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PerioVive in Practice: Diabetes and Dental Health

stethescope and other physician accessories to manage diabetes

A strong bi-directional association exists between diabetes and dental health with each negatively impacting the other. Diabetes mellitus (DM) has been shown to significantly increase the risk of gingivitis, periodontitis, and tooth loss in companion animals and people (1,2,3,4). Conversely, poor oral health negatively impacts glycemic control by reducing insulin response. For these reasons, it is crucial to consider periodontal health as an integral component of diabetes management.


The mechanisms underlying the links between DM and oral health are not fully understood but involve aspects of immune functioning, neutrophil activity, and cytokine biology (3). An interaction appears to exist between inflammatory, immune and metabolic processes causing patients (both human and companion animals) with DM to suffer from compromised periodontal health (5). Elevated blood glucose levels contribute to the deterioration of gingival tissue which promotes oral bacterial invasion and growth, resulting in increased inflammation and subsequent damage to the periodontium (6,7). Immune function is also weakened by elevated blood glucose levels, compromising the body’s response to bacterial infections (2,5).


Multiple studies have confirmed the correlation between DM and periodontal disease (PD) in people and pets. A meta-analysis showed that people with DM are two to three times as likely to suffer from periodontitis as non-diabetics (67.8% vs 35.5%) (8). Another review article revealed that DM increases the risk of developing or worsening PD by 86% (9). There is a direct correlation between the level of hyperglycemia and the severity of periodontitis (3). In addition, people with poorly controlled DM are at increased risk of alveolar bone loss and subsequent tooth loss compared with non-diabetics (3,10). Diabetic dogs and cats have also been shown to be at higher risk of developing periodontal diseases (4,6,7).


Periodontitis has been linked to poor control of DM and accelerated disease progression (5,11,12,13,14). Poor glycemic control is also a major contributing factor to the development of complications associated with DM including diabetic ketoacidosis (4).

This association is based on multiple factors. First, PD involves chronic infection and inflammation which cause the release of inflammatory mediators that, in turn, adversely impact glucose metabolism and result in hyperglycemia (5,14). The inflammation associated with PD also compromises the body’s ability to produce or effectively use insulin, contributing to poor diabetic control (3,13). Indirectly, the pain associated with severe periodontitis can lead to difficulty in eating and food aversion which further complicates glycemic control


The negative impact of PD on DM is further supported by research demonstrating that reducing periodontal inflammation can improve glycemic control in individuals with DM and delay the onset or progression of complications (3,13,14,15). Indirectly, markers of glycemic control including glycosylated hemoglobin levels, fructosamine and HbA1c levels have been shown to improve following periodontal therapy with the most dramatic results seen in dogs with more severe PD (4,13).


A vicious cycle exists in diabetic patients: poorly controlled blood glucose levels contribute to periodontitis which in turn induces hyperglycemia. For this reason, it is crucial to implement effective prevention and treatment strategies that address both diabetes and oral health (16). Proper dental care, including both home care and regular professional dental assessment and treatment, is critical for both oral health and the maintenance of stable glycemic control in diabetic pets (1,4,16,17).


The use of PerioVive, a hyaluronic acid gel, following dental procedures in diabetic patients dramatically increases the efficacy of periodontal procedures and decreases the progression of PD. PerioVive has multiple qualities (anti-inflammatory, osteoinductive, angiogenic, antimicrobial action) that double the rate and quality of oral tissue regeneration.


A new, highly effective hyaluronic acid product called PerioPearls will be on the market soon. PerioPearls is a soluble tablet added to the water daily to improve the condition of the periodontium. This, in turn, may lead to improved diabetic control.


Using PerioVive in your practice can be a powerful tool to treat diabetes and overall dental health.


REFERENCES


  1. Hrițcu, T, Munteanu, A, Mihalcea, S, Hrițcu, L and Spataru, M. The Impact of Diabetes on Dental Health in Companion Animals. Rom. J. Vet. Sci. 2025, 58, 2 https://doi.org/10.59463/rjvs.2025.2.03.

  2. Habibian, Mina. The Overlooked Link Between Diabetes and Oral Health: A Silent Public Health Crisis. December 5, 2025. Community Oral Health. Herman Ostrow School of Dentistry, USC.

