A pinboard by
Ghada Adayil

I am a master degree candidate at Faculty of Dentistry-Cairo University,Periodontist and implantologist.


A healthy body starts with a healthy mouth. A happy tooth equal to a happy body. let's know how!

Periodontal diseases are infections of the gums and bone that hold the teeth in place. .Periodontitis is a chronic inflammatory disorder characterised by destruction of the supporting structures of the teeth ( mainly bone). How can I know if I have a periodontal disease?! The following are the most common signs and symptoms: Red, swollen, tender bleedy gums Receding gums Loose teeth Bad breath

Diabetes mellitus is a metabolic disorder characterized by high blood sugar level (hyperglycemia). Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger.

If you have diabetes, you know the disease can harm your eyes, nerves, kidneys, heart and other main systems in the body. Do you know that it can also cause problems in your mouth? Diabetes is a major risk factor for periodontitis; susceptibility to periodontitis is increased by approximately threefold in people with diabetes.The level of glycemic control is of key importance in determining increased risk. There is a clear relationship between the degree of hyperglycaemia and severity of periodontitis. In the early 1990s periodontitis was sometimes referred to as the ‘sixth complication of diabetes’, and in 2003 the ADA acknowledged that periodontal disease is often found in people with diabetes.

It works also the other way round, how is that possible?! There has recently been much emphasis on the ‘two-way’ relationship between diabetes and periodontitis. That is, not only is diabetes a risk factor for periodontitis, but periodontitis could have a negative effect on glycemic control. Moreover, periodontitis increases the severity of diabetes complications. Studies show that the incidence of macroalbuminuria and end-stage renal disease are increased twofold and threefold, respectively, in diabetic individuals who also have severe periodontitis. Furthermore, people with diabetes and severe periodontitis have three times higher risk of cardiorenal mortality compared with those without severe periodontitis.

Inflammation is a central feature of the pathogenesis of diabetes and periodontitis. A lot of other pathogenic mechanisms linking diabetes and periodontitis were described to illustrate the intimate interrelation.

Effective periodontal treatment was shown to be associated with decreased risk of diabetes complications. keep calm and visit your dentist twice a year to keep your teeth happy and your body healthy.

Enjoy reading papers for more detailed information.


Periodontal disease: associations with diabetes, glycemic control and complications.

Abstract: This report reviews the evidence for adverse effects of diabetes on periodontal health and periodontal disease on glycemic control and complications of diabetes.MEDLINE search of the English language literature identified primary research reports published on (a) relationships between diabetes and periodontal diseases since 2000 and (b) effects of periodontal infection on glycemic control and diabetes complications since 1960.Observational studies provided consistent evidence of greater prevalence, severity, extent, or progression of at least one manifestation of periodontal disease in 13/17 reports reviewed. Treatment and longitudinal observational studies provided evidence to support periodontal infection having an adverse effect on glycemic control, although not all investigations reported an improvement in glycemic control after periodontal treatment. Additionally, evidence from three observational studies supported periodontal disease increasing the risk for diabetes complications and no published reports refuted the findings.The evidence reviewed supports diabetes having an adverse effect on periodontal health and periodontal infection having an adverse effect on glycemic control and incidence of diabetes complications. Further rigorous study is necessary to establish unequivocally that treating periodontal infections can contribute to glycemic control management and to the reduction of the burden of diabetes complications.

Pub.: 14 Mar '08, Pinned: 11 Oct '17

Current status of diabetes management, glycemic control and complications in children and adolescents with diabetes in Egypt. Where do we stand now? And where do we go from here?

Abstract: of this study was to use the Diabetes Registry of the Pediatric Diabetes Clinic, Ain Shams University Hospital to examine risk factors related to poor glycemic control and to provide data to health professionals for planning, evaluation and optimizing diabetes care.Data from 600 children and adolescents with diabetes with information in the registry provide information on current clinical status, metabolic control, acute and long-term complications, presence of concomitant autoimmune diseases, and psychiatric aspects of patients.Mean age of patients was 13.3±5.1 years, mean duration of diabetes was 6.4±3.6 years, mean HbA1c was 8.8±4.6% [73±27 mmol/mol], and 71% had poor glycemic control. Acute complications included ketoacidosis in 19.7% and severe hypoglycemia in 2.8%. Chronic complications including peripheral neuropathy, retinopathy, and persistent microalbuminuria were present in 6.3%, 1.8%, and 6.8%, respectively. The majority (97.2%) were on intensive insulin therapy. Patients with poor glycemic control had higher disease duration, DKA frequency and diabetic microvascular complications. However, regular education lecture attendance and regular SMBG were associated with better glycemic control.These registry data indicate that although the majority of the patients were on intensive insulin therapy, poor glycemic control was common and diabetic microvascular complications were observed. These findings will provide potential avenues to improve quality of care and could be the first step in the development of a national registry for diabetes in Egypt.

