Diabetes and periodontitis

Question 1

How many Americans had diabetes in
2021?

Answer 1

38.4 million Americans (11.6% of the population).

Question 2

Of the 38.4 million adults with diabetes, how many were diagnosed vs. undiagnosed?

Answer 2

29.7 million were diagnosed, and 8.7 million were undiagnosed.

Question 3

How many Americans are diagnosed with diabetes each year?

Answer 3

1.2 million.

Question 4

What is diabetes mellitus?

Answer 4

A metabolic disorder characterized by chronic hyperglycemia and altered lipid and protein metabolism.

Question 5

What causes diabetes mellitus?

Answer 5

Diminished insulin production, impaired insulin action, or a combination of both.

Question 6

Why does blood glucose remain high in diabetes?

Answer 6

The inability of glucose to be transported from the bloodstream into tissues.

Question 7

What are some other types of Diabetes?

Answer 7

Gestational Diabetes, Pancreatic disease, Immune-related, Drug-induced, etc.

Question 8

What is the diagnostic criteria for diabetes using Fasting Plasma Glucose?

Answer 8

≥126 mg/dL after an 8-hour fast.

Question 9

What FPG level is considered prediabetes?

Answer 9

100-125 mg/dL.

Question 10

What does the HbA1c test measure?

Answer 10

Average blood glucose level over the past 3 months.

Question 11

What HbA1c level indicates diabetes?

Answer 11

≥6.5%.

Question 12

What HbA1c range indicates prediabetes?

Answer 12

5.7% - 6.4%.

Question 13

What HbA1c level indicates uncontrolled diabetes?

Answer 13

> 7%.

Question 14

What is the cause of type 1 diabetes?

Answer 14

Autoimmune destruction of beta cells.

Question 15

What is the main cause of type 2 diabetes?

Answer 15

Insulin resistance or low insulin response to glucose.

Question 16

What blood glucose level defines hypoglycemia and what are the symptoms?

Answer 16

<70 mg/dL.
Dizziness, fatigue, and cognitive impairment.

Question 17

Symptoms of diabetes?

Answer 17

Always hungry, thirsty
Weakness, numbness in hands/feet
Weight loss, nausea
Frequent urination
Blurry vision

Question 18

How many Americans over 50 have at least one chronic disease?

Answer 18

71 million, with numbers expected to double by 2050.

Question 19

What two diseases are highly prevalent and often coexist?

Answer 19

Diabetes and periodontitis.

Question 20

What was considered sever periodontitis in the Genco 2013 (Perio 2000) study?

Answer 20

Radiographic bone loss >50%
Attachment loss >6mm for at least one of six index teeth

Question 21

What were the key findings in the Genco 2013 (Perio 2000) study?

Answer 21

Severe periodontitis at baseline increased the risk of poor glycemic control (HbA1c = 9%)

2.81 times more (attachment loss)
3.43 times more(alveolar bone loss)

Question 22

What was the conclusion of the Genco 2013 (Perio 2000) study?

Answer 22

Type 2 diabetes increases the risk of destructive periodontal disease by ~3-fold, independent of age, sex, and oral hygiene.

Question 23

T or F: Periodontitis should be considered a complication of diabetes.

Answer 23

True

Question 24

Why is periodontitis and diabetes considered a bidirectional relationship?

Answer 24

Diabetes increases the risk of periodontitis by threefold.
Periodontitis worsens glycemic control which further complicates diabetic management

Question 25

How does diabetes affect the oral microbiome?

Answer 25

It increases the pathogenicity of the oral microbiome.

Question 26

Which periodontal pathogen is found in higher levels in type 2 diabetics with periodontitis?

Answer 26

Porphyromonas gingivalis (P. gingivalis).

Question 27

How does diabetes contribute to increased susceptibility to periodontal disease?

Answer 27

Through changes in salivary flow (flux) and concentration, including alterations in gingival crevicular fluid (GCF).

Question 28

What happens when elevated glucose reacts with plasma proteins?

Answer 28

It forms Advanced Glycation End Products (AGEs).

Question 29

How do AGEs contribute to diabetic complications?

Answer 29

Through pro-inflammatory and pro-oxidant effects.

Question 30

What are the effects of the AGE-RAGE axis on vascular integrity?