  3. Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, Taylor R. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012 Jan;55(1):21-31. doi: 10.1007/s00125-011-2342-y. Epub 2011 Nov 6. PMID: 22057194; PMCID: PMC3228943.

  4. Verhulst MJL, Loos BG, Gerdes VE, Teeuw WJ. Assessment of all potential oral complications of diabetes mellitus. Front Endocrinol. 2019;10:56. doi:10.3389/fendo.2019.00056.

  5. Mealey BL. Periodontal Disease and Diabetes: A Two-Way Street. J Am Dent Assoc. 2006;137(1):12-18. doi:10.14219/jada.archive.2006.0404.

  6. DeBowes LJ. The effects of dental disease on systemic disease. Vet Clin North Am Small Anim Pract. 2015;Available online January 13, 2015. doi:10.1016/S0195-5616(98)50102-7.

  7. Cunha PO, Rosa IMB, Sant'ana ACP, et al. Glycemic control in patients with type 1 diabetes affects periodontal health but not salivary status: An observational study. J Indian Soc Periodontol. 2024;28(4):456-460. doi:10.4103/jisp.jisp_365_23.

  8. Zheng M, Wang C, Ali A, Shih YA, Xie Q, Guo C. (2021). Prevalence of periodontitis in people clinically diagnosed with diabetes mellitus: a meta-analysis of epidemiologic studies. Acta Diabetes. 58(10):1307–1327. https://doi.org/10.1007/s00592-021-01738-2

  9. Teeuw WJ, Gerdes VE, Loos BG. (2010). Effect of periodontal treatment on glycemic control of diabetic patients: a systematic review and meta-analysis. Diabetes Care. 33(2):421–427. https://doi.org/10.2337/dc09-1378

  10. Weijdijk LPM, Ziukaite L, Van der Weijden GAF, Bakker EWP, Slot DE. The risk of tooth loss in patients with diabetes: A systematic review and meta-analysis. Int J Dent Hyg. 2022 Feb;20(1):145-166. doi: 10.1111/idh.12512. Epub 2021 Aug 24. PMID: 33973353; PMCID: PMC9291053.

  11. Nivy R, Bar-Am Y, Retzkin H, Bruchim Y, Mazaki-Tovi M. Preliminary evaluation of the impact of periodontal treatment on markers of glycaemic control in dogs with diabetes mellitus: A prospective, clinical case series. Vet Rec. 2024 Jan 6;194(1):e3310. doi: 10.1002/vetr.3310. Epub 2023 Aug 22. PMID: 37608628

  12. Antonsen PG, Grønvold SL. Is there a link between oral health and systemic diseases in dogs and cats? Thesis University of Life Sciences Ås, 2020.

  13. Nivy R, Bar-Am Y, Retzkin H, Bruchim Y, Mazaki-Tovi M. Preliminary evaluation of the impact of periodontal treatment on markers of glycaemic control in dogs with diabetes mellitus: A prospective, clinical case series. Vet Rec. 2023;1–8. https://doi.org/10.1002/vetr.3310.

  14. Taylor, G. and Borgnakke, W. (2008), Periodontal disease: associations with diabetes, glycemic control and complications. Oral Diseases, 14: 191-203. https://doi.org/10.1111/j.1601-0825.2008.01442.x

  15. Simpson TC, Clarkson JE, Worthington HV, MacDonald L, Weldon JC, Needleman I, Iheozor-Ejiofor Z, Wild SH, Qureshi A, Walker A, Patel VA, Boyers D, Twigg J. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev. 2022 Apr 14;4(4):CD004714. doi: 10.1002/14651858.CD004714.pub4. PMID: 35420698; PMCID: PMC9009294.

  16. Braga JFV, dos Santos JPP, da Silva FWR, Faustino MAG, Gioso MA. Oral and Dental Health in Dogs and Its Possible Impact on Systemic Health: A Comprehensive Review. Animals. 2022;12(11):1417. doi:10.3390/ani12111417.

  17. Bellows J, Berg ML, Dennis S, et al. AAHA 2019 dental care guidelines for dogs and cats. J Am Anim Hosp Assoc. 2019;55(2). doi:10.5326/JAAHA-MS-6933.


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