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Patients with type 2 diabetes who have periodontitis are more likely than other diabetic patients to develop kidney disease, including end-stage renal failure. What remains unclear, however, is whether treating the periodontitis reduces the risk of developing diabetic nephropathy later on.
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Periodontitis left unchecked can lead to systemic physiological changes, and the main culprit appears to be inflammation in tissue surrounding the gums.1 "Both periodontitis and kidney disease are associated with inflammatory markers such as C-reactive protein, and chronic low inflammation levels associated with periodontitis could lead to endothelial dysfunction, which plays a role in the pathogenesis of kidney disease," explains Wendy Shultis, PhD, lead researcher and author in the Phoenix branch of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a branch of the National Institutes of Health. Shultis proposes that the link between gum disease and the subsequent development of kidney disease is inflammation.
Shultis and other researchers studied the relationship between
periodontitis and nephropathy among 529 members of the Gila River Indian
Community in Arizona. At the beginning of the study, all the individuals were
25 years; 20% had no periodontitis or a mild condition, 38% had moderate
periodontitis, 22% had severe periodontitis, and 20% were toothless. A total
of 193 participants showed signs of kidney disease within a follow-up period
lasting >9 years, and 68 participants had developed end-stage renal disease
14.9 years into the study, researchers
conclude.2
"Moderate and severe periodontitis as well as having no teeth predicted the development of nephropathy," says Shultis. Compared with subjects with no periodontitis or a mild condition, individuals with moderate gum disease had twice the risk of developing kidney disease, those with severe gum disease had 2.1 times the risk, and participants who were toothless had 2.6 times the risk, according to Shultis.
Diabetes is the primary cause of kidney failure in the U.S., according to
the National Kidney Foundation. Additionally, almost half (45%) of new
patients starting dialysis each year in the U.S. are patients with diabetes,
the foundation notes. 
Periodontitis Signs and Symptoms
Screen patients with type 2 diabetes by examining for or asking about the following symptoms:
Source: Fighting gum disease: How to keep your teeth. Available online at www.fda.gov/Fdac/features/2002/302_gums.html. Accessed April 3, 2007.
Footnotes
The National Institute of Dental and Craniofacial Research, a subsidiary of the National Institutes of Health, offers information about oral health and gum disease at www.nidcr.nih.gov/HealthInformation.
For educational resources and teaching materials to help patients with diabetes manage chronic kidney disease, access the National Kidney Foundation's Web site at www.kidney.org.
References
2. Shultis W, Weil E, Looker H, et al.: Effect of periodontitis on
overt nephropathy and end-stage renal disease in type 2 diabetes.
Diabetes Care 30:306–311, 2007.
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