Answer 30

Alters the inflammatory response and decreases vascular stability.

Question 31

How does diabetes affect vascular pathology?

Answer 31

It leads to apoptosis (cell death), decreased capillary growth, and reduced vessel proliferation.

Question 32

How does a hyperglycemic state affect wound healing?

Answer 32

It impairs fibroblast function, slowing tissue repair.

Question 33

How do Advanced Glycation End Products (AGEs) affect collagen?

Answer 33

They reduce collagen stability, increasing the risk of infection.

Question 34

How does impaired collagen metabolism impact wound healing?

Answer 34

It leads to inflammatory-induced tissue destruction.

Question 35

How does hyperglycemia affect polymorphonuclear leukocyte (PMN) function?

Answer 35

It impairs PMN function, reducing the body’s ability to fight infections.

Question 36

How does diabetes affect monocyte cytokine production?

Answer 36

It increases production of IL-1β and TNF-α, leading to heightened inflammation.

Question 37

What is the common link between periodontal disease and diabetes mellitus?

Answer 37

Inflammation.

Question 38

How does TNF-α affect insulin sensitivity?

Answer 38

It impairs insulin receptor signaling and directly induces insulin resistance.

Question 39

How does IL-6 contribute to insulin resistance?

Answer 39

It promotes TNF-α production and stimulates hepatic C-reactive protein (CRP) production.

Question 40

How do the cytokine interactions between TNF-α and IL-6 affect glycemic control in diabetic patients?

Answer 40

They further impair glycemic control by increasing inflammation and insulin resistance.

Question 41

T or F: Periodontal treatment will cause a reduction in HbA1c levels and restore insulin sensitivity

Answer 41

True

Question 42

How does obesity contribute to systemic inflammation?

Answer 42

It creates a chronic inflammatory state, increasing insulin resistance (IR) and disease risk.

Question 43

What chronic condition is associated with both type 2 diabetes (T2D), obesity and periodontitis?

Answer 43

Metabolic syndrome.

Question 44

What are the key conditions of metabolic syndrome?

Answer 44

High blood pressure High blood sugar High triglycerides Low HDL cholesterol Excess body fat

Question 45

What proinflammatory substances are released by adipose tissue?

Answer 45

Adipokines (e.g., leptin, resistin, adiponectin) and cytokines (IL-6, TNF-α).

Question 46

How does a higher BMI affect periodontal disease risk?

Answer 46

Increased BMI → More inflammatory mediators → Greater periodontal disease risk.

Question 47

How does diet lead to obesity?

Answer 47

Diet → Free Fatty Acids → Obesity Adipocytes release proinflammatory cytokines (IL-6, TNF-α).

Question 48

How does obesity lead to insulin resistance?

Answer 48

Obesity → Increased TNF-α → Insulin Resistance (IR) TNF-α inhibits insulin signaling. Free fatty acids trigger β-cell apoptosis, worsening Insulin resistance.

Question 49

How does insulin resistance progress to diabetes and periodontal disease?

Answer 49

Insulin resistance → Diabetes Mellitus (hyperinflammatory state). Diabetes → Periodontal Infections (exaggerated immune response).

Question 50

According to the International Diabetes Federation & European Federation of Periodontology, how much does periodontal therapy reduce HbA1c?

Answer 50

By 0.27-0.48% after 3 months.

Question 51

How does poorly controlled type 2 diabetes (HbA1c >8.1%) affect implant therapy?

Answer 51

It decreases implant stability and requires a longer healing time.

Question 52

What are the implant survival rates in diabetic patients?

Answer 52

98.6% at 1 year 96.6% at 2 years

Question 53

Increased Inflammatory Responses causes:

Answer 53

Advanced glycation end-products (AGEs) Increased AGE receptor expression Activation of protein kinase C isoforms Increased reactive oxygen species

Question 54

Decreased Wound Healing causes:

Answer 54

Ischemia (reduced blood flow) Neuropathy Trauma Poor cellular chemotaxis (impaired immune cell movement)

Question 55

Decreased Osseointegration causes:

Answer 55

Impaired osteoblast function (bone-forming cells) Poor matrix production

Question 56

Increased Peri-implant Disease Progression causes:

Answer 56

Increased AGEs Exacerbated and persistent inflammation