The House of Hygiene · Course P1

Perio & Diabetes
Quick Reference

For RDHs: the two-way street, recognizing risk, 2017 staging & grading, and co-management.

HOH-P1
Self-Study
The Bidirectional Link

Each Disease Worsens the Other

DirectionEffect
Diabetes → Perio~2–3× risk; faster, more severe disease
Perio → GlycemiaPerio therapy ↓ HbA1c ~0.43% (Cochrane 2022)
Löe (1993): periodontal disease = the "sixth complication of diabetes." Mechanism: TNF-α/IL-6 → insulin resistance; AGEs/RAGE amplify perio inflammation.
HbA1c at a Glance

Thresholds & Target

HbA1cCategory
< 5.7%Normal
5.7–6.4%Prediabetes
≥ 6.5%Diabetes
General target for many adults: < 7% (individualized by physician). ≥ 7% is a perio grade modifier → Grade C.
2017 AAP/EFP Staging & Grading
Stage = Severity / Complexity
StageHallmark
IInitial; ~1–2 mm CAL; coronal-third bone loss
IIModerate; 3–4 mm CAL
IIISevere; ≥5 mm CAL; mid-third+ bone loss; potential tooth loss
IVAdvanced; masticatory dysfunction; extensive loss
Grade = Progression Risk (Modifiers)
GradeSmokingHbA1c
A (slow)Non-smokerNo diabetes
B (mod)< 10/day< 7.0%
C (rapid)≥ 10/day≥ 7.0%
Document the modifier used, e.g., "Grade C: HbA1c 8.4%."
Spotting Risk in the Chair

Clues & Oral Signs

Scope: recognize & refer for HbA1c — do NOT diagnose. Physician confirms & manages.
Treatment & Co-Management

The Plan

"Gum disease and blood sugar feed each other. Treating your gums can help your blood sugar, and getting your sugar checked helps your gums heal."

The House of Hygiene · Professional Development for RDHs Course P1 · Perio–Systemic Connection · Self-Study thehouseofhygiene.org