On this World Diabetes Day, the European Federation of Periodontology (EFP) calls attention to the growing body of scientific evidence that underscores the critical connection between gum disease (periodontitis) and diabetes.

As diabetes continues to impact millions of lives globally (9), understanding its effects on oral health (as well as the effects of gum disease on diabetes) is essential for improving overall health. This year’s theme, Diabetes and well-being, emphasises the need for accessible care and support for all individuals living with diabetes - and that includes prioritising gum health.

The two-way relationship between diabetes and gum disease

Periodontitis is a chronic inflammatory disease that affects the gums and supporting structures of the teeth, leading to tooth loss and other complications if left untreated.“Recent research has shown that diabetes is not only a major risk factor for periodontitis but that the relationship between the two conditions is bidirectional, meaning they both influence and exacerbate one another,” said Anton Sculean, chair of EuroPerio11, the premier congress in periodontology, hosted by the EFP. “Moreover, moderate/severe periodontitis is associated with an increased risk of all-cause and CVD-related mortality in adults with diabetes (1).”

Diabetes is a chronic condition that occurs when the body either doesn't produce enough insulin or cannot effectively use the insulin it produces, leading to elevated blood sugar levels. People with diabetes are significantly more susceptible to developing severe gum disease, with studies showing that they are at a threefold higher risk (2). The connection between these conditions is particularly evident in patients with poorly controlled blood sugar levels. The higher the level of hyperglycaemia, the more severe the gum disease tends to be. This is due to the impact of high blood sugar on the immune system, which weakens the body’s ability to combat infections, including those in the gums. Additionally, diabetes disrupts the body’s inflammatory response, resulting in an exaggerated immune reaction in the gums that leads tofurther tissue damage.

Conversely, periodontitis can complicate diabetes management. The inflammation caused by gum disease isn’t confined to the gums; it can spread throughout the body, increasing systemic inflammation and, in turn, impairing insulin sensitivity. This makes it harder for people with periodontitis to control their blood sugar levels, contributing to a vicious cycle that complicates both conditions. Furthermore, it has been demonstrated that severe periodontitis may be a risk indicator to develop diabetes in patients initially normoglycemic (3).

Emerging evidence shows that treating periodontitis can lead to improved glycaemic control in people with diabetes, highlighting the importance of integrated care (4-6). This finding reinforces the need for dental professionals to work closely with other healthcare providers, ensuring that patients receive comprehensive care that addresses both their oral health and diabetes management.

EFP: a longstanding advocate for awareness

The EFP has been a leader in raising awareness about the strong link between gum disease and diabetes. In 2017, the EFP launched the Perio & Diabetes campaign following the findings of the Perio-Diabetes Workshop held in collaboration with the International Diabetes Federation (7). This campaign offered essential guidelines, tools, and resources for healthcare professionals, policymakers, and the public to enhance understanding and effectively address the interconnection between these two conditions.

Focus on diabetes at EuroPerio11 

This topic remains at the forefront of the EFP’s agenda, and it will take centre stage at the upcoming EuroPerio11 congress in Vienna (14–17 May 2025). On 16 May, a dedicated session will explore clinical considerations for managing patients with diabetes and periodontal disease, including screening for diabetes in dental settings. The session, moderated by Eduardo Montero from Spain, will include expert insights from international speakers, highlighting the need for collaborative care between dental and medical professionals.

“The EFP places great importance on addressing the link between diabetes and gum disease, as it affects not only oral health but the overall well-being of millions of people worldwide,” said Montero. “Raising awareness among the public, health professionals, and policymakers is essential. We need to move towards more holistic health systems that recognise the bidirectional relationship between diabetes and periodontitis and integrate oral health into global health strategies.”

The global burden of periodontitis and diabetes 

Severe periodontal disease is a significant global health issue, affecting around 19% of the world’s adult population—more than 1 billion cases worldwide. According to the World Health Organization, oral diseases, including periodontitis, affect approximately 3.5 billion people globally (8). At the same time, diabetes is also on the rise, with the International Diabetes Federation reporting 537 million adults living with diabetes, representing 10% of the adult population. Alarmingly, an estimated 240 million people are living with undiagnosed diabetes (9), highlighting the urgent need for greater awareness and early intervention in managing both conditions.

This World Diabetes Day, the EFP calls on healthcare professionals, policymakers, and the public to ensure that gum health is part of diabetes care. Together, we can improve the well-being of people living with diabetes by supporting comprehensive and holistic healthcare systems that address the complex connections between oral and general health.