The relationship of diabetes, periodontitis and cardiovascular disease.

Cardiovascular complications in diabetic patients comprise of interaction between traditional and non-traditional risk factors. This interaction is thought to play role in four-times increment of cardiovascular mortality risk in diabetic patients, compared to non-diabetics. Chronic inflammation is known to be one of atherosclerosis non-traditional risk factor and has a role on every phase of atherogenesis. Periodontitis is the most common cause of chronic inflammation in diabetic patient. Both periodontitis and diabetes have detrimental effect on each other in terms of alveolar bone destruction and poor metabolic control, by continuous inflammatory mediator activation. Defect of bacteria elimination ability and monocyte hyper-responsiveness in diabetic patients leads to persistent elevation of systemic inflammatory mediators. This process give rise to prolonged and augmented exposure to inflammatory cytokines. This exposure interacts with traditional risk factor could lead to initiation of endothelial dysfunction, the first phase of atherogenesis.