Periodontitis and Diabetes Mellitus

The association of sever periodontitis and diabetes mellitus is very strong and complex.

The periodontitis is a chronic inflammatory disease characterised by the destruction of supporting structures of the teeth, the periodontal fibres and alveolar bone. It is a highly prevalent disease.

Severe periodontitis is prevalent in 10-15% of the population. It affects the quality of life adversely.
Epidemiological studies have shown that Diabetes is a major risk factor for periodontitis.

Susceptibility to develop periodontitis increases approximately three folds if a person becomes diabetic.
It has been proved that there is a direct correlation between the severity of highperglycaemia and the severity of the periodontitis.

The mechanism that plays role in this interaction has not been fully deciphered. It has been shown through few experiments that the defective neutrophil function, immunologic malfunctions and cytokines do play their roles.

Emerging evidences show that the diabetes does have a role in the increase in the severity of periodontitis; and the inflammatory process of periodontitis makes the glycaemic control difficult. Therefore, it is a two way relationship.
Not only the diabetes makes the periodontitis worst, but it becomes friend with the periodontitis when it comes to damage the other body organs. The incidence of end stage renal disease and macro albumin urea increases three times and two times respectively in diabetic individuals with severe periodontitis than those diabetic patients without severe periodontitis.

Furthermore, the risk of having cardio-renal mortality (like ischemic heart disease and diabetic nephropathy combined) increases three folds in diabetics with sever periodontitis than diabetics without severe periodontitis.
Studies have shown that the treatment of periodontitis results in approximately 0.4% reduction in the level of HbA1c. The oral and periodontal health promotion should be made the integral part of the diabetes management.


Periodontal Abscess


Periodontal abscess is seen almost exclusively in patients with existing periodontal disease and/or uncontrolled diabetes.

The discomfort associated with the swelling, is usually not enough to keep the patient awake at night.

Pain is often difficult to locate. The flora associated with periodontal abscess is more mixed than with most other periodontal infection.

periodontal abscess
Periodontal abscess is clearly visible as red swollen area associated with maxillary canine and premolar.

Q. What is the treatment of periodontal abscess?

Answer: Mechanical or surgical access to the tooth root of any plaque and calculus.

In advance cases, extractions may be considered.

If systemic signs and symptoms are present, or if patient is not responding to local treatment, antimicrobial therapy should be considered.

  1.      Phenoxymethylpenicilline 500 mg four times a day, 5 days in (children:10 mg/kg body weight up to 500mg for 5 days)


  1.      Amoxicillin 500mg, 3 times a day, for 5 days;

In case of hyprsensitivity to penicillin, give

  1.      Clindamycin 500 mg (child: 10 mg/kg up to 500 mg) orally, 3 times a day for 5 days.

Patients who are not responding to treatment and are desirous of  retaining their teeth require management by a specialist

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Acute Ulcerative Gingivitis


Acute ulcerative gingivitis which was previously known as acute necrotizing ulcerative gingivitis, trench mouth, and Vincent's disease, is an extremely painful infection of the periodontal tissues.


Signs & Symptoms

  • It is characterized by punched out inter-dental papilla, ulcers often covered with a grayish membrane and, usually have fetid odor.
  • It is rarely associated with systemic signs and symptoms.
  • Acute ulcerative gingivitis is most commonly seen in young adult smokers.
  • It is rarely seen in children, acute herpetic gingivo-stomatitis is sometimes diagnosed as a acute ulcerative gingivitis.




  • Irrigation and debridement of the necrotic area and tooth surfaces.
  • Oral hygiene instructions, oral rinses, pain control, and management of systemic manifestations including appropriate antibiotic therapy as necessary.


  • The initial management of acute ulcerative gingivitis is usually local debridement that is scaling and root planning under local anesthesia.
  • It should be accompanied by improved plaque control with the adjunctive use of chlorhexidine mouthwash, smoking cessation counseling and metronidazole.


Gum Healthy: Stop Gum Bleeding


When systemic signs and symptoms are present, use the following:

  • Metronidazole 400 milligram, 8 to 12 hourly for 5 days
  • Chlorhexidine 2% mouth was 10 ml rinsed in mouth for 1 minute, 8 to 12 hourly.


  • Chlorhexidine 0.12 percent mouthwash, 15 ml in mouth for 1 minute 8 to 12 hourly.
  • Metronidazole is often given as 200 milligrams orally 3 times daily, however, it is recommended as 400 mg 12 hourly. It is considered to increase patient adherence to the treatment.
  • Antibiotic therapy alone without debridement and oral hygiene improvement, invariably lead to recurrence in most cases. In an unresponsive case, in patients with HIV infection, specialist referral is indicated.
  • Acute ulcerative gingivitis can spread to involve the underlying bone, it should be treated by a specialist.


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Article written by Dr. Ajai Singh

Ref: Therapeutic guidelines 2008





Q1. What is gingivitis?


  •         Gingivitis is inflammation of gingival tissues.
  •         Gingivitis is restricted to the gingiva.
  •         Gingiva becomes red and swollen, and bleeds easily.
  •         It is rarely painful and with correct, treatment, is reversible.
  •         Gingivitis develops because of the presence of an undisturbed bacterial bio-film, known as plaque in the gingival crevices and adjacent to the gingival margins.
  •         The gingival inflammation caused by this bio-film is a nonspecific inflammatory response to the diffusion of bacterial antigenic product into the adjacent gingival tissues.
Papillary gingivitis: evident by swollen interdental papillae.

Q2. What is the management of gingivitis?

  •         Gingivitis should be managed by a dentist.
  •         The objective of the treatment is to remove the plaque by meticulous dental cleaning and smooth any roughness on the teeth that   allows plaque to accumulate; for example, removal of the calculus.
  •         This should be combined with patient education about oral hygiene.
  •         Calculus deposits are removed by dental scaling. Complete resolution of the inflammation can be expected within one week.

When inflammation restricts normal brushing, the short-term use of mouthwash to inhibit supra-gingival plaque formation may be used. The following medicines can be prescribed:

  •         Chlorhexidine 0.2 % mouthwash 10 ml rinsed in mouth for 1 minute 8 to 12 hourly for 5 to 10 days.


  •         Chlorhexidine 0.12 % mouthwash 15 ml rinsed in mouth for 1 minute 8 to 12 hourly for 5 to 10 days.


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Article written by Dr. Ajai Singh

Ref: Therapeutic guidelines 2008

Periodontal Disease

photograph showing periodontitis

Q1. What is periodontal disease?

Answer: Periodontal disease is inflammation of the gingivae and the supporting structure of the teeth- the periodontal ligament, the cementum and the alveolar bone.


Q2. What are the common forms of the periodontal disease?

Answer: The most common forms of periodontal disease present as chronic conditions. There are two major forms of chronic periodontal diseases:

  1. Plaque induced gingivitis
  2. Periodontitis.
photograph showing periodontitis
Periodontitis: You can clearly see the spontaneous gum bleed. The calculus deposits are present in the receded gingivae.

Periodontitis has two major variations

  1. chronic periodontitis
  2. aggressive periodontitis

Acute forms of periodontal disease include

  1. acute ulcerative gingivitis
  2. periodontal abscess


Q3. What are the causes of periodontal disease?

Answer: Periodontal disease is caused by dental plaque.

Dental plaque is a complex bio-film of microorganisms and their by-products that builds up on the teeth surface.

Plaque can calcify to become calculus.

The accumulation of plaque and calculus is associated with poor oral hygiene, that is, the teeth have not been cleaned thoroughly and/or often enough.


Q4. What are the different stages of periodontal disease?

Answer: In the early stage of periodontal disease, bacteria in plaque cause inflammation of the gingivae. This inflammatory condition of gingivae is known as gingivitis.

In some patients, untreated gingivitis progresses to a more advanced stage of periodontal disease called "periodontitis".

Periodontitis may result in loss of the bone and the tissue that support the teeth.

As gingivitis progress, periodontal pockets are formed, and the gingivae may recede from the teeth.

As a result of damage to the supporting tissues, the teeth can become loose and may eventually exfoliate or require extraction.

Q5. How can periodontal disease be treated?

Gingivitis can usually be treated successfully by removal of the plaque and calculus which is to be followed by thorough and regular oral hygiene practices.

Article written by Dr. Ajai Singh


Ref: Therapeutic guidelines 2008