Pub.: 05 Feb '15, Pinned: 11 Oct '17

Local inflammatory reactions in patients with diabetes and periodontitis.

Abstract: The impact of diabetes mellitus on the prevalence, severity and progression of periodontal disease has been known for many years and intense efforts have been made to elucidate the underlying mechanisms. It is widely reported that hyperglycemia causes numerous systemic changes, including altered innate immune-cell function and metabolic changes. The aim of this review was to summarize and discuss the evidence for mechanisms that probably play a role in the altered local inflammatory reactions in the periodontium of patients with diabetes, focusing on local changes in cytokine levels, matrix metalloproteinases, reactive oxygen species, advanced glycation end-products, immune-cell functions, the RANKL/osteoprotegerin axis and toll-like receptors. Apart from the systemic effects of diabetes, recent evidence suggests that local changes in the periodontal tissues are characterized by enhanced interactions between leukocytes and endothelial cells and by altered leukocyte functions [resulting in increased levels of reactive oxygen species and of proinflammatory cytokines (interleukin-1β, interleukin-6 and tumor necrosis factor-α)]. These local changes are amplified by the enhanced accumulation of advanced glycation end-products and their interaction with receptors for advanced glycation end-products. Furthermore, the increased levels of proinflammatory cytokines lead to an up-regulation of RANKL in periodontal tissues, stimulating further periodontal tissue breakdown.

Pub.: 08 Aug '15, Pinned: 11 Oct '17

Periodontal treatment and glycaemic control in patients with diabetes and periodontitis: an umbrella review

Abstract: Studies suggest that non‐surgical periodontal treatment improves glycaemic control in patients with diabetes and periodontitis. The aim of this umbrella review is to summarize the effects of periodontal treatment on glycaemic control in patients with periodontitis and diabetes.A systematic review of systematic reviews with or without meta‐analysis published between 1995 and 2015 was performed. Three independent reviewers assessed for article selection, quality and data extraction.Thirteen (13) systematic reviews/meta‐analysis were included for qualitative synthesis. A reduction (0.23 to 1.03 percentage points) in the levels of HbA1c at 3 months after periodontal intervention was found. This reduction was statistically significant in 10/12 meta‐analysis. One review with sufficiently large samples found a non‐significant reduction (−0.014 percentage points; 95% CI −0.18 to 0.16; p = 0.87). Only three studies separated the use of adjunctive antibiotics and found a reduction of 0.36 percentage points but the difference was not statistically significant.Highly heterogeneous short‐term studies with small sample size suggest that periodontal treatment could help improve glycaemic control at 3 months in patients with type 2 diabetes and periodontitis. However, longer term studies having sufficient sample size do not provide evidence that periodontal therapy improves glycaemic control in these patients.

Pub.: 26 Feb '16, Pinned: 11 Oct '17

Management of diabolical diabetes mellitus and periodontitis nexus: Are we doing enough?

Abstract: Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease is bacterial biofilm, which accumulates on the teeth as dental plaque. In addition to the biofilm microorganisms, other factors such as environmental, systemic and genetic are also responsible in progression of periodontitis. Diabetes mellitus (DM) is metabolic disorder which has an impact on the global health. DM plays a crucial role in the pathogenesis of periodontitis. Periodontitis is declared as the "sixth" major complication of DM. Evidence based literature has depicted an enhanced incidence and severity of periodontitis in subjects with DM. A "two way" relationship has been purported between periodontitis and DM. Mutual management of both conditions is necessary. Periodontal therapy (PT) may assist to diminish the progression of DM and improve glycemic control. Various advanced technological facilities may be utilized for the purpose of patient education and disease management. The present paper clarifies the etio-pathogenesis of periodontitis, establishing it as a complication of DM and elaborating the various mechanisms involved in the pathogenesis. The role of PT in amelioration of DM and application of digital communication will be discussed. Overall, it is judicious to create an increased patient cognizance of the periodontitis-DM relationship. Conjunctive efforts must be undertaken by the medical and oral health care professionals for the management of periodontitis affected DM patients.

