Endeavor Business Media Dental Group. Read more articles and Sign up.
bibliographical references
- Diabetes. World Health Organisation.
- Nazir MA. Prevalence of periodontal disease, association with systemic diseases and prevention. Int J Health Sci (Qassim). 2017? 11 (2): 72-80.
- Chee B, Park B, Bartold PM. Periodontitis and type II diabetes: a bidirectional relationship. Int J Evid Based Healthc. 2013? 11 (4): 317-329. doi: 10.1111/1744-1609.12038
- Ryan ME, Ramamurthy NS, Sorsa T, Golub LM. MMP-mediated events in diabetes. Ann NY Acad Sci. 1999, 878:311-334. doi:10.1111/j.1749-6632.1999.tb07692.x
- Sorsa T, Ingman T, Suomalainen K, et al. Cellular source and tetracycline-inhibition of collagenase in gingival fluid scars of patients with unstable diabetes mellitus. J Clin Periodontol. 1992, 19(2):146-149. doi:10.1111/j.1600-051x.1992.tb00454.x
- Safkan-Seppälä B, Sorsa T, Tervahartiala T, Beklen A, Konttinen YT. Collagenases in gingival fluid in type 1 diabetes mellitus. J Periodontol. 2006;77(2):189-194. doi:10.1902/jop.2006.040322
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- Dandona P, Aljada A, Bandyopadhyay A. Inflammation: the link between insulin resistance, obesity and diabetes. Trends Immunol. 2004? 25 (1): 4-7. doi:10.1016/j.it.2003.10.013
- Hotamisligil GS. Molecular mechanisms of insulin resistance and the role of the adipocyte. Int J Obes Relat Metab Disord. 2000;24(Suppl 4):S23-S27. doi:10.1038/sj.ijo.0801497
- Rotter V, Nagaev I, Smith U. Interleukin-6 (IL-6) induces insulin resistance in 3T3-L1 adipocytes and is overexpressed, like IL-8 and tumor necrosis factor-alpha, in human adipocytes from resistant individuals. to insulin. J Biol Chem. 2003;278(46):45777-45784. doi:10.1074/jbc.M301977200
- Heikkilä P, Niskanen L, But A, Sorsa T, Haukka J. Oral health associated with incident diabetes but not other chronic diseases: a registry-based cohort study. Front Oral Health. 2022? 3:956072. doi:10.3389/froh.2022.956072
- Lauhio A, Färkkilä E, Pietiläinen KH, et al. Association of MMP-8 with obesity, smoking and insulin resistance. Eur J Clin Invest. 2016;46(9):757-765. doi:10.1111/eci.12649
- Naguib G, Al-Mashat H, Desta T, Graves DT. Diabetes prolongs the inflammatory response to a bacterial stimulus through cytokine dysregulation. J Invest Dermatol. 2004, 123(1): 87-92. doi:10.1111/j.0022-202X.2004.22711.x
- D’Aiuto F, Parkar M, Andreou G, et al. Periodontitis and systemic inflammation: control of local infection is associated with a reduction in serum inflammatory markers. J Dent Res. 2004;83(2):156-160. doi:10.1177/154405910408300214
- Lalla E, Cheng B, Lal S, et al. Diabetes mellitus promotes periodontal destruction in children. J Clin Periodontol. 2007? 34 (4): 294-298. doi:10.1111/j.1600-051X.2007.01054.x
- Chaparro A, Realini O, Hernandez M, et al. Early pregnancy levels of gingival crevicular fluid matrix metalloproteinases-8 and -9 are associated with periodontitis severity and development of gestational diabetes mellitus. J Periodontol. 2021;92(2):205-215. doi:10.1002/JPER.19-0743
Nina Garlo-Melkas, MSc, is a health and science journalist working as a communications manager at Koite Health Ltd., a fast-growing health technology company and innovator of light-activated antibacterial solutions for the treatment and prevention of oral diseases.
