The causes of type 1 DM appear to be much different than those for type 2 DM,

appearance of type 1 DM is suspected to follow exposure to an "environmental trigger,"

such as an unidentified virus, stimulating an immune attack against the beta cells of the

pancreas (that produce insulin) in some genetically predisposed people. Risk factors for

type 2 DM include older age, obesity, family history of diabetes, prior history of

gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity.

 Both Type 1 and 2 DM are risk factors for periodontal disease. Patients with Type

1 DM, especially those that have had the condition for a long duration, have been found

to have more gingivitis and more deep periodontal pockets than controls [15, 16, and 17].

Uncontrolled or poorly controlled diabetes has been shown to be associated with

increased susceptibility to oral infections, including periodontitis [18, 19]. There have

been several studies which have reported a significantly poorer periodontal health in

Type 2 DM patients and some of these reports have provided epidemiologic parameter

estimates of association and risk. The odds that have been reported for Type 2 diabetics

to have greater risk of destructive periodontal disease are from 2.6 to 4.0 [20, 21, and 22].

There have also been two population-based surveys that have provided epidemiologic

estimates of association for diabetes and attachment loss severity, with diabetic

individuals being twice as likely to have more severe attachment loss as those without

diabetes [23, 24].

 Current evidence supports the fact that inferior glycemic control contributes to

poorer periodontal health. Recent studies that have been published on the association

between glycemic control and periodontal disease have shown that inadequate glycemic

control is a significant factor associated with poorer periodontal health [25, 26, and 27].