Destructive periodontal disease can result in loss of attachment of supporting ligaments and alveolar bone of the tooth and eventually, loss of involved teeth. Diabetes may complicate the pathogenesis of periodontitis by causing abnormalities in the vasculature of the gingival tissues, deregulating the normal production of cytokines and growth factors, decreasing the synthesis and cross-linking of collagen, increasing collagenase levels, and depressing immune responses.

The reason for the greater occurrence of periodontal destruction in diabetes is not clear. However, studies of the periodontal flora find similar pathogens in diabetic and non-diabetic individuals, which could suggest, that the alteration in host defense-response to periodontal pathogens account for these differences in periodontal destruction.

The risk of periodontitis among patients with poorly or uncontrolled diabetes is generally two to four times the risk among patients with properly controlled diabetes. A review of the literature suggests that tight metabolic control of blood glucose levels can block the onset of periodontal disease complications associated with diabetes. Furthermore, that prevention and control for oral infections must be part of the overall treatment plan for patients with diabetes mellitus.