Is Periodontitis the Chicken or the Egg?

We’ve known for some time that people with diabetes are at a greater risk of developing periodontitis, among other infectious conditions, compared with non-diabetics. But now a study published in Diabetes Care indicates that periodontal disease may precede diabetes.

Researchers used data from the National Health and Nutritional Examination Survey (NHANES-1) to see whether baseline periodontal disease predicted the development of type 2 diabetes in the next 20 years. Over 9,250 non-diabetic men and women who had a baseline dental exam in 1971-1976, and had at least one follow-up exam in 1982-1992 were studied. A total of 817 cases of diabetes were established using death certificates, participants’ self-reports, and hospital discharge codes.

Analysis of the relationship between the degree of periodontitis (if present) and the occurrence of diabetes showed that those with more severe gum disease were more likely to develop diabetes later in life, compared to those without periodontitis. The increased risk was present even when adjustments were made for possibly interfering factors, like age, smoking, obesity, high blood pressure, and differing nutrition.

To address the title question: it looks as if periodontal disease can predispose or at least predict the occurrence of some cases of type 2 diabetes, while diabetes may predispose to the occurrence of periodontitis. If you don’t have diabetes, you might care to try the red-wine approach to preventing periodontitis (and hence diabetes); it may help, and it surely won’t hurt.