Diabetes-Associated Periodontitis

A 45-year-old diabetic patient presents with rapidly progressing periodontal attachment loss, deep pocket formation, and alveolar bone destruction despite regular oral hygiene practices. Discuss the pathophysiological interplay between poorly controlled diabetes mellitus and aggressive periodontitis, including the role of advanced glycation end-products (AGEs), impaired neutrophil function, and cytokine dysregulation in disease progression.