Periodontal Disease as a Predictor of Undiagnosed Diabetes or Prediabetes in Dental Patients: A Comprehensive Review

Abstract

Periodontal disease and diabetes mellitus represent two of the most prevalent chronic diseases affecting the global population, with emerging evidence demonstrating a bidirectional relationship between these conditions. Recent studies have identified periodontal disease as a potential clinical marker for undiagnosed diabetes and prediabetes in dental patients. The presence of severe periodontal parameters, particularly clinical attachment loss greater than 3 mm, has demonstrated significant predictive value for identifying subjects with dysglycemia who have not yet been formally diagnosed with diabetes. This comprehensive review synthesizes current scientific evidence regarding the utility of periodontal examination findings in screening for undiagnosed diabetes and prediabetes in dental populations, examines the underlying biological mechanisms linking these conditions, and evaluates the potential for integrating diabetes screening protocols within dental clinical practice. Systematic review of peer-reviewed literature indicates that patients presenting with advanced periodontal disease exhibit a two to three-fold increased risk for undiagnosed diabetes or prediabetes. Logistic regression models incorporating periodontal parameters alongside traditional risk factors demonstrate predictive accuracy ranging from 69.4% to 73%, with clinical attachment loss emerging as the most significant periodontal predictor. Furthermore, treatment of periodontitis improves glycemic control in patients with established diabetes, reducing glycated hemoglobin (HbA1c) levels by 0.3–0.6%. This review underscores the importance of interprofessional collaboration between dental and medical practitioners, advocates for the integration of chairside diabetes screening tools in dental settings, and discusses the clinical implications of identifying undiagnosed dysglycemia through periodontal assessment.