Pub.: 11 Mar '16, Pinned: 11 Oct '17

Diabetes mellitus and inflammatory periodontal diseases.

Abstract: Periodontal diseases are inflammatory conditions that were once thought to have manifestations localized to the oral cavity alone, and were therefore considered the concern of only dentists and other oral health professionals. Emerging evidence has changed this view and now suggests that periodontal diseases may play a role in numerous conditions that impact systemic well being, including diabetes mellitus. This review examines the relationships that exist between periodontal diseases and diabetes mellitus, with a focus on potential common pathophysiologic pathways including those associated with inflammation, altered host responses, and insulin resistance.Periodontal inflammation is associated with an elevated systemic inflammatory state and an increased risk of major cardiovascular events such as myocardial infarction and stroke, adverse pregnancy outcomes such as preeclampsia, low birth weight and preterm birth, and altered glycemic control in people with diabetes. Intervention trials suggest that periodontal therapy, which decreases the intraoral bacterial bioburden and reduces periodontal inflammation, can have a significant impact on systemic inflammatory status. Evidence suggests that periodontal therapy is associated with improved glycemic control in many patients with both diabetes and periodontal diseases.Recognition of the bilateral relationships between oral and systemic health will challenge physicians and dentists to work together closely in the future when managing patients with diabetes and periodontal disease.

Pub.: 05 Mar '08, Pinned: 11 Oct '17

Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases.

Abstract: Diabetes and periodontitis are complex chronic diseases with an established bidirectional relationship. There is long-established evidence that hyperglycaemia in diabetes is associated with adverse periodontal outcomes. However, given the ubiquity of periodontal diseases and the emerging global diabetes epidemic, the complications of which contribute to significant morbidity and premature mortality, it is timely to review the role of periodontitis in diabetes.To report the epidemiological evidence from cross-sectional, prospective and intervention studies for the impact of periodontal disease on diabetes incidence, control and complications and to identify potential underpinning mechanisms.Over the last 20 years, consistent and robust evidence has emerged that severe periodontitis adversely affects glycaemic control in diabetes and glycaemia in non-diabetes subjects. In diabetes patients, there is a direct and dose-dependent relationship between periodontitis severity and diabetes complications. Emerging evidence supports an increased risk for diabetes onset in patients with severe periodontitis.Type 2 diabetes is preceded by systemic inflammation, leading to reduced pancreatic β-cell function, apoptosis and insulin resistance. Increasing evidence supports elevated systemic inflammation (acute-phase and oxidative stress biomarkers) resulting from the entry of periodontal organisms and their virulence factors into the circulation, providing biological plausibility for the effects of periodontitis on diabetes. AGE (Advanced Glycation Endproducts)-RAGE (Receptor for AGEs) interactions and oxidative-stress-mediated pathways provide plausible mechanistic links in the diabetes to periodontitis direction.Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal therapy associates with approximately a 0.4% reduction in HbA1C at 3 months, a clinical impact equivalent to adding a second drug to a pharmacological regime for diabetes. RCTs are needed with larger numbers of subjects and longer term follow-up, and if results are substantiated, adjunctive periodontal therapies subsequently need to be evaluated. There is no current evidence to support adjunctive use of antimicrobials for periodontal management of diabetes patients.Given the current evidence, it is timely to provide guidelines for periodontal care in diabetes patients for medical and dental professionals and recommendations for patients/the public.

Pub.: 03 May '13, Pinned: 11 Oct '17

Effects of periodontal treatment on glycemic control in type 2 diabetic patients: a meta-analysis of randomized controlled trials.

Abstract: The association between diabetes and inflammatory periodontal diseases has been studied extensively. However, there is a lack of robustness and homogeneity among studies describing effects of periodontal treatment on glycemic control. The aim of this study was to carry out a meta-analysis to understand whether periodontal treatment could improve glycemic control in type 2 diabetic patients. Electronic searches were carried out on MEDLINE, EMBASE and the Cochrane central register of controlled trials from 1980 to July 2012. Randomized controlled trials of periodontal therapy on glycemic control in diabetic patients with a minimum of 3 months of follow-up were included. Meta-analysis was carried out with 8 studies involving 515 participants using Stata 11.0 software. Our results showed that periodontal treatment could lead to a significant decrease in HbA1c level. The standardized mean difference between intervention groups and control groups was significant: 1.03% (95% confidence interval: 0.31% to 1.70%, P = 0.003) from baseline to 3 months, and 1.18% (95% confidence interval: 0.72% to 1.64%, P < 0.001) from baseline to 6 months. Periodontal treatment could lead to a non-significant decrease in fasting plasma glucose (FPG) levels from baseline to 3 months. The standardized mean difference between the intervention and the control group was 0.69 mg/dl (95% confidence interval: -0.27 mg/dl to 1.66 mg/dl, P = 0.158). Our analysis indicated that periodontal treatment could improve glycemic control in type 2 diabetic patients with periodontal diseases.

Pub.: 13 Jan '15, Pinned: 11 Oct '17

Status Update on Translation of Integrated Primary Dental-Medical Care Delivery for Management of Diabetic Patients.

Abstract: Escalating prevalence of both diabetes and periodontal disease, two diseases associated with bidirectional exacerbation, has been reported. Periodontal disease represents a modifiable risk factor that may reduce diabetes onset or progression, and integrated models of cross-disciplinary care are needed to establish and manage glycemic control in affected patients. An ad-hoc environmental scan of current literature and media sought to characterize factors impacting status of integrated care models based on review of the existing evidence base in literature and media surrounding: 1) current cross-disciplinary practice patterns, 2) epidemiological updates, 3) status on risk assessment and screening for dysglycemia in the dental setting, 4) status on implementation of quality metrics for oral health, 5) care model pilots, and 6) public health perspectives. The survey revealed: escalating prevalence of diabetes and periodontitis globally; greater emphasis on oral health assessment for diabetic patients in recent medical clinical practice guidelines; high knowledgeability surrounding oral-systemic impacts on diabetes and growing receptivity to medical-dental integration among medical and dental providers; increasing numbers of programs/studies reporting on positive impact of emerging integrated dental-medical care models on diabetic patient healthcare access and health outcomes; a growing evidence base for clinically significant rates of undiagnosed dysglycemia among dental patients reported by point-of-care pilot studies; no current recommendation for population-based screening for dysglycemia in dental settings pending a stronger evidence base; improved definition of true periodontitis prevalence in (pre)/diabetics; emerging recognition of the need for oral health quality indicators and tracking; evidence of persistence in dental access disparity; updated status on barriers to integration. The potential benefit of creating clinically-applicable integrated care models to support holistic management of an escalating diabetic population by targeting modifiable risk factors including periodontitis is being recognized by the health industry. Cross-disciplinary efforts supported by high quality research are needed to mitigate previously- and newly-defined barriers of care integration and expedite development and implementation of integrated care models in various practice settings. Implementation of quality monitoring in the dental setting will support definition of the impact and efficacy of interventional clinical care models on patient outcomes.

Pub.: 05 Apr '17, Pinned: 11 Oct '17

Periodontitis and diabetes: a two-way relationship.

Abstract: Periodontitis is a common chronic inflammatory disease characterised by destruction of the supporting structures of the teeth (the periodontal ligament and alveolar bone). It is highly prevalent (severe periodontitis affects 10-15% of adults) and has multiple negative impacts on quality of life. Epidemiological data confirm that diabetes is a major risk factor for periodontitis; susceptibility to periodontitis is increased by approximately threefold in people with diabetes. There is a clear relationship between degree of hyperglycaemia and severity of periodontitis. The mechanisms that underpin the links between these two conditions are not completely understood, but involve aspects of immune functioning, neutrophil activity, and cytokine biology. There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control. Incidences of macroalbuminuria and end-stage renal disease are increased twofold and threefold, respectively, in diabetic individuals who also have severe periodontitis compared to diabetic individuals without severe periodontitis. Furthermore, the risk of cardiorenal mortality (ischaemic heart disease and diabetic nephropathy combined) is three times higher in diabetic people with severe periodontitis than in diabetic people without severe periodontitis. Treatment of periodontitis is associated with HbA(1c) reductions of approximately 0.4%. Oral and periodontal health should be promoted as integral components of diabetes management.

Pub.: 08 Nov '11, Pinned: 11 Oct '17