Periodontitis, diabetes mellitus, cardiovascular disease: A Bermuda Triangle

The research presented in this thesis contributes to the understanding of the complex relationship between periodontitis and diabetes mellitus (DM), and periodontitis and atherosclerotic cardiovascular disease (ACVD). It was observed that a substantial number of suspected new DM patients could be found in patients with periodontitis. Furthermore, periodontitis patients showed increased C-reactive protein (CRP) levels and more arterial stiffness compared to controls, reflecting an increased atherosclerotic profile and risk for ACVD. Moreover, periodontal treatment improves the levels of molecular and clinical biomarkers for metabolic regulation and atherosclerosis. However, patient characteristics, such as genetics, lifestyle and the presence of co-morbidities contribute to the complexity of this relationship. Based on these observations and in agreement with a recent consensus report of the joint EFP/AAP workshop on periodontitis and systemic diseases, it is recommend that cardiologists, diabetologists and family physicians ask their patients to be screened by dental care professionals for the presence of periodontitis. If so, these patients should undergo periodontal therapy, which helps to improve their metabolic status and lower their cardiovascular risk profile. This again may reduce the risk for future occurrence of ACVD and DM related complications. In addition, it is proposed that periodontists should consider that their patients with severe periodontitis may have DM. Referral to the family physician or perhaps future ‘point of care’ testing devices may help with this. When a new case of DM is identified, treatment to improve metabolic status can be initiated. Reciprocally, this will contribute to a successful treatment of periodontitis.