Experts from the fields of gum health and diabetes met in Madrid at the SEPA Gum Health Centre on February 19 and 20 for the Perio-Diabetes Workshop, a pioneering international summit that explored the latest evidence on the links between periodontal disease and diabetes. The workshop reached a new scientific consensus on how these widespread chronic conditions reinforce each other and produced recommendations on how dentists and physicians can work more effectively together to help prevent and treat them.
Fifteen specialists from around the world took part in the Perio-Diabetes Workshop, jointly organized by the European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF), in partnership with Sunstar and with participation of CIBERDEM. Both the EFP and the IDF are considered as global scientific benchmarks in their fields of expertise.
Among their conclusions were:
• Periodontitis patients have a higher chance of developing prediabetes and type-2 diabetes.
• While there is no data to support a causal relationship between the periodontal microbiome, the microorganisms involved in periodontal disease, and the presence of diabetes, recent studies do show an association between altered glucose metabolism in prediabetes and diabetes and changes in the periodontal microbiome.
• There is a moderate level of evidence that certain biological mechanisms mediate the effect of periodontitis on the control of diabetes.
• There is evidence that improving the control of diabetes results in improvements to periodontal status and that improving periodontal health has benefits in improving metabolic control and/or the complications of diabetes.
Guidelines drawn up by the workshop include providing oral-health education to all patients with diabetes and informing them that they have a greater risk of periodontal disease which, if left untreated, could have a negative impact on metabolic control and may also increase the risk of complications including cardiovascular and kidney disease. Patients should also be advised that successful periodontal therapy can have a positive impact on their metabolic control and complications.
Scott Froum, DDS, editorial director of Perio-Implant Advisory comments: "The link between periodontal disease and diabetes is certainly an important factor to examine, being that the incidence of diabetes in our society continues to rise, especially among young adults ages 20–30. A consensus statement that urges both patients and doctors to be aware of how their oral condition can affect their systemic health is extremely important and is a step in the right direction toward prevention."
Discussions during the Perio-Diabetes Workshop focused around three key points:
a) Evidence of pathogenic mechanisms that may link periodontitis and diabetes, based on a report authored by diabetologist David Polak and periodontist Lior Shapira, of the Hebrew University-Haddasah School of Dental Medicine in Jerusalem, Israel.
b) Epidemiological observational evidence on the effect of periodontal disease on diabetes, based on a systematic review and meta-analysis written by periodontist Filippo Graziani and diabetologists Stefano Gennai, Anna Solini, and Morena Petrini of the University of Pisa, Italy.
c) Evidence on the potential impact of periodontal therapy on diabetes outcomes, based on an update by Phoebus Madianos of the University of Athens, Greece, who is also chair of the EFP’s scientific affairs committee.
The Perio-Diabetes Workshop was co-chaired by Prof Mariano Sanz (EFP, Spain) and Prof Antonio Ceriello (IDF, Italy). The other EFP participants were Prof Iain Chapple (United Kingdom, secretary general), Prof Juan Blanco (Spain, president), Prof Filippo Graziani, Prof Søren Jepsen (Germany), Prof Phoebus Madianos, and Prof Lior Shapira. Prof Maurizio Tonetti (Italy), editor of the Journal of Clinical Periodontology, joined them via videoconference.
The other experts from the IDF at the meeting were Dr Manu Mathur (India), Prof Ryan Demmer (United States), Dr Eduard Montanya (Spain), Dr Luca Lione (Italy), Dr Daniel Vegh (Hungary), and Prof Martin Buysschaert (Belgium). Representatives of Sunstar’s scientific and innovation strategy departments were also present at the workshop, along with members of the board of SEPA, the Spanish society of periodontology.
“Evaluating the available scientific evidence from both the medical and dental viewpoints has allowed us to develop consensus guidelines on how physicians should evaluate the oral condition of their diabetic patients and how dentists should screen for the risk factors associated with diabetes,” said Prof Sanz. “This is a major step forward toward a more comprehensive care of both diabetic and periodontal patients.”
“Perio-Diabetes Workshop has been a unique opportunity for experts of both fields to interact and share their experiences,” explained Prof Ceriello. “Diabetes is a pandemic disease, currently affecting more than 400 million people around the world. Periodontal problems in diabetes are often neglected as until recently, health-care professionals considered periodontopathy just as an effect of living with diabetes.”
“Recent evidence, however, suggests that this situation may worsen diabetes control and the prognosis for diabetes complications,” warned Ceriello. “I am confident that this joint EFP-IDF meeting, aimed at agreeing on specific guidelines, will be the first step of a very fruitful collaboration to improve the quality of life of people with diabetes.”
“The Consensus Report and the Clinical Guidelines will be very useful tools to increase the awareness in the scientific community and among health providers, patients, and the population”, added Eduard Montanya, scientific director of the Spanish network CIBERDEM Diabetes Biomedical Research Centre, “about the important negative links between diabetes and periodontitis, two highly prevalent chronic pathologies with a very significant impact on the health system.”
“We are truly excited by the opportunity to bring together some of the top experts in the worlds of dentistry and diabetes care,” said Marzia Massignani, scientific affairs manager at Sunstar. “We recognize that professionals coming from both worlds are key to achieving this objective. Uniting the complementary expertise of the EFP and the IDF to collaborate on this shared vision is a wonderful opportunity to contribute to a more holistic management of diabetes and improved patient outcomes.”
Perio-Diabetes Workshop 2017 built on the important work of the 9th European Workshop in Periodontology, organized by the EFP and the American Academy of Periodontology (AAP) and held in November 2012, which explored the links between periodontal disease and various systemic diseases including diabetes. It clarified the evidence in key areas about the interrelation between oral and general health, exploring epidemiological association, risk factors, and pathogenic mechanisms.