Moreover,
AGE have the capacity to increase the endothelium permeability
and express high levels of molecular adhesion
receptors. These changes could explain the greater susceptibility
to infections and the delayed wound healing
in diabetic patients (8). This depressed immune response
could explain why it may not be possible to eradicate
periodontal infection totally in diabetics after conventional
periodontal therapy. This might be one of the reasons
why antibiotics may be suggested with mechanical
therapy for diabetic patients, especially for uncontrolled
cases (7). By contrast, in trying to determine the capacity
of periodontal disease to adversely affect the control
of diabetes by influencing gylcemia levels, it has been
hypothesized that chronic low grade inflammations such
as this might result in insulin resistance (9).
Some studies report that specific treatment of periodontal
disease in diabetic patients may improve their glycemic
control. Nevertheless, the evidence currently available
does not provide sufficient information on which to
confidently base any clinical recommendations (10, 11,
12). This has motivated the preparation of a randomized
and controlled trial which will provide evidence- based
recommendations for clinicians (DIAPERIO trial, whose
definitive results will be published in 2013) (12).
The relationship between DM and dental caries has been
studied, but it has not been possible to establish a clear
association between these conditions. The results obtained
vary considerably depending on the study; some
of them found a higher prevalence of caries in diabetic
patients (13, 14), some found lower (15), while other reported
no difference (16).
Diabetic patients sometimes complain of having a