Consensus report of the Joint EFP/AAP Workshop: Diabetes and periodontal diseases

This guideline is for:

• Healthcare professionals
• Commissioners and providers
• Patient with type 2 diabetes (and their families and carers)

Recommendations outlined:

1. Individualised care:
   • Recognise the bidirectional relationship between type 2 diabetes and periodontal disease.
   • People living with diabetes should be informed that periodontal disease risk is increased by diabetes.
   • Include comprehensive periodontal evaluations as part of diabetes management.
   • Periodontal care plans should be personalised, considering the patient’s glycemic management and other systemic health factors.
   • Encourage dental rehabilitation for individuals with tooth loss to improve mastication and nutritional intake.
2.  Education:
   • Educate patients about the increased risk of periodontal disease in diabetes and how it can worsen glycemic management. Inform patients that hyperglycaemia enhances oxidative stress in periodontal tissues.
   • Train healthcare professionals on the integration of periodontal care in diabetes management.
   • Provide culturally and linguistically appropriate materials to increase awareness among diverse populations – offer oral health education to every individual living with diabetes.
3. Dietary and lifestyle guidance:
   • Counsel patients on maintaining proper oral hygiene as part of comprehensive diabetes care.
   • Promote dietary habits supporting oral and systemic health – inform people living with diabetes that the use of antioxidant micronutrients reduces diabetes-enhanced periodontal inflammation.
4. Screening and diagnosing:
   • Perform routine periodontal screenings for individuals living with diabetes, starting at diagnosis and repeated annually.
   • Screen patients presenting with periodontal disease for undiagnosed diabetes, particularly when other risk factors (e.g., obesity) are present.
   • Offer oral screening for early signs of periodontal involvement starting at the age of 6 years.
   • People living with any kind of diabetes should receive a thorough oral examination as the part of their initial evaluation.
5. Treatment recommendations:
   • Implement professional mechanical debridement (scaling and root planing) to manage periodontal disease.
   • Avoid routine use of adjunctive antibiotics unless clinically indicated.
   • Recognise that periodontal therapy can improve HbA1c levels, with reductions comparable to adding a second diabetes medication.
   • Encourage effective home oral care practices and regular dental/medical check ups to sustain the benefits of professional treatment.
6. Management of complications
   • Identify and address systemic complications associated with severe periodontitis, such as increased risks for cardiovascular disease, kidney disease, and other diabetic complications.
   • Inform people living with diabetes that severe periodontitis adversely affects blood glucose management
   • Monitor and manage other oral health issues which are common among people living with diabetes such as dry mouth, burning mouth syndrome, and delayed wound healing.
7. Integration into care pathways:
   • Foster interdisciplinary collaboration between dental and medical care teams.
   • Establish clear referral systems for patients needing periodontal or diabetes care.
8. Research and evidence development:
   • Encourage further research to clarify the mechanisms linking diabetes and periodontal disease.
   • People living with Diabetes should be evaluated for the presence of periodontitis in the medical practice.
   • Dental practices should serve as a potential screening point to identify people with undiagnosed diabetes.
   • Conduct long-term studies to evaluate the sustained impact of periodontal therapy on diabetes management and complications.
9. Practical implications:
   • Promote early and regular dental visits as part of comprehensive diabetes care.
   • Integrate periodontal assessments in routine medical evaluations for diabetes.
   • Develop public health initiatives emphasizing the importance of oral health in diabetes prevention and management.
   • Underscore the fact that gum disease, like diabetes, is a chronic condition and requires a lifelong maintenance.

This consensus statement highlights the critical role of periodontal care in the holistic management of diabetes, urging collaboration across healthcare disciplines to improve outcomes for affected individuals.