Periodontics · patient case question
Which best describes the link between diabetes and periodontitis?
Patient case: Deep pockets and a rising HbA1c
demo: 49-year-old female
chief: Bleeding gums and bad taste; she has noticed her front teeth are drifting.
history: Type 2 diabetes for eight years, most recent HbA1c 8.9 percent. Smokes half a pack a day. An implant placed at site 30 two years ago has recently begun to feel tender.
meds: Metformin, estradiol.
findings: Generalised probing depths of 5 to 6 mm with bleeding on probing at 62 percent of sites and no acute symptoms. Radiographs show generalised horizontal bone loss and saucer-shaped bone loss around the implant at 30 with bleeding and suppuration on probing.
Show answer and explanation
Correct answer: D. Hyperglycaemia amplifies the inflammatory response and impairs healing, and periodontal inflammation in turn worsens glycaemic control
- A. The association is well established, biologically explained and bidirectional.
- B. Microvascular change contributes, but reducing the whole relationship to vessel thinning misses the dominant inflammatory and immune mechanisms.
- C. Raised glucose in gingival crevicular fluid alters the local environment, but it is a minor part of a much larger picture.
- D. Correct. The relationship is bidirectional. Advanced glycation end products accumulate and bind RAGE receptors, driving cytokine release; neutrophil chemotaxis and phagocytosis are impaired; collagen turnover is disturbed. In the other direction, the systemic inflammatory burden of periodontitis increases insulin resistance, and treating periodontitis produces a measurable fall in HbA1c.