Oral Biofilms and its Connection to Diabetes, Kidney Disease and Pancreatic Cancer
Main Article Content
Abstract
Systemic and oral health are interconnected via bacteria which may originate in the oral biofilm (plaque) which can circulate through the circulatory system. Oral biofilm and its associated periodontal health have not been frequently addressed in patients with systemic health issues. This is especially true for patients who do not respond to medical treatment from their physician for systemic issues. The clinical presence of periodontal disease (bleeding on probing, gingival inflammation) may have oral biofilm present. Periodontal reaction is dependent on the patient’s immune response to the associated bacteria and their byproducts present in the oral biofilm. Increasing evidence has emerged in recent years that are connecting oral biofilms with systemic conditions, either by initiating them or by complicating those medical conditions. Patient health needs to be considered as a whole-body system with connections that may originate in the oral cavity and have distant effects throughout the body. In order to maximize the patient’s total health, healthcare needs to be a coordinated effort between the physician and dentist to eliminate the oral biofilm and aid in the prevention of systemic disease or minimize these effects to improve the overall patient health and their quality of life. Various systemic health areas have been associated with the bacteria in oral biofilms and their byproducts. Specifically, diabetes, chronic kidney disease and pancreatic cancer have been connected to the oral biofilm. This article will discuss oral biofilm, its systemic effects related to diabetes, kidney disease, pancreatic issues and methods to control the oral biofilm and affect positive changes in the diabetic patient.
Keywords:
Oral biofilm, chronic kidney disease, diabetes, pancreatic cancer
Article Details
How to Cite
KURTZMAN, Gregori M. et al.
Oral Biofilms and its Connection to Diabetes, Kidney Disease and Pancreatic Cancer.
Medical Research Archives, [S.l.], v. 13, n. 6, june 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6700>. Date accessed: 15 july 2025.
doi: https://doi.org/10.18103/mra.v13i6.6700.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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18. Palmer BF.: Management of hypertension in patients with chronic kidney disease and diabetes mellitus. Am J Med. 2008 Aug;121(8 Suppl):S16-22. doi: 10.1016/j.amjmed.2008.05.018.
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20. Buhlin K, Bárány P, Heimbürger O, et al. Oral health and pro-inflammatory status in end-stage renal disease patients. Oral Health Prev Dent. 2007;5(3):235-244.
21. Colucci F.: An oral commensal associates with disease: chicken, egg, or red herring? Immunity. 2015 Feb 17;42(2):208-10. doi: 10.1016/j.immuni.2015.01.024.
22. “Periodontal Disease and Pancreatic Cancer Linked” Article date: 1/19/07, www.medicalnewstoday.com https://www.health.harvard.edu/staying-healthy/gum-disease-may-signal-warning-for-pancreatic-cancer
23. Michaud DS.: Role of bacterial infections in pancreatic cancer. Carcinogenesis. 2013 Oct;34(10):2193-7. doi: 10.1093/carcin/bgt249. Epub 2013 Jul 10.
24. Palmer, RJ, Caldwell DE.: A flowcell for the study of plaque removal and regrowth. J Micro Methods 1995;24(2):171-82
25. Ng E, Lim LP. An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dent J (Basel). 2019 Jun 1;7(2):56. doi: 10.3390/dj7020056. PMID: 31159354; PMCID: PMC6630384.
26. Teles FR, Teles RP, Sachdeo A.: Comparison of microbial changes in early redeveloping biofilms on natural teeth and dentures. J Periodontol. 2012 Sep;83(9):1139-48. doi: 10.1902/jop.2012.110506. Epub 2012 Mar 23.
27. Shen Y, Stojicic S, Haapasalo M.: Antimicrobial efficacy of chlorhexidine against bacteria in biofilms at different stages of development. J Endod. 2011 May;37(5):657-61. doi: 10.1016/j.joen.2011.02.007. Epub 2011 Mar 23.
28. Wyganowska-Swiatkowska M, Kotwicka M, Urbaniak P, Nowak A, Skrzypczak-Jankun E, Jankun J. Clinical implications of the growth-suppressive effects of chlorhexidine at low and high concentrations on human gingival fibroblasts and changes in morphology. Int J Mol Med. 2016 Jun;37(6):1594-600. doi: 10.3892/ijmm.2016.2550. Epub 2016 Apr 7. PMID: 27082817.
29. Kerémi B, Márta K, Farkas K, et al. Effects of chlorine dioxide on oral hygiene–A systematic review and meta-analysis. Curr Pharm Des. 2020;26(25):3015-3025. doi:10.2174/1381612826666200515134450
30. Ma JW, Huang BS, Hsu CW, et al. Efficacy and safety evaluation of a chlorine dioxide solution. Int J Environ Res Public Health. 2017 Mar 22;14(3):329. doi:10.3390/ijerph14030329
31. Raghavendran K, Mylotte JM, Scannapieco FA. Nursing home-associated pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia: the contribution of dental biofilms and periodontal inflammation. Periodontology 2000. 2007;44:164.
32. Kouidhi B, Al Qurashi YM, Chaieb K.: Drug resistance of bacterial dental biofilm and the potential use of natural compounds as alternative for prevention and treatment. Microb Pathog. 2015 Mar;80:39-49. doi: 10.1016/j.micpath.2015.02.007. Epub 2015 Feb 21.
33. Rams TE, Degener JE, van Winkelhoff AJ.: Antibiotic resistance in human chronic periodontitis microbiota. J Periodontol. 2014 Jan;85(1):160-9. doi: 10.1902/jop.2013.130142. Epub 2013 May 20.
34. Palma LF, Porfírio TDS, Serrano RV, Campos L, de Moraes LOC. Photobiomodulation Therapy for Managing Motor and Sensory Dysfunctions Following Temporomandibular Joint Surgery: A Case Report. J Lasers Med Sci. 2023 Dec 28;14:e67. doi: 10.34172/jlms.2023.67. PMID: 38318222; PMCID: PMC10843219.
35. Balhaddad AA, AlQranei MS, Ibrahim MS, Weir MD, Martinho FC, Xu HHK, Melo MAS. Light Energy Dose and Photosensitizer Concentration Are Determinants of Effective Photo-Killing against Caries-Related Biofilms. Int J Mol Sci. 2020 Oct 15;21(20):7612. doi: 10.3390/ijms21207612. PMID: 33076241; PMCID: PMC7589159.
36. Barroso RA, Navarro R, Tim CR, de Paula Ramos L, de Oliveira LD, Araki ÂT, Fernandes KGC, Macedo D, Assis L. Antimicrobial photodynamic therapy against Propionibacterium acnes biofilms using hypericin (Hypericum perforatum) photosensitizer: in vitro study. Lasers Med Sci. 2021 Aug;36(6):1235-1240. doi: 10.1007/s10103-020-03163-3. Epub 2020 Oct 21. PMID: 33083912.
37. Huang S, Qi M, Chen Y. Photonics-based treatments: Mechanisms and applications in oral infectious diseases. Front Microbiol. 2023 Feb 10;14:948092. doi: 10.3389/fmicb.2023.948092. PMID: 36846804; PMCID: PMC9950554.
38. Soh WK, Cheah KF, Veettil SK, Pandiar D, Nimbalkar S, Gopinath D. Photobiomodulation Therapy in the Management of Oral Lichen Planus: A Systematic Review and Meta-Analysis. Eur J Dent. 2024 May 14. doi: 10.1055/s-0044-1782213. Epub ahead of print. PMID: 38744337.
39. Jabłoński P, Musiał M, Wiench R, Stefanik N, Olchowy C, Matys J, Skaba D, Grzech-Leśniak K. Photobiomodulation Therapy in the Treatment of Oral Mucositis-A Case Report. Medicina (Kaunas). 2022 Apr 29;58(5):618. doi: 10.3390/medicina58050618. PMID: 35630035; PMCID: PMC9147415
2. Hajishengallis G, Chavakis T. Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities. Nat Rev Immunol. 2021 Jul;21(7):426-440. doi: 10.1038/s41577-020-00488-6. Epub 2021 Jan 28. PMID: 33510490; PMCID: PMC7841384.
3. Gilbert P, Maira-Litran T, McBain AJ, Rickard AH, Whyte FW: The physiology and collective recalcitrance of microbial biofilm communities. Adv Microb Physiol. 2002; 46():202-56.
4. Kouidhi B, Al Qurashi YM, Chaieb K. Drug resistance of bacterial dental biofilm and the potential use of natural compounds as alternative for prevention and treatment. Microb Pathog. 2015 Mar;80:39-49. doi: 10.1016/j.micpath.2015.02.007. Epub 2015 Feb 21. PMID: 25708507.
5. Huang R, Li M, Gregory RL. Bacterial interactions in dental biofilm. Virulence. 2011 Sep-Oct;2(5):435-44. doi: 10.4161/viru.2.5.16140. Epub 2011 Sep 1. PMID: 21778817; PMCID: PMC3322631.
6. Wade W, Thompson H, Rybalka A, Vartoukian S.: Uncultured Members of the Oral Microbiome. J Calif Dent Assoc. 2016 Jul;44(7):447-56.
7. Prazdnova EV, Gorovtsov AV, Vasilchenko NG, Kulikov MP, Statsenko VN, Bogdanova AA, Refeld AG, Brislavskiy YA, Chistyakov VA, Chikindas ML. Quorum-Sensing Inhibition by Gram-Positive Bacteria. Microorganisms. 2022 Feb 3;10(2):350. doi: 10.3390/microorganisms10020350. PMID: 35208805; PMCID: PMC8875677.
8. Marsh PD, Featherstone A, McKee AS, et al.: A microbiological study of early caries of approximal surfaces in schoolchildren. J Dent Res. 1989 Jul; 68(7):1151-4. Larsen T, Fiehn NE. Dental biofilm infections - an update. APMIS. 2017 Apr;125(4):376-384. doi: 10.1111/apm.12688. PMID: 28407420.
9. Hua, X, Cook, GS, Costerton, JW, et al.: Intergeneric Communication in Dental Plaque Biofilms. Journal of Bacteriology. 2000. Volume 182. p. 7067-7069.
10. National Diabetes Statistics Report, 2014. Centers for Disease Control and Prevention website. www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf.
11. Stanko P, Izakovicova Holla L.: Bidirectional association between diabetes mellitus and inflammatory periodontal disease. A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014;158(1):35-8. doi: 10.5507/bp.2014.005. Epub 2014 Jan 27.
12. Mealey BL, Rethman MP. Periodontal disease and diabetes mellitus. Bidirectional relationship. Dent Today. 2003 Apr;22(4):107-13. PMID: 12733412.
13. Gurav AN. Periodontal therapy -- an adjuvant for glycemic control. Diabetes Metab Syndr. 2012 Oct-Dec;6(4):218-23. doi: 10.1016/j.dsx.2012.09.007. Epub 2012 Oct 24. PMID: 23199544.
14. Kumar M, Mishra L, Mohanty R, Nayak R. "Diabetes and gum disease: the diabolic duo". Diabetes Metab Syndr. 2014 Oct-Dec;8(4):255-8. doi: 10.1016/j.dsx.2014.09.022. Epub 2014 Oct 13. PMID: 25450824
15. Paurobally N, Kruger E, Tennant M. Awareness About the Oral and Systemic Complications of Diabetes Among a Cohort of Diabetic Patients of the Republic of Mauritius. Int Dent J. 2021 Oct;71(5):438-448. doi: 10.1016/j.identj.2020.12.019. Epub 2021 Feb 25. PMID: 33640154; PMCID: PMC9275114.
16. Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet. 2005;366(9499):1809-1820.
17. Bascones-Martínez A, Muñoz-Corcuera M, Noronha S, et al. Host defense mechanisms against bacterial aggression in periodontal disease: Basic mechanisms. Med Oral Patol Oral Cir Bucal. 2009;14(12):e680-e685.
18. Palmer BF.: Management of hypertension in patients with chronic kidney disease and diabetes mellitus. Am J Med. 2008 Aug;121(8 Suppl):S16-22. doi: 10.1016/j.amjmed.2008.05.018.
19. DePaola DP, ed. Periodontitis and renal disease. Colgate Oral Care Report. 2007;17(4). Li L, Zhang YL, Liu XY, Meng X, Zhao RQ, Ou LL, Li BZ, Xing T. Periodontitis Exacerbates and Promotes the Progression of Chronic Kidney Disease Through Oral Flora, Cytokines, and Oxidative Stress. Front Microbiol. 2021 Jun 11;12:656372. doi: 10.3389/fmicb.2021.656372. PMID: 34211440; PMCID: PMC8238692.
20. Buhlin K, Bárány P, Heimbürger O, et al. Oral health and pro-inflammatory status in end-stage renal disease patients. Oral Health Prev Dent. 2007;5(3):235-244.
21. Colucci F.: An oral commensal associates with disease: chicken, egg, or red herring? Immunity. 2015 Feb 17;42(2):208-10. doi: 10.1016/j.immuni.2015.01.024.
22. “Periodontal Disease and Pancreatic Cancer Linked” Article date: 1/19/07, www.medicalnewstoday.com https://www.health.harvard.edu/staying-healthy/gum-disease-may-signal-warning-for-pancreatic-cancer
23. Michaud DS.: Role of bacterial infections in pancreatic cancer. Carcinogenesis. 2013 Oct;34(10):2193-7. doi: 10.1093/carcin/bgt249. Epub 2013 Jul 10.
24. Palmer, RJ, Caldwell DE.: A flowcell for the study of plaque removal and regrowth. J Micro Methods 1995;24(2):171-82
25. Ng E, Lim LP. An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dent J (Basel). 2019 Jun 1;7(2):56. doi: 10.3390/dj7020056. PMID: 31159354; PMCID: PMC6630384.
26. Teles FR, Teles RP, Sachdeo A.: Comparison of microbial changes in early redeveloping biofilms on natural teeth and dentures. J Periodontol. 2012 Sep;83(9):1139-48. doi: 10.1902/jop.2012.110506. Epub 2012 Mar 23.
27. Shen Y, Stojicic S, Haapasalo M.: Antimicrobial efficacy of chlorhexidine against bacteria in biofilms at different stages of development. J Endod. 2011 May;37(5):657-61. doi: 10.1016/j.joen.2011.02.007. Epub 2011 Mar 23.
28. Wyganowska-Swiatkowska M, Kotwicka M, Urbaniak P, Nowak A, Skrzypczak-Jankun E, Jankun J. Clinical implications of the growth-suppressive effects of chlorhexidine at low and high concentrations on human gingival fibroblasts and changes in morphology. Int J Mol Med. 2016 Jun;37(6):1594-600. doi: 10.3892/ijmm.2016.2550. Epub 2016 Apr 7. PMID: 27082817.
29. Kerémi B, Márta K, Farkas K, et al. Effects of chlorine dioxide on oral hygiene–A systematic review and meta-analysis. Curr Pharm Des. 2020;26(25):3015-3025. doi:10.2174/1381612826666200515134450
30. Ma JW, Huang BS, Hsu CW, et al. Efficacy and safety evaluation of a chlorine dioxide solution. Int J Environ Res Public Health. 2017 Mar 22;14(3):329. doi:10.3390/ijerph14030329
31. Raghavendran K, Mylotte JM, Scannapieco FA. Nursing home-associated pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia: the contribution of dental biofilms and periodontal inflammation. Periodontology 2000. 2007;44:164.
32. Kouidhi B, Al Qurashi YM, Chaieb K.: Drug resistance of bacterial dental biofilm and the potential use of natural compounds as alternative for prevention and treatment. Microb Pathog. 2015 Mar;80:39-49. doi: 10.1016/j.micpath.2015.02.007. Epub 2015 Feb 21.
33. Rams TE, Degener JE, van Winkelhoff AJ.: Antibiotic resistance in human chronic periodontitis microbiota. J Periodontol. 2014 Jan;85(1):160-9. doi: 10.1902/jop.2013.130142. Epub 2013 May 20.
34. Palma LF, Porfírio TDS, Serrano RV, Campos L, de Moraes LOC. Photobiomodulation Therapy for Managing Motor and Sensory Dysfunctions Following Temporomandibular Joint Surgery: A Case Report. J Lasers Med Sci. 2023 Dec 28;14:e67. doi: 10.34172/jlms.2023.67. PMID: 38318222; PMCID: PMC10843219.
35. Balhaddad AA, AlQranei MS, Ibrahim MS, Weir MD, Martinho FC, Xu HHK, Melo MAS. Light Energy Dose and Photosensitizer Concentration Are Determinants of Effective Photo-Killing against Caries-Related Biofilms. Int J Mol Sci. 2020 Oct 15;21(20):7612. doi: 10.3390/ijms21207612. PMID: 33076241; PMCID: PMC7589159.
36. Barroso RA, Navarro R, Tim CR, de Paula Ramos L, de Oliveira LD, Araki ÂT, Fernandes KGC, Macedo D, Assis L. Antimicrobial photodynamic therapy against Propionibacterium acnes biofilms using hypericin (Hypericum perforatum) photosensitizer: in vitro study. Lasers Med Sci. 2021 Aug;36(6):1235-1240. doi: 10.1007/s10103-020-03163-3. Epub 2020 Oct 21. PMID: 33083912.
37. Huang S, Qi M, Chen Y. Photonics-based treatments: Mechanisms and applications in oral infectious diseases. Front Microbiol. 2023 Feb 10;14:948092. doi: 10.3389/fmicb.2023.948092. PMID: 36846804; PMCID: PMC9950554.
38. Soh WK, Cheah KF, Veettil SK, Pandiar D, Nimbalkar S, Gopinath D. Photobiomodulation Therapy in the Management of Oral Lichen Planus: A Systematic Review and Meta-Analysis. Eur J Dent. 2024 May 14. doi: 10.1055/s-0044-1782213. Epub ahead of print. PMID: 38744337.
39. Jabłoński P, Musiał M, Wiench R, Stefanik N, Olchowy C, Matys J, Skaba D, Grzech-Leśniak K. Photobiomodulation Therapy in the Treatment of Oral Mucositis-A Case Report. Medicina (Kaunas). 2022 Apr 29;58(5):618. doi: 10.3390/medicina58050618. PMID: 35630035; PMCID: PMC9147415