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Systemic disease

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Systemic disease

Periodontitis is an inflammatory disease of the soft tissues and bone supporting the teeth in susceptible individuals that is associated with dental plaque biofilm. This has been linked with an increase in systemic inflammation, which may impact on other body tissues and increase risks associated with other inflammation-mediated conditions (e.g. diabetes or cardiovascular disease).

Key recommendations

For patients with diabetes and periodontitis, provide periodontal treatment, including oral hygiene instruction and supra- and subgingival professional mechanical plaque removal (PMPR), with the aim of reducing oral inflammation and improving diabetes control.

(Strong recommendation; moderate certainty evidence)


For patients with periodontitis and with systemic conditions that may be related to periodontitis, provide periodontal treatment, including oral hygiene instruction and supra- and subgingival professional mechanical plaque removal (PMPR), with the aim of reducing oral inflammation. 

(Conditional recommendation; low certainty evidence)

Patients with diabetes have an increased risk of developing periodontal diseases. Sub-optimally controlled diabetes enhances the signs and symptoms of gingivitis and periodontitis and has an adverse effect on wound healing, making treatment of these patients more difficult. There is moderate certainty evidence that non-surgical periodontal treatment improves glycaemic control in patients with a diagnosis of periodontitis who also have diabetes.21 The improvements observed are clinically significant and sustained over at least a 12-month period. The certainty of the evidence is considered moderate due to risk of bias, largely due to lack of blinding in the primary studies. The NICE guidelines on management of diabetes recommend that adults with diabetes have regular oral health reviews and that those who have been diagnosed with periodontitis are offered dental appointments to manage and treat their periodontal disease.22, 23

There is a body of evidence indicating an association between periodontitis and cardiovascular disease. This may be due to shared risk factors and/or the impact of chronic inflammatory diseases (such as periodontitis) on the cardiovascular system. However, there is currently no reliable evidence that treatment of periodontal disease can improve cardiovascular outcomes. Two Cochrane reviews did not find any conclusive evidence regarding the effect of periodontal treatment on cardiovascular disease or hypertension.96, 97

Associations between periodontitis and other chronic conditions, such as rheumatoid arthritis, chronic kidney disease and psoriasis, have been proposed but there is insufficient evidence to determine if periodontal treatment influences the activity of these diseases.98-100 In addition, Alzheimer’s disease has been linked with periodontitis but further research is required to determine the significance of this and to determine if periodontal treatment has an impact on clinical outcomes.101, 102 

Further details on the development of the recommendations in this guidance can be found in Methodology.

Explain to all patients who have diabetes that sub-optimally controlled diabetes increases the risk of developing periodontitis or worsening existing periodontitis. Give personalised advice on oral hygiene (see Oral hygiene) and carry out periodontal treatment where required.

For patients who have both a diagnosis of periodontitis and diabetes, explain that treatment of their periodontal disease is likely to improve control of their diabetes. Consider communicating with their general medical practitioner or diabetic care team if necessary (see Control of diabetes).

For patients who have both a diagnosis of periodontitis and diabetes, carry out non-surgical periodontal treatment, including subgingival PMPR where required.  

For patients with other health conditions that may be linked to periodontitis (e.g. cardio-vascular disease, rheumatoid arthritis), emphasise the importance of good oral health and control of oral inflammation to general health. Carry out periodontal treatment where required.

  • For patients with unstable cardiovascular disease, consider the health status of the patient and the potential risks of a full mouth delivery approach before periodontal instrumentation is carried out.