15 December 2025

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Optimizing periodontal care in patients with diabetes: the crucial role of communication across disciplines

Eric Z. Shapira

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In dental practice, the successful management of a patient with periodontitis and concurrent diabetes can be challenging. More than likely, a medical provider is having difficulty achieving and maintaining glycemic targets in this patient, despite lifestyle changes and diabetes medication adjustments. Unfortunately, the patient’s periodontal health may not be prioritized as a factor impacting glycemic control. This scenario is undoubtedly common, as over half of adults with diabetes have periodontitis (Zhang et al. 2023). The bidirectional relationship between periodontitis and diabetes creates a self-perpetuating cycle that can be triggered by either condition.

For example, poor glycemic control can contribute to oral microbiome dysbiosis. Periodontal pathogens subsequently trigger a localized inflammatory cascade, which can lead to breakdown in the integrity of oral tissues and bone resorption. As this process progresses, translocation of pathogens and release of proinflammatory mediators into the bloodstream contributes to systemic inflammation which, in turn, can worsen glycemic control and perpetuate an ongoing cycle (Yang et al. 2024; Graves, Corrêa, and Silva 2019). Notably, poor glycemic control is associated with impaired healing processes that can further exacerbate periodontal disease, potentially leading, if left untreated, to progressive destruction of oral tissue and bone and subsequent tooth loss.

Dental and medical providers may be aware of the close relationship between periodontitis and diabetes; however, awareness alone will not translate to improvement in either condition. Beyond the biologic factors, inadequate communication among dentists, medical providers, and patients is an important but underappreciated contributor that allows pathologic processes to proceed unchecked. When medical providers managing diabetes do not consider oral health, and dental practitioners focus exclusively on it, this siloed approach results in suboptimal management and poor patient outcomes.

Compounding this challenge is the fact that many patients do not see both dental and medical providers in a given year: an estimated one-third of patients may have only medical visits and almost 10% may have only dental visits (Manski et al. 2001). At a minimum, dental providers should directly ask patients about their diabetes care follow-up visits and, medical providers should inquire about oral health care check-ups, making interdisciplinary referrals when needed. When a patient has suboptimal control of their condition, a direct line of communication between dental and medical providers should be established to create a collaborative patient-centered care plan. 

Appropriate patient engagement will be central to the success of any management plan. For many patients, understanding that periodontal disease and diabetes influence one another may provide crucial motivation to implement and adhere to their treatment plan, especially when this message is reinforced by both dental and medical providers. The concept that maintaining oral care can diminish oral disease and potentially slow the long-term complications of diabetes may be particularly compelling. Lack of understanding and fear are barriers to patient self-care and may interfere with their willingness to communicate concerns with providers (Weinert et al. 2025; Ritholz et al. 2014). Providers can overcome such barriers through proactive and positive communication. 

Unfortunately, communication is not consistently prioritized in professional training. In my experience as a lecturer, I have found that both dental and medical students, when given the choice between a lecture on communication or a treatment-related topic, invariably chose the latter. I speculate they perceive communication as less novel or clinically relevant. However, when I anecdotally questioned them about their communication training, most indicate having received approximately 1 hour of instruction on speaking and listening skills during their 4 years of education. Encouragingly, medical and dental school curricula are increasingly emphasizing quality communication skills—a trend that must continue if we are to improve interdisciplinary collaboration and patient outcomes.

To address patient-related barriers, dental and medical providers must deliver information in a positive, clear, and empathetic manner (Leotin 2025; Colloca and Miller 2011). Providers should take care not to project negative expectations during patient encounters, as this can result in adverse health outcomes (Colloca and Miller 2011). It is critical to establish the expectation that both periodontitis and diabetes are chronic diseases that can be managed but require ongoing monitoring and periodic adjustments to therapy to achieve optimal outcomes.

A Call to Action

Communication may ultimately be the key to breaking the cycle of periodontitis and diabetes in the patients we serve. Collaborative interdisciplinary effort, emphasizing timely and open communication, is essential for creating individualized and integrated dental and medical care plans. Successful implementation requires empathetic patient engagement to achieve meaningful improvement in both oral and systemic health outcomes.

References

• Colloca, L., and F. G. Miller. 2011. 'The nocebo effect and its relevance for clinical practice', Psychosom Med, 73: 598-603.
• Graves, D. T., J. D. Corrêa, and T. A. Silva. 2019. 'The oral microbiota is modified by systemic diseases', J Dent Res, 98: 148-56.
• Leotin, S. 2025. 'Addressing health communication gaps: improving patient experiences and outcomes through human-centered design', J Patient Exp, 12: 23743735251334015.
• Manski, R., F. Rohde, T. Ricks, and N. I. Chalmers. 2001. 'Trends in the number and percentage of the population with any dental or medical visits, 2019.' in, Statistical Brief (Medical Expenditure Panel Survey [US]) (Agency for Healthcare Research and Quality (US): Rockville (MD)).
• Ritholz, M. D., E. A. Beverly, K. M. Brooks, M. J. Abrahamson, and K. Weinger. 2014. 'Barriers and facilitators to self-care communication during medical appointments in the United States for adults with type 2 diabetes', Chronic Illn, 10: 303-13.
• Weinert, L., N. El Sayed, M. Wensing, B. Dannewitz, and S. Listl. 2025. 'Exploring barriers to periodontal treatment adherence in patients with periodontitis to inform development of a digital companion: a qualitative study [published online ahead of print October 7, 2025]', J Clin Periodontol.
• Yang, Y., X. Sun, Y. Yang, and Y. Qie. 2024. 'Insight of the interrelationship and association mechanism between periodontitis and diabetes mellitus', Regen Ther, 26: 1159-67.
• Zhang, Y., S. G. Leveille, S. M. Camhi, and L. Shi. 2023. 'Association of oral care with periodontitis and glycemic control among US adults with diabetes', BMC Oral Health, 23: 903.