The Connection of Periodontal Disease and Diabetes Mellitus: The Role of Matrix Metalloproteinases and Oxidative Stress

Diabetes mellitus, a chronic disease considered by the World Health Organization to be an epidemic, is now recognized as one of the factors behind the onset of periodontal disease. The connection between periodontal disease, which is an irreversible inflammatory disease of the supporting tissue of the teeth, and systemic diseases is reflected in the existence of common risk factors, subgingival dental biofilm, as a constant source of proinflamma-tory cytokines synthesized intensely in inflammatory periodontium. Diabetes mellitus leads to increased oxidative stress in periodontal tissues causing worsening of the disease and periodontopathy exacerbates deficiency of pancreatic β-cells. The most important role in primary inflammatory response in the pathogenesis of periodontopathy is played by neutrophils. Neutrophils cause periodontium destruction by the release of enzymes (matrix metalloproteinases), cytotoxic substances (free radicals, reactive oxygen and nitrogen species) and the expression of membrane receptors. Matrix metalloproteinases within the “protease network” are critical to many physiological and pathological processes, including immunity, inflammation, bone resorption and wound healing. Matrix metalloproteinases levels are elevated in patients with metabolic syndrome and diabetes mellitus, which may contribute to more frequent complications. In this paper, the review of available literature data shows the correlation between periodontal disease and diabetes mellitus, as well as the role of matrix metalloproteinases and oxidative stress in these. In this regard, determining the value of matrix metalloproteinases may be helpful in the diagnosis of periodontal disease complicated by diabetes mellitus. Also, the parameters of oxidative stress could help to clarify the mechanisms of pathogenesis and etiology of periodontal disease, or indicate the potential benefit of antioxidant supplementation in these individuals. As the role of matrix metalloproteinases has not been fully clarified in the pathogenesis of periodontopathy, additional studies will be needed to indicate their importance.