Periodontics · patient case question
The periodontal prognosis is most influenced by which comorbidity?
Patient case: Generalised deep pockets in type 2 diabetes
Patient: Male, 49 years old
Chief complaint: “I'm here for my check-up.”
History: Type 2 diabetes mellitus, hypertension, fatty liver. Medications: metformin, valsartan, atorvastatin. Wears a maxillary removable partial denture.
Findings: Generalised bleeding on probing with pocket depths of 5–8 mm in all four quadrants. Reports a persistently dry mouth.
Show answer and explanation
Correct answer: D. Type 2 diabetes mellitus
- A. Hypercholesterolaemia and statin therapy have no meaningful negative periodontal effect. If anything, statins have been studied for a modest anti-inflammatory benefit.
- B. Hypertension does not itself affect periodontal healing. Some antihypertensives matter for other reasons — calcium channel blockers cause gingival enlargement — but valsartan, an angiotensin receptor blocker, does not.
- C. Fatty liver contributes to systemic inflammation and is part of the metabolic syndrome, but it has no direct established effect on periodontal outcome.
- D. CORRECT. Diabetes is the systemic condition with the strongest, best-documented effect on periodontal prognosis. Hyperglycaemia impairs NEUTROPHIL chemotaxis and phagocytosis, drives accumulation of advanced glycation end products that stiffen collagen and amplify inflammatory cytokine release, and causes microvascular disease that reduces tissue perfusion and healing. Glycaemic control, more than any other single variable here, determines the response to periodontal therapy.
Note: The relationship is bidirectional: periodontal treatment produces a measurable HbA1c reduction of roughly 0.3 to 0.4 percent, comparable to adding a second oral hypoglycaemic. That is worth saying to the